Response to: "Antimicrobial drug-resistant microbes have a higher risk of health care-associated pneumonia in eastern Taiwan".

Before responding to the statement of Chang et al, we have to clarify the following definitions of nosocomial infection, healthcare-associated infections, and healthcare-associated pneumonia (HCAP). Otherwise, the readers will be misled. First, in the definition of the Center for Disease Control, R.O.C. (Taiwan), “nosocomial infection” has been replaced with “healthcare-associated infections,” which enrolled the patients after admission to acute care hospitals. Low respiratory tract infection orHCAP is one of the 12 categories in the guideline. Second, the guidelines for preventing HCAP, published by the Centers for Disease Control and Prevention (USA) in 2003, covered all pneumonia cases in acute care hospitals, and in other healthcare settings and other facilities where healthcare is provided. Third, the American Thoracic Society (ATS) and the Infectious Diseases Society of America introduced their HCAP guidelines according to the conditions of patients prior to admission in 2005. The term “HCAP” includes those patients who have been hospitalized in an acutecare hospital for 2 days in the past 90 days, have been residents in a nursing home or long-term care facility (nursing home-acquired pneumonia), have received intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days, or have attended a hospital or hemodialysis clinic. We would agree with the viewpoint of Chang et al on core microbes with high drug resistant rate if the healthassociated pneumonia were nosocomial pneumonia following the definition of the CDC, Taiwan. However, the HCAP reported by Wu et al enrolled patients according to