Difference of health-care associated pneumonia between large hospitals and small hospitals in Japan

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Objective : Health-care associated pneumonia (HCAP) is a new category ofpneumonia. We investigated differences of epidemiology, pathogens, and outcomes betweenHCAP patients in large hospitals and those in small hospitals. Methods : This wasa retrospective observational study of patients hospitalized with HCAP from December2009 to March 2010. HCAP was defined according to ATS/IDSA criteria. A large hospitalwas defined as 200 beds and a small hospital was 200 beds. Results : Of 117 patients, 61patients were admitted to large hospitals and 56 patients were admitted to small hospitals.There was a significant difference of HCAP diagnostic criteria between the two groups.The A-DROP severity class was worse in the large hospital group than the small hospitalgroup (P 0.05). Respiratory failure and disturbance of consciousness were more frequentin the large hospital group (P 0.05). The mortality rate was 8.2% in the large hospitalgroup versus 1.8% in the small hospital group. Patients in the very severe A-DROP classhad a high mortality rate of 33% in both groups. Conclusion : Patients with severe HCAPwere more likely to be admitted to large hospitals. Patients in the very severe A-DROPclass should receive intensive antibiotic therapy, but not all patients need broad-spectrumtherapy.