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.
|ジャーナル||American Journal of Respiratory and Critical Care Medicine|
|出版ステータス||Published - 15-10-2013|
All Science Journal Classification (ASJC) codes