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Objectives: To examine the differences in antimicrobial selection outcomes in nursing and healthcare-associated pneumonia (NHCAP) patients with and without risk factors for drug-resistant pathogen (RDRP) infection, and to identify the cause of in-hospital death after improvement of NHCAP. Methods: We conducted a retrospective analysis of the medical records of hospitalized adult patients with NHCAP. NHCAP patients were divided into the RDRP and non-RDRP groups. The RDRP group was further classified into the narrow and broad subgroups according to the type of empirical antimicrobial agent selected. The difference in mortality between these subgroups was then examined. The cause of all in-hospital deaths was also evaluated. Results: We evaluated 220 patients with NHCAP. There was no difference in mortality between the narrow and broad subgroups (11.8% vs. 15.4%, p=0.655). Among the group with improved NHCAP, 11.3% (n=23/203) died in hospital before discharge. Although the causes of death in patients who improved after NHCAP were diverse, the most common was recurrence of pneumonia. Conclusions: Empirical antimicrobial therapy for NHCAP may not always require selection of broad-spectrum antimicrobial agents, as has been previously reported. Patients with NHCAP may die from other causes, even after NHCAP has improved.

Objectives: To determine whether the prevalence of gram-negative bacilli (GNB; Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli) in sputum and urine specimens from outpatients and inpatients differed by season and according to temperature and humidity changes. Methods: In this retrospective study, microbiologic data for adult patients from 2008 to 2019 were retrieved from the electronic database of a hospital in Japan. Data were categorized by specimen type (sputum and urine) and specimen collection (outpatient and inpatient). Associations between variables were assessed using Spearman’s rank correlation coefficients. Differences between groups were assessed using Pearson’s chi-square test and analysis of discrete variance. Results: Among inpatients, the frequencies of P. aeruginosa and K. pneumoniae isolation from sputum specimens were higher in summer and autumn. The frequency of P. aeruginosa isolation from urine specimens was higher in autumn. These seasonal trends were observed in specimens from both outpatients and inpatients. No seasonal trend was observed in the frequency of E. coli isolation. Mean monthly temperature was positively correlated with the frequency of isolating P. aeruginosa (r=0.2198, p=0.0081) and K. pneumoniae (r=0.3443, p=0.00002) from sputum as well as with the frequency of isolating K. pneumoniae (r=0.1905, p=0.0222) from urine. Mean monthly humidity was positively correlated with the frequency of isolating K. pneumoniae (r=0.2602, p=0.0016) from sputum. Conclusions: GNB were isolated more frequently in summer and autumn than in other seasons. These seasonal trends were observed for both outpatient and inpatient specimens. Seasonality should be considered for optimal infection control of GNB in hospitals.

Objectives: To determine the usefulness of the pneumococcal urinary antigen test (PUT) and to describe the characteristics of pneumococcal pneumonia. Methods: In this retrospective study, we examined the effects of prior antibiotic treatment, pneumonia onset period, and sputum quality on the results of PUT. Clinical information was collected via medical records from all adult patients who were hospitalized at the Fujita Health University Bantane Hospital with “pneumonia” as a new diagnosis from April 2015 to March 2018. Results: A total of 482 patients with pneumonia were included, of whom 103 had pneumococcal pneumonia. The frequency of PUT positivity did not differ significantly in patients with a pneumonia onset period of ≥3 days compared with those with a period of ≤2 days (P=0.514). Patients with a history of prior antimicrobial therapy had a significantly lower rate of positive sputum culture vs those with no such history (P=0.005); however, PUT positivity in the two groups did not differ significantly (P=0.367). Conclusions: Our results showed that urinary antigen testing for pneumococcal pneumonia is useful for diagnosis regardless of prior antibiotic treatment and time since symptom onset.

Objectives: Aspergillus sensitization is important for patients with asthma. In Japan, the methods applied to measure allergen-specific immunoglobulin E (IgE) levels in blood are the single antigen test, ImmunoCAP (IC), and multiple antigen simultaneous tests, View Allergy® (VA) or MAST IV® (MA). Here, we report the concordance rates (CR) for Aspergillus-specific IgE levels between IC and VA or MA. Methods: Aspergillus-specific IgE levels in serum samples from 34 male and 23 female patients with bronchial asthma were measured by ImmunoCAP, View Allergy® (both Thermo Fisher Scientific, Uppsala, Sweden) and MAST IV® (Hitachi Chemical Diagnostics, Inc. Mountain View, CA, USA). Results of Class 1 or greater were regarded as positive, and the CRs between the methods were assessed. Results: Of the 57 patients, 24 were found to be positive for Aspergillus-specific IgE by IC, and 5 had allergic bronchopulmonary aspergillosis (ABPA). Significant intraclass correlations were observed between IC and VA (r=0.964, p

Objectives: Asthma and chronic obstructive pulmonary disease (COPD) are representative respiratory diseases characterized by obstructive ventilatory impairment. Asthma–COPD overlap syndrome (ACOS) has recently attracted attention. This study aimed to analyze the pathology of obstructive ventilatory impairment by assessment of respiratory function and impedance in smokers with fixed airflow obstruction, regardless of the disease entity. Methods: Thirty-eight elderly patients with a minimum of a 10 pack-year smoking history and fixed airflow obstruction with a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of