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

Am J Respir Crit Care Med. 2013 Oct 15;188(8):985-95. doi: 10.1164/rccm.201301-0079OC.

Abstract

Rationale: Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia.

Objectives: To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.

Methods: A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant 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 antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-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 receiver operating characteristic curve for counting the number of 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 either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / etiology
  • Community-Acquired Infections / microbiology
  • Cross Infection / drug therapy*
  • Cross Infection / etiology
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial
  • Enteral Nutrition / adverse effects
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Immunosuppression / adverse effects
  • Japan
  • Male
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / etiology
  • Pneumonia, Bacterial / microbiology
  • Prospective Studies
  • ROC Curve
  • Risk Factors

Substances

  • Anti-Bacterial Agents