TY - JOUR
T1 - Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia
AU - Shindo, Yuichiro
AU - Ito, Ryota
AU - Kobayashi, Daisuke
AU - Ando, Masahiko
AU - Ichikawa, Motoshi
AU - Shiraki, Akira
AU - Goto, Yasuhiro
AU - Fukui, Yasutaka
AU - Iwaki, Mai
AU - Okumura, Junya
AU - Yamaguchi, Ikuo
AU - Yagi, Tetsuya
AU - Tanikawa, Yoshimasa
AU - Sugino, Yasuteru
AU - Shindoh, Joe
AU - Ogasawara, Tomohiko
AU - Nomura, Fumio
AU - Saka, Hideo
AU - Yamamoto, Masashi
AU - Taniguchi, Hiroyuki
AU - Suzuki, Ryujiro
AU - Saito, Hiroshi
AU - Kawamura, Takashi
AU - Hasegawa, Yoshinori
PY - 2013/10/15
Y1 - 2013/10/15
N2 - 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.
AB - 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.
KW - Antibacterial agents
KW - Decision support techniques
KW - Microbial sensitivity tests
KW - Nosocomial infections
KW - Respiratory tract infections
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U2 - 10.1164/rccm.201301-0079OC
DO - 10.1164/rccm.201301-0079OC
M3 - Article
C2 - 23855620
AN - SCOPUS:84886434344
SN - 1073-449X
VL - 188
SP - 985
EP - 995
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 8
ER -