Skip to main content

A retrospective study of health care-associated pneumonia patients at Aichi Medical University hospital


Health care-associated pneumonia (HCAP) was defined in the American Thoracic Society/Infectious Disease Society of America guidelines on hospital-acquired pneumonia in 2005. However, little is known about the occurrence of HCAP in Japan. A retrospective review of background characteristics, pathological conditions, causative organisms, initial treatments, and risk factors for HCAP was conducted to determine the relationship of HCAP to community-acquired pneumonia and hospital-acquired pneumonia. Thirty-five patients who were admitted to our hospital for pneumonia acquired outside our hospital were included and were stratified by disease severity according to the Japanese Respiratory Society risk stratification guidelines (A-DROP [age, dehydration, respiratory failure, orientation disturbance, and shock blood pressure] criteria). All patients had an underlying disease. A total of 70 microbial strains (25 gram-positive, 37 gram-negative, 6 anaerobic, and 2 causative of atypical pneumonia) were isolated from sputum cultures, showing high isolation frequencies of Pseudomonas aeruginosa and Staphylococcus aureus and extremely low isolation frequencies of Streptococcus pneumoniae and Haemophilus influenzae. “History of hospitalization within 90 days before the onset of pneumonia” was the most common risk factor, and most of the patients had two or three risk factors. Initially, monotherapy [mainly tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), ceftriaxone (CTRX), cefepime (CPFM), carbapenems, or fluoroquinolones] or combination therapy (beta-lactam and fluoroquinolone) were administered and gave clinical effects in 63% (22/35) of cases. Bacteriological effects were seen in most strains (57%; 40/70). Since the causative organisms of HCAP were closely related to those of hospital-acquired pneumonia and not to community-acquired pneumonia, we believe that aggressive chemotherapy using broad-spectrum antimicrobials is needed in the initial treatment.

This is a preview of subscription content, access via your institution.


  1. Ishida T. Etiology of respiratory infections. Antibiot Chemother. 2000;16:1023–8.

    Google Scholar 

  2. American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies. Am J Respir Crit Care Med. 1995;153:1711–25.

    Google Scholar 

  3. American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–54.

    Google Scholar 

  4. Miyashita N, Matsushima T, Oka M, Japanese Respiratory Society. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med. 2006;45:419–28.

    PubMed  Article  Google Scholar 

  5. Seki M, Watanabe A, Mikasa K, Kadota J, Kohno S. Revision of the severity rating and classification of hospital-acquired pneumonia in the Japanese Respiratory Society guidelines. Respirology. 2008;13:880–5.

    PubMed  Article  Google Scholar 

  6. American Thorac Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.

    Article  Google Scholar 

  7. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005;128:3854–62.

    PubMed  Article  Google Scholar 

  8. Shindo Y, Sato S, Murayama E, et al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest. 2009;135:633–40.

    PubMed  Article  Google Scholar 

  9. Carratal J, Fernndez-Sab N, Ortega L, Castellsagu X, Rosn B, Dorca J, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142(3):165–72.

    Google Scholar 

  10. The Committee for the Japanese Respiratory Society Guidelines for the Management of Respiratory Infections. The Japanese Respiratory Society guidelines for the management of community-acquired pneumonia in adults. Respirology. 2006;11(Suppl 3):S1–133.

    Google Scholar 

  11. Niederman MS. Hospital-acquired pneumonia, health care-associated pneumonia, ventilator-associated pneumonia, and ventilator-associated tracheobronchitis: definition and challenges in trial design. Clin Infect Dis. 2010;51(S1):S12–7.

    PubMed  Article  Google Scholar 

  12. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumionia: a single-center experience. Antimicrob Agents Chemother. 2007;51:3568–73.

    PubMed  Article  CAS  Google Scholar 

  13. Ishida T, Hashimoto T, Arita M, et al. Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan. Chest. 1998;114:1588–93.

    PubMed  Article  CAS  Google Scholar 

  14. Miyashita N, Ouchi K, Kawasaki K, et al. Comparison of serological tests for detection of immunoglobulin M antibodies to Chlamydophila pneumoniae. Respirology. 2008;13:427–31.

    PubMed  Article  Google Scholar 

  15. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twentieth informational supplement M100-S20. Wayne: CLSI; 2010. National Committee for Clinical Laboratory Standards, 2004.

  16. Clinical and Laboratory Standards Institute. Methods for antimicrobial susceptibility testing of anaerobic bacteria. Approved standard, 7th ed. CLSI document M11-A7. Wayne: Clinical and Laboratory Standards Institute; 2007.

  17. Carratalà J, Garcia-Vidal C. What is healthcare-associated pneumonia and how is it managed? Curr Opin Infect Dis. 2008;21:168–73.

    PubMed  Article  Google Scholar 

  18. Carratalà J, Mykietiuk A, Fernàndez-Sabé N, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med. 2007;167:1393–9.

    PubMed  Article  Google Scholar 

  19. Venditti M, Falcone M, Corrao S, Licata G, Serra P, The Study Group of the Italian Society of Internal Medicine. Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med. 2009;150:19–26.

    PubMed  Google Scholar 

  20. Zilberberg MD, Shorr AF, Micek ST, Mody SH, Kollef MH. Antimicrobial therapy escalation and hospital mortality among patients with health-care associated pneumonia: a single-center experience. Chest. 2008;134:963–8.

    PubMed  Article  Google Scholar 

  21. Brito V, Niederman MS. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Curr Opin Infect Dis. 2009;22:316–25.

    PubMed  Article  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Hiroshige Mikamo.

Additional information

Y. Yamagishi and H. Mikamo contributed equally to this investigation.

About this article

Cite this article

Yamagishi, Y., Mikamo, H. A retrospective study of health care-associated pneumonia patients at Aichi Medical University hospital. J Infect Chemother 17, 756–763 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Health care-associated pneumonia (HCAP)
  • Community-acquired pneumonia (CAP)
  • Aspiration