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

研究成果: Article査読

175 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)985-995
ページ数11
ジャーナルAmerican Journal of Respiratory and Critical Care Medicine
188
8
DOI
出版ステータスPublished - 15-10-2013
外部発表はい

All Science Journal Classification (ASJC) codes

  • 呼吸器内科
  • 集中医療医学

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