Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia

Yuichiro Shindo, Ryota Ito, Daisuke Kobayashi, Masahiko Ando, Motoshi Ichikawa, Akira Shiraki, Yasuhiro Goto, Yasutaka Fukui, Mai Iwaki, Junya Okumura, Ikuo Yamaguchi, Tetsuya Yagi, Yoshimasa Tanikawa, Yasuteru Sugino, Joe Shindoh, Tomohiko Ogasawara, Fumio Nomura, Hideo Saka, Masashi Yamamoto, Hiroyuki TaniguchiRyujiro Suzuki, Hiroshi Saito, Takashi Kawamura, Yoshinori Hasegawa

Research output: Contribution to journalArticlepeer-review

170 Citations (Scopus)

Abstract

Rationale: Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia. Objectives: Toelucidateclinicalfeaturesofcommunity-acquiredpneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors fordrug-resistantpathogens inpatientswithCAPandHCAP. Methods: A prospective observational study was conducted in hospitalizedpatientswithpneumoniaat10institutions inJapan.Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam,macrolides, and respiratory fluoroquinolones were defined as CAP drugresistant 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 patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. 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 antibioticuse( AOR,2.45;95%CI,1.51-3.98),useofgastricacid-suppressive agents (AOR, 2.22; 95%CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiveroperating characteristic curve for counting the numberof 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 patients with eitherCAPorHCAPbytaking account of the cumulativenumber of the risk factors.

Original languageEnglish
Pages (from-to)985-995
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume188
Issue number8
DOIs
Publication statusPublished - 15-10-2013
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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