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Chest. 2016 Aug;150(2):415-25. doi: 10.1016/j.chest.2016.03.042. Epub 2016 Apr 7.

Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug-Resistant Pseudomonas aeruginosa.

Author information

1
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
2
Department of Microbiology, Hospital Clinic, Barcelona, Spain.
3
Department of Infectious Disease, Hospital Clinic, Barcelona, Spain.
4
Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York.
5
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain. Electronic address: atorres@clinic.ub.es.

Abstract

BACKGROUND:

Pseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa.

METHODS:

Prospective observational study of 2,023 consecutive adult patients with CAP with definitive etiology.

RESULTS:

P aeruginosa was found in 77 (4%) of the 2,023 cases with microbial etiology. In 22 (32%) of the 68 cases of P aeruginosa with antibiogram data, the isolates were MDR. Inappropriate therapy was present in 49 (64%) cases of P aeruginosa CAP, including 17/22 (77%) cases of MDR P aeruginosa CAP. Male sex, chronic respiratory disease, C-reactive protein <12.35 mg/dL, and pneumonia severity index risk class IV to V were independently associated with P aeruginosa CAP. Prior antibiotic treatment was more frequent in MDR P aeruginosa CAP compared with non-MDR P aeruginosa (58% vs 29%, P = .029), and was the only risk factor associated with CAP resulting from MDR P aeruginosa. In the multivariate analysis, age ≥65 years, CAP resulting from P aeruginosa, chronic liver disease, neurologic disease, nursing home, criteria of ARDS, acute renal failure, ICU admission, and inappropriate empiric treatment were the factors associated with 30-day mortality.

CONCLUSIONS:

P aeruginosa is an individual risk factor associated with mortality in CAP. The risk factors described can help clinicians to suspect P aeruginosa and MDR P aeruginosa.

KEYWORDS:

Pseudomonas aeruginosa; community-acquired pneumonia; multidrug-resistant; pneumonia

PMID:
27060725
DOI:
10.1016/j.chest.2016.03.042
[Indexed for MEDLINE]

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