Guest Editor’s Introduction

Abstract

Background and aim: Nursing- and healthcare-associated pneumonia (NHCAP) is a new concept, proposed by the Japanese Respiratory Society in 2011 (Kohno S, et al. Respir Investig 2013; 51:103-126). It is a modification of the healthcare-associated pneumonia described for the US to more accurately reflect the situation in Japan. The optimal treatments for NHCAP are still unclear. Although NHCAP patients often have drug-resistant pathogens, it has been reported that the outcomes do not depend on the antibiotics administered, but on the status of the patients. To evaluate the contribution of the broad-spectrum antibiotics for high-risk NHCAP, we examined the admitted NHCAP patients. Methods: We retrospectively examined 172 patients who met the NHCAP criteria and the definition of high-risk pneumonia. The criteria for NHCAP were as described in the NHCAP guidelines. The definition of high-risk was a severe or very severe classification, or a Performance status of 3 or 4. We divided the high-risk patients into two groups. In the Narrow group, patients were treated with narrow-spectrum antibiotics, while the patients treated with broad-spectrum antibiotics were included in the Broad group. The patient survival was analyzed using Kaplan-Meier curves and the log-rank test. Results: There were 127 in the Narrow group and 45 in the Broad group. The 30-day mortality rates were 12.6% and 24.4%, respectively. Although the difference was not significant, the survival rate of the Narrow group tended to be higher than that of the Broad group (p = 0.08). Conclusions: We herein demonstrated that broad-spectrum antibiotics did not improve the prognoses of high-risk NHCAP patients.