A New Strategy for Healthcare-Associated Pneumonia: A 2-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-Resistant Pathogens to Select Initial Empiric Therapy

Maruyama, Takaya; Fujisawa, Takao; Okuno, Masataka; Toyoshima, Hirokazu; Tsutsui, Kiyoyuki; Maeda, Hikaru; Yuda, Hisamichi; Yoshida, Masamichi; Kobayashi, Hiroyasu; Taguchi, Osamu; Gabazza, Esteban C.; Takei, Yoshiyuki; Miyashita, Naoyuki; Ihara, Toshiaki; Brito, Verónica; Niederman, Michael S.

doi:10.1093/cid/cit571

Cited by 110 publications

(94 citation statements)

References 32 publications

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“…21,22 An alternative approach for classifying patients with COP is to identify the number of risk factors for MDR infection they have in order to better direct the use of broad-spectrum antibiotics. 23 Our study found that NOTE. ICU, intensive care unit.…”

Section: Discussionmentioning

confidence: 64%

“…Scoring systems to identify patients with MDR infections, including MDR P. aeruginosa, are available but limited in their overall ability to predict MDR infection. 23,36,37 A number of novel methods aimed at improving the early identification of pathogens and related antibiotic susceptibilities are also entering the diagnostic arena. Such technological advances offer a strategy that could potentially maximize the administration of appropriate antibiotic therapy while minimizing unnecessary antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

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Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Micek

Kollef

Torres

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo 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]).DESIGNWe 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).SETTINGTwelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).PATIENTS/PARTICIPANTSA total of 742 patients with Pa-NP.RESULTSHospital 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.CONCLUSIONSAmong 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

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Micek

Kollef

Torres

et al. 2015

Infect. Control Hosp. Epidemiol.

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show abstract

“…Several other risk factor models have been developed as outlined in Table 1 [7][8][9][10][11][12]. These algorithms were locally developed by investigators, often with the assistance of outside experts, with the primary goal of improving upon the identification of patients with pneumonia attributed to antibiotic-resistant bacteria.…”

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confidence: 99%

“Does this patient have…” “Is this patient at risk for infection with multidrug resistant bacteria?”

Guillamet

Kollef

2015

Intensive Care Med

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“…In hospital setting, it is widely associated with nosocomial infection (Idris et al 2012). Over the years, the isolation of multidrug-resistant P. aeruginosa (MDRPA) isolates from hospitalized patients has been increasingly reported, especially in the critically ill patients (Aloush et al 2006;Hsu et al 2005;Maruyama et al 2013;Padmakrishnan et al 2009). This leads to the severe adverse outcomes of the infection due to limited availability of antimicrobial agents for treatment.…”

Section: Introductionmentioning

confidence: 99%