Risk Factors for Drug-Resistant Pathogens in Community-Acquired and Healthcare-Associated Pneumonia.
Am J Respir Crit Care Med. 2013 Jul 15;
Authors: Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, Goto Y, Fukui Y, Iwaki M, Okumura J, Yamaguchi I, Yagi T, Tanikawa Y, Sugino Y, Shindoh J, Ogasawara T, Nomura F, Saka H, Yamamoto M, Taniguchi H, Suzuki R, Saito H, Kawamura T, Hasegawa Y, on behalf of the Central Japan Lung Study Group
Rationale: Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia. Objectives: To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in CAP and HCAP patients. Methods: A prospective observational study was conducted in hospitalized patients with pneumonia at ten institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin/sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs). Measurements and Main Results: In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in HCAP patients (26.6%) than in CAP patients (8.6%). Independent risk factors for CAP-DRPs were almost identical in CAP and HCAP patients. These included prior hospitalization [adjusted odds ratio (AOR), 2.06; 95% confidence interval (CI), 1.23-3.43], immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and non-ambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined CAP and HCAP patients. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84). Conclusions: The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in either CAP or HCAP patients by taking account the cumulative number of the risk factors.
PMID: 23855620 [PubMed - as supplied by publisher]