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Clinical Practice Guidelines for Nursing- and Healthcare-associated Pneumonia (NHCAP) [Complete translation]  Shigeru Kohno, Yoshifumi Imamura, Yuichiro.

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Presentation on theme: "Clinical Practice Guidelines for Nursing- and Healthcare-associated Pneumonia (NHCAP) [Complete translation]  Shigeru Kohno, Yoshifumi Imamura, Yuichiro."— Presentation transcript:

1 Clinical Practice Guidelines for Nursing- and Healthcare-associated Pneumonia (NHCAP) [Complete translation]  Shigeru Kohno, Yoshifumi Imamura, Yuichiro Shindo, Masafumi Seki, Tadashi Ishida, Shinji Teramoto, Junichi Kadota, Kazunori Tomono, Akira Watanabe  Respiratory Investigation  Volume 51, Issue 2, Pages (June 2013) DOI: /j.resinv Copyright © Terms and Conditions

2 Fig. 1 Mortality from pneumonia by age and gender (per 100,000 patients) according to FY2005 vital statistics data. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

3 Fig. 2 Definition of HCAP according to the ATS-IDSA Guidelines: risk factors for multidrug-resistant pathogens causing HAP. Revised from Ref. [4]. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

4 Fig. 3 Positioning of CAP, NHCAP, and HAP in Japan. No clear distinctions between CAP, NHCAP, and HAP can be made in Japan. Would cases that have been counted as cases of CAP in Japan (e.g., cases in which the patient is convalescing at home but has frequently been admitted to core hospitals) be counted as cases of HCAP in the U.S.?. Would cases counted as cases of HAP in Japan (e.g., cases of repeated aspiration pneumonia at long-term care hospitals and not at acute care hospitals) be counted as cases of HCAP in the U.S.? Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

5 Fig. 4 Pneumonia that does not completely meet the definition of either CAP or HAP. There are two forms for such pneumonia. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

6 Fig. 5 Proportions of CAP cases and HCAP cases in Japan and abroad.
Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

7 Fig. 6 Categories of HAP, HCAP, and CAP by type of facility and type of patient in Japan: realities in the “Nursing Care Insurance System”. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

8 Fig. 7 Treatment category algorithm.
Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

9 Fig. 8 Recommendations of initial empiric antibiotic therapy. AMPC/CVA: amoxicillin/clavulanic acid; SBTPC: sultamicillin; CAM: clarithromycin; AZM: azithromycin; GRNX: garenoxacin; MFLX: moxifloxacin; LVFX: levofloxacin; CTRX: ceftriaxone; SBT/ABPC: sulbactam/ampicillin; PAPM/BP: panipenem/betamipron; TAZ/PIPC: tazobactam/piperacillin; IPM/CS: imipenem/cilastatin; MEPM: menopenem; DRPM: doripenem; CFPM: cefepim; CPR: cefpirome; MTZ: metronidazole; CLDM: clindamycin; CPFX: ciprofloxacin; PZFX: pazufloxacin; VCM: vancomycin; TEIC : teicoplanin; LZD: linezolid. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

10 Fig. 9 Streamlining and changes in antibiotics.
Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

11 Fig. 10 Diagnostic flow chart for aspiration pulmonary disorders.
Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

12 Fig. S1 Outcome of HCAP patients: mortality Rates of CAP, HCAP, HAP, and VAP patients (United States) Period: January December Retrospective analysis of 4,543 culture-positive pneumonia cases in 59 U.S. hospitals and registered in the Cardinal Health-Atlas Research Database Revised from Ref. [7]. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

13 Fig. S2 Severity Classification (I-ROAD Classification) from The JRS Guidelines for the Management of Hospital-Acquired Pneumonia in Adults — Severity Classification of Pneumonia According to Predictors of Life Expectancy. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

14 Fig. S3 Pneumonia severity assessment index. Pneumonia Severity Index and recommended treatment facility. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

15 Fig. S4 Nomogram for obtaining eGFR values. (Reprinted with permission from the Clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease 2009). Example: The eGFR of a 30-year-old man with a serum Cr level of 3.0mg/dL is 22 mL/min/1.73m2 and that of a female of the same age and with the same values is 16mL/min/1.73m2. eGFR (mL/min/1.73m2)=194×serum creatinine−1.094×age −0.287 (×0.739, if female). Note: It is desirable to adjust the drug dose according to the eGFR without correction for BSA. Formula for eGFR uncorrected for BSA=eGFR×BSA/1.73. Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

16 Fig. S5 Overall mortality by age of patients vaccinated with both influenza vaccine and PPV. Vaccinated group (n=124,702) Control group (n=134,045). Respiratory Investigation  , DOI: ( /j.resinv ) Copyright © Terms and Conditions

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