Broad-spectrum antibiotics cannot improve the prognoses of high-risk nursing- and healthcare-associated pneumonia

Background and aim: In 2011, the Japanese Respiratory Society proposed the guideline for Nursing- and healthcare-associated pneumonia (NHCAP) (Kohno S, et al. Respir Investig 2013; 51:103-126), which is a modification of Healthcare-associated pneumonia guidelines of the US. However, it is still unclear what are the proper treatments for NHCAP. Though NHCAP patients are recognized as having drug resistant pathogens, the mortalities does not depend on the proper antibiotics for them but on the situations of the patients. To evaluate the contribution of the broad-spectrum antibiotics for high-risk NHCAP, we retrospectively examined the admitted NHCAP patients. Methods: We defined the “high-risk patients” as those in severe or very severe classification, or with PS 3 or 4. The criteria for NHCAP were as described in NHCAP guideline. Out of 864 hospitalized pneumonia patients, we retrospectively investigated the 209 patients who meet the NHCAP criteria and also the high-risk definition. Then we divided the high-risk patients into to following two groups. In Narrow group, patients were treated with narrow-spectrum antibiotics and patients treated with broad-spectrum antibiotics were in Broad group. Survival was analyzed using Kaplan-Meier curves and log-rank test. Results: The numbers of the patients were 164 in Narrow group and 63 in Broad group. The 30-day mortalities were 15.1% and 25.4%, respectively. Although the difference was not significant, the survival rate of Narrow group tended to be higher than that of Broad group (p = 0.074). Conclusions: We demonstrated that broad-spectrum antibiotics could not always improve the prognoses of the high-risk NHCAP patients.