Epidemiology and predictors of multidrug-resistant community-acquired and health care-associated pneumonia

Alan E. Gross, Trevor C VanSchooneveld, Keith M. Olsen, Mark Edmund Rupp, Thu Hong Bui, Elsie Forsung, Andre C Kalil

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Abstract

There are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired pneumonia (CAP) and health care-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 January 2010 to December 2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate whether HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score-adjusted multivariate analyses were performed. A total of 521 patients (50.5% CAP and 49.5% HCAP) were included. The most common etiologies of pneumonia were primary viral and Streptococcus pneumoniae. MDROs were isolated in 20 (3.8%) patients overall, and MDROs occurred in 5.9% and 1.9% of HCAP and CAP patients, respectively. The presence of an MDRO was not associated with HCAP classification (odds ratio [OR] = 1.95; 95% confidence interval [95% CI], 0.66 to 5.80; P = 0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and >48-h hospitalization in the last 90 days). Independent predictors of MDRO included the following: Pseudomonas aeruginosa colonization/infection in the previous year (OR = 7.43; 95% CI, 2.24 to 24.61; P < 0.001), antimicrobial use in the previous 90 days (OR = 2.90; 95% CI, 1.13 to 7.45; P = 0.027), admission from a nursing home (OR = 4.19; 95% CI, 1.55 to 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 empirical overprescribing of antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa.

Original languageEnglish (US)
Pages (from-to)5262-5268
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Volume58
Issue number9
DOIs
StatePublished - Sep 2014

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Community Health Services
Pneumonia
Epidemiology
Delivery of Health Care
Odds Ratio
Confidence Intervals
Pseudomonas aeruginosa
Hospitalization
Home Hemodialysis
Viral Pneumonia
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Infectious Diseases
  • Medicine(all)

Cite this

Epidemiology and predictors of multidrug-resistant community-acquired and health care-associated pneumonia. / Gross, Alan E.; VanSchooneveld, Trevor C; Olsen, Keith M.; Rupp, Mark Edmund; Bui, Thu Hong; Forsung, Elsie; Kalil, Andre C.

In: Antimicrobial Agents and Chemotherapy, Vol. 58, No. 9, 09.2014, p. 5262-5268.

Research output: Contribution to journalArticle

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abstract = "There are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired pneumonia (CAP) and health care-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 January 2010 to December 2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate whether HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score-adjusted multivariate analyses were performed. A total of 521 patients (50.5{\%} CAP and 49.5{\%} HCAP) were included. The most common etiologies of pneumonia were primary viral and Streptococcus pneumoniae. MDROs were isolated in 20 (3.8{\%}) patients overall, and MDROs occurred in 5.9{\%} and 1.9{\%} of HCAP and CAP patients, respectively. The presence of an MDRO was not associated with HCAP classification (odds ratio [OR] = 1.95; 95{\%} confidence interval [95{\%} CI], 0.66 to 5.80; P = 0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and >48-h hospitalization in the last 90 days). Independent predictors of MDRO included the following: Pseudomonas aeruginosa colonization/infection in the previous year (OR = 7.43; 95{\%} CI, 2.24 to 24.61; P < 0.001), antimicrobial use in the previous 90 days (OR = 2.90; 95{\%} CI, 1.13 to 7.45; P = 0.027), admission from a nursing home (OR = 4.19; 95{\%} CI, 1.55 to 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 empirical overprescribing of antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa.",
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AU - Bui, Thu Hong

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AU - Kalil, Andre C

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