Skip to main content

Clinical efficacy of carbapenems on hospital-acquired pneumonia in accordance with the Japanese Respiratory Society Guidelines for management of HAP


Hospital-acquired pneumonia (HAP) is the second most common cause of hospital-acquired infection and is the leading cause of death. In 2002, the Japanese Respiratory Society (JRS) published guidelines for the diagnosis and treatment of HAP (JRS GL 2002). In these guidelines, treatment with carbapenems is recommended for all disease types of HAP, excluding cases of mild or moderate pneumonia with no risk factors, and cases with early-onset ventilation-acquired pneumonia. To evaluate the efficacy of carbapenems on HAP in accordance with JRS GL 2002, we conducted a prospective study of HAP patients treated with carbapenems based on JRS GL 2002. The results of this study were also analyzed based on the revised guidelines published in June 2008 (JRS GL 2008), and the validity of the new guidelines was examined. Of the 33 subjects, 19 were judged as responders to the treatment, corresponding to a response rate of 57.6%. There were 3 deaths, corresponding to a mortality rate of 9.1%. The efficacy of carbapenems for the treatment of HAP based on JRS GL 2002 was confirmed. The severity rating system in JRS GL 2002 has a tendency to overestimate the severity of the cases and may lead to overtreatment in some cases. On the other hand, the severity rating system by JRS GL 2008 seemed to be more accurate and closely correlated with the efficacy of the treatment. It is suggested that JRS GL 2008 is more useful in clinical practice for accurately judging the severity of the disease and initiating appropriate subsequent antibiotic therapy.

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


  1. Weinstein RA. Health care-associated infections. In: Fauci AS, Braunwald E, Kasper DL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw-Hill; 2007. p. 835–42.

    Google Scholar 

  2. Chesnutt MS, Gifford AH, Prendergast TJ. Pneumonia. In: McPhee SJ, Papadakis MA, editors. Current medical diagnosis and treatment. New York: McGraw-Hill; 2010. p. 243–51.

  3. Craven DE, Steger KA. Epidemiology of nosocomial pneumonia. New perspectives on an old disease. Chest. 1995;108:1S–16S.

    PubMed  Article  CAS  Google Scholar 

  4. The Committee for the Japanese Respiratory Society Guidelines in the Management of Respiratory Infections. The Japanese Respiratory Society guidelines for the management of hospital-acquired pneumonia in adults. Respirology. 2004;9(Suppl.):S1–S59.

    Google Scholar 

  5. Watanabe A, Yanagihara K, Kohno S, et al. HAP study group. Multicenter survey on hospital-acquired pneumonia and the clinical efficacy of first-line antibiotics in Japan. Intern Med 2008;47:245–254.

    Google Scholar 

  6. Perry CM, Ibbotson T. Biapenem. Drugs. 2002;62:2221–34.

    PubMed  Article  CAS  Google Scholar 

  7. Kozawa O, Uematsu T, Matsuno H, et al. Pharmacokinetics and safety of a new parenteral carbapenem antibiotic, biapenem (L-627), in elderly subjects. Antimicrob Agents Chemother. 1998;42:1433–6.

    PubMed  CAS  Google Scholar 

Download references


The authors thank Mr. Tom Kiper for editing the manuscript.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Takeshi Kaneko.

About this article

Cite this article

Ito, M., Kaneko, T., Goto, H. et al. Clinical efficacy of carbapenems on hospital-acquired pneumonia in accordance with the Japanese Respiratory Society Guidelines for management of HAP. J Infect Chemother 17, 770–775 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Hospital-acquired pneumonia (HAP)
  • Japanese Respiratory Society
  • Guidelines
  • Carbapenems