A retrospective survival analysis of nursing and healthcare associated pneumonia in patients with resistant pathogens

Background: The aging rate of Japan is currently ≥ 27%, which is the highest in the world. Pneumonia is the third leading cause of death in Japan; 97% of the patients who died of pneumonia were 65 years of age or older. The Japanese Respiratory Society’s definition of Nursing and healthcare associated pneumonia (NHCAP) is a modification of the US definition of healthcare associated pneumonia. The incidence of NHCAP is increasing in Japan’s rapidly aging society. The proper treatments for NHCAP remain unclear. To evaluate the contribution of broad-spectrum antibiotics in the treatment of NHCAP, we studied hospitalized NHCAP patients with resistant pathogens. Methods: Out of 589 hospitalized pneumonia, we retrospectively analyzed 66 patients in whom resistant pathogens were detected among 273 NHCAP patients from November 2009 to October 2016. The patients were divided, according to the treatments they received, into the escalation and de-escalation groups. Results: There were 33 patients in the escalation group and 24 patients in the de-escalation group. The isolated resistant bacteria included MRSA (n=37), P. aeruginosa (n=29) and ESBL-producing Enterobacteriaceae (n=2). The 30-day mortality in the escalation and de-escalation groups were 9.1% and 20.8%, respectively. A multivariate logistic regression analysis revealed that 30-day mortality was associated with the serum albumin level and severity, but not de-escalation therapy. Discussion: The results showed that de-escalation therapy was not useful for all NHCAP patients, even when they had resistant pathogens. Conclusion: We must further evaluate the proper application and risk of broad spectrum antibiotics.