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Crit Care. 2015 May 6;19:219. doi: 10.1186/s13054-015-0926-5.

An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance.

Author information

1
St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110-1088, USA. scott.micek@stlcop.edu.
2
Northwestern University Feinberg School of Medicine, McGaw Pavilion Suite M-300, 240 E Huron, Chicago, IL, 60611, USA. r-wunderink@northwestern.edu.
3
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. mkollef@dom.wustl.edu.
4
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. cxchen@dom.wustl.edu.
5
Vall d'Hebron University Hospital, Passeig Vall d'Hebron, 119, Barcelona, 08035, Spain. jrello@crips.es.
6
Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. jean.chastre@psl.aphp.fr.
7
Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, Rome, 00168, Italy. m.antonelli@rm.unicatt.it.
8
Medizinische Hochschule, Carl-Neuberg-Str. 1, Hannover, 30625, Germany. welte.tobias@mh-hannover.de.
9
Hôpital Raymond Poincaré, 104 boulevard Raymond Poincaré, Garches, 92380, France. Bernard.clair@rpc.ap-hop-paris.fr.
10
Department of Hematology, University Hospital Grosshadern, Marchioninistr 15, Munich, D-81377, Germany. helmut.ostermann@med.uni-muenchen.de.
11
Hospital Universitari MútuaTerrassa, Plaça Dr. Robert, 5, Terrassa, 08221, Spain. ecalbo@mutuaterrassa.es.
12
Pneumology Department, Clinic Institute of Thorax, Villarroel 170, Barcelona, 08036, Spain. ATORRES@clinic.ub.es.
13
Malattie Infettive, Az. Ospedaliera Universitaria Pisana, Via Paradisa 2 - Cisanello, Pisa, 56100, Italy. menichettifrancesco@gmail.com.
14
Pharmacy Services, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. schramm.garrett@mayo.edu.
15
Cubist Pharmaceuticals, Inc., 65 Hayden Avenue, Lexington, MA, 02421, USA. Vandana.Menon@cubist.com.

Abstract

INTRODUCTION:

Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality.

METHODS:

We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death. Twelve hospitals in 5 countries (United States, n = 3; France, n = 2; Germany, n = 2; Italy, n = 2; and Spain, n = 3) participated. We compared characteristics of patients who had MDR strains to those who did not and derived regression models to identify predictors of MDR and hospital mortality.

RESULTS:

Of 740 patients with Pa-NP, 226 patients (30.5%) were infected with MDR strains. In multivariable analyses, independent predictors of multidrug-resistance included decreasing age (adjusted odds ratio [AOR] 0.91, 95% confidence interval [CI] 0.96-0.98), diabetes mellitus (AOR 1.90, 95% CI 1.21-3.00) and ICU admission (AOR 1.73, 95% CI 1.06-2.81). Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis.

CONCLUSIONS:

Among patients with Pa-NP the presence of infection with a MDR strain is associated with increased in-hospital mortality. Identification of patients at risk of MDR Pa-NP could facilitate appropriate empiric antibiotic decisions that in turn could lead to improved hospital survival.

PMID:
25944081
PMCID:
PMC4446947
DOI:
10.1186/s13054-015-0926-5
[Indexed for MEDLINE]
Free PMC Article

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