Community-Acquired Pneumonia due to Multidrug and non-Multidrug resistant Pseudomonas aeruginosa.
Chest. 2016 Apr 6;
Authors: Cillóniz C, Gabarrús A, Ferrer M, Puig de la Bellacasa J, Rinaudo M, Mensa J, Niederman MS, Torres A
Abstract
BACKGROUND: Pseudomonas aeruginosa is not a frequent pathogen in Community Acquired Pneumonia (CAP). However, in patients with severe CAP, P. aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes and risk factors associated with CAP due to multidrug and non-multidrug resistant P. aeruginosa.
METHODS: Prospective observational study of 2023 consecutive adult CAP patients with definitive etiology.
RESULTS: P. aeruginosa was found in 77 (4%) of the 2023 cases with microbial etiology. In 22 (32%) of the 68 cases of P. aeruginosa with antibiogram data, the isolates were multidrug-resistant (MDR). Inappropriate therapy was present in 49 (64%) cases of P. aeruginosa CAP, including 17/22 (77%) cases of MDR P. aeruginosa CAP. Male sex, chronic respiratory disease, C-reactive protein <12.35 mg/dL, and PSI risk class IV - V were independently associated with P. aeruginosa CAP. Prior antibiotic treatment was more frequent in MDR P. aeruginosa CAP compared with non-MDR P. aeruginosa (58% vs. 29%, p=0.029), and was the only risk factor associated with CAP due to MDR P. aeruginosa. In the multivariate analysis, age ≥65 years, CAP due to P. aeruginosa, chronic liver disease, neurologic disease, nursing-home, criteria of ARDS, acute renal failure, ICU admission, and inappropriate empiric treatment were the factors associated with 30-day mortality.
CONCLUSIONS: P. aeruginosa is an individual risk factor associated with mortality in CAP. The risk factors described can help clinicians to suspect P. aeruginosa and MDR P. aeruginosa.
PMID: 27060725 [PubMed - as supplied by publisher]