infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Pseudomonas aeruginosa Nosocomial Pneumonia: Impact of Pneumonia Classification
Scott T. Micek, PharmD;1 Marin H. Kollef, MD;2 Antoni Torres, MD;3 Catherine Chen, MD;2 Jordi Rello, MD;4
Jean Chastre, MD;5 Massimo Antonelli, MD;6 Tobias Welte, MD, PhD;7 Bernard Clair, MD;8 Helmut Ostermann, MD, PhD;9 Esther Calbo, MD;10 Richard Wunderink, MD;11 Francesco Menichetti, MD, PhD;12 Garrett Schramm, PharmD;13 Vandana Menon, MD14
objective. To describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).
design. We conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).
setting. Twelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3). patients/participants. A total of 742 patients with Pa-NP.
results. Hospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.
conclusions. Among patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.
Infect. Control Hosp. Epidemiol. 2015;36(10):1190–1197
Nosocomial pneumonia (NP) can occur in a diverse spectrum of patients and can be attributed to varied etiologic pathogens.1 NP is typically classified according to the location and condi- tions of infection onset (community-onset usually with healthcare-associated risk factors [COP], hospital-acquired pneumonia [HAP], or pneumonia acquired during mechan- ical ventilation).2 Few studies have attempted to evaluate NP according to the location and conditions of infection or to compare outcomes among these categories of NP.3–5 Notably, recent trends show an increase in the prevalence of NP caused by multidrug-resistant (MDR) gram-negative bacteria, most
commonly Pseudomonas aeruginosa.6–10 Mortality associated with P. aeruginosa NP (Pa-NP) is among the highest of any bacteria owing to both the virulence of P. aeruginosa as well as the administration of inappropriate initial antibiotic therapy (IIAT) in MDR isolates.11–15 The escalating prevalence of antibiotic resistance in
P. aeruginosa, along with the development and availability of novel antimicrobial therapies, requires a precise under- standing of how the various categories of Pa-NP influence outcome. A comparison of mortality of Pa-NP, as well as risk factors for mortality, according to pneumonia classification
Affiliations: 1. St. Louis College of Pharmacy, St. Louis, Missouri; 2. Washington University School of Medicine, St. Louis, Missouri; 3. Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona–Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)–SGR 911–Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain; 4. Hospital Vall D’Hebron, Barcelona, Spain; 5. Groupe Hospita- lier Pitie-Salpetriere, Paris, France; 6. Policlinico Universitario A. Gemelli, Rome, Italy; 7. Medizinische Hochschule Hannover, Hannover, Germany; 8. Hôpital Raymond Poincaré, Garches, France; 9. University Hospital of Munich, Munich, Germany; 10. Hospital Universitari Mutua de Terrassa, Barcelona, Spain; 11. Northwestern University Feinberg School of Medicine, Chicago, Illinois; 12. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 13. Mayo Clinic, Rochester, Minnesota; 14. Cubist Pharmaceuticals, Lexington, Massachusetts.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0009. DOI: 10.1017/ice.2015.167 Received April 3, 2015; accepted June 20, 2015; electronically published July 20, 2015
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