Epidemiology and Predictors of Multidrug-Resistant Community-Acquired and Healthcare-Associated Pneumonia.
Antimicrob Agents Chemother. 2014 Jun 23;
Authors: Gross AE, Van Schooneveld TC, Olsen KM, Rupp ME, Bui TH, Forsung E, Kalil AC
Abstract
There are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired (CAP) and healthcare-associated pneumonia (HCAP). However, concern for the presence of these pathogens drives the prescribing of empiric broad-spectrum antibiotics for CAP and HCAP. A retrospective study of all adults hospitalized with community-onset pneumonia (CAP and HCAP) at a large U.S. medical center from 1/2010-12/2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate if HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score adjusted multivariate analyses were performed. 521 patients (50.5% CAP, 49.5% HCAP) were included. The most common etiologies of pneumonia were primary viral and Streptococcus pneumoniae. MDRO were isolated in 20 (3.8%) patients overall, and MDRO occurred in 5.9% and 1.9% of HCAP and CAP patients, respectively. MDRO was not associated with HCAP classification (OR=1.95;95%CI 0.66-5.80;P=0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and ≥48h hospitalization in last 90 days). Independent predictors of MDRO included: P. aeruginosa colonization/infection in the previous year (OR=7.43;95%CI 2.24-24.61;P<0.001), antimicrobial use in the previous 90 days (OR=2.90;95%CI 1.13-7.45;P=0.027), admission from nursing home (OR=4.19;95%CI 1.55-11.31;P=0.005), and duration of hospitalization in the previous 90 or 180 days (P=0.013 and P=0.002, respectively). MDROs were uncommon in HCAP and CAP. HCAP did not predict MDRO isolation. Local etiology of community-onset pneumonia and specific MDRO risk factors should be integrated into therapeutic decisions to prevent empiric overprescribing of antibiotics for MRSA and P. aeruginosa.
PMID: 24957843 [PubMed - as supplied by publisher]