Journal Article

Risk Factors Associated with Potentially Antibiotic-Resistant Pathogens in Community-Acquired Pneumonia

Prina, Elena, Menéndez, Rosario, Polverino, Eva, Cillóniz, Catia, Fernandez, Laia, Puig de la Bellacasa, Jorge, Mensa, Josep, Ranzani, Otavio T., Torres, Antoni, Ferrer, Miquel

2015

Overview

Abstract Rationale To identify pathogens that require different treatments in community-acquired pneumonia (CAP), we propose an acronym, “PES” (P  seudomonas aeruginosa, E  nterobacteriaceae extended-spectrum β-lactamase–positive, and methicillin-resistant S  taphylococcus aureus). Objectives To compare the clinical characteristics and outcomes between patients with CAP caused by PES versus other pathogens, and to identify the risk factors associated with infection caused by PES. Methods We conducted an observational prospective study evaluating only immunocompetent patients with CAP and an established etiological diagnosis. We included patients from nursing homes. We computed a score to identify patients at risk of PES pathogens. Measurement and Main Results: Of the 4,549 patients evaluated, we analyzed 1,597 who presented an etiological diagnosis. Pneumonia caused by PES was identified in 94 (6%) patients, with 108 PES pathogens isolated (n = 72 P. aeruginosa, n = 15 E  nterobacteriaceae extended-spectrum β-lactamase positive, and n = 21 methicillin-resistant S  taphylococcus aureus). These patients were older (P = 0.001), had received prior antibiotic treatment more frequently (P < 0.001), and frequently presented with acute renal failure (P = 0.004). PES pathogens were independently associated with increased risk of 30-day mortality (adjusted odds ratio = 2.51; 95% confidence interval = 1.20–5.25; P = 0.015). The area under the curve for the score we computed was 0.759 (95% confidence interval, 0.713–0.806; P < 0.001). Conclusions PES pathogens are responsible for a small proportion of CAP, resulting in high mortality. These pathogens require a different antibiotic treatment, and identification of specific risk factors could help to identify these microbial etiologies.

• Publisher: Oxford University Press
• Subject: Acute Kidney Injury - epidemiology / Age Factors / Aged / Aged, 80 and over / Anti-Bacterial Agents - therapeutic use / Area Under Curve / beta-Lactam Resistance / Bronchiectasis - epidemiology / Cohort Studies / Community-Acquired Infections - drug therapy / Community-Acquired Infections - epidemiology / Community-Acquired Infections - microbiology / Comorbidity / Consciousness Disorders - epidemiology / Drug Resistance, Bacterial / Enterobacteriaceae - isolation & purification / Enterobacteriaceae - physiology / Enterobacteriaceae Infections - drug therapy / Enterobacteriaceae Infections - epidemiology / Enterobacteriaceae Infections - microbiology / Female / Fever - epidemiology / Humans / Immunocompetence / Male / Methicillin Resistance / Methicillin-Resistant Staphylococcus aureus - isolation & purification / Methicillin-Resistant Staphylococcus aureus - physiology / Middle Aged / Pneumonia, Bacterial - drug therapy / Pneumonia, Bacterial - epidemiology / Pneumonia, Bacterial - microbiology / Prospective Studies / Pseudomonas aeruginosa - isolation & purification / Pseudomonas aeruginosa - physiology / Pseudomonas Infections - drug therapy / Pseudomonas Infections - epidemiology / Pseudomonas Infections - microbiology / Pulmonary Disease, Chronic Obstructive - epidemiology / Renal Insufficiency, Chronic - epidemiology / Risk Factors / Sex Factors / Staphylococcal Infections - drug therapy / Staphylococcal Infections - epidemiology / Staphylococcal Infections - microbiology / Staphylococcal Infections - mortality