Community-Acquired Pneumonia Due to Gram-Negative Bacteria and Pseudomonas aeruginosa

Arancibia, Francisco; Bauer, Torsten T.; Ewig, Santiago; Mensa, Josep; González, Julià; Niederman, Michael S.; Torres, Antoni

doi:10.1001/archinte.162.16.1849

Cited by 369 publications

(315 citation statements)

References 37 publications

(44 reference statements)

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“…In our study, 29.9 of patients with disease progression after initial antibiotic therapy had received appropriate therapy, and 5 of 10 non-survivors with MDR pathogen infection had received appropriate therapy. Similar studies have also been reported 35,36 , and these ndings suggest that treatment strategies for HCAP other than antibiotic selection are also required. HCAP patients are often functionally disabled, and patient-related factors including functional status may be needed in the analysis of prognostic factors, which was dif cult in the present study due to its retrospective nature.…”

Section: Discussionsupporting

confidence: 81%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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Section: Discussionsupporting

confidence: 81%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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“…34 It is also interesting that the observed mortality for COP was lower than that observed more than 10 years ago despite the high rate of bacteremia, suggesting that these may have been less virulent strains of gram-negative bacteria. 35 The high rates of MDR and IIAT in Pa-NP for all pneumonia types mandate that clinicians have therapeutic strategies in place to optimize therapy. Scoring systems to identify patients with MDR infections, including MDR P. aeruginosa, are available but limited in their overall ability to predict MDR infection.…”

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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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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“…Cystic fibrosis (CF) is an autosomal recessive genetic disease (6); the opportunistic pathogen Pseudomonas aeruginosa may cause chronic lung disease in CF patients, depending on the genetic adaptation of the pathogen, and is a prevalent pathogen in CF patients with pulmonary infection (1)(2)(3)(4)(5). Worldwide, 80% of CF patients were found to be infected with P. aeruginosa (7,8).…”

Section: Introductionmentioning

confidence: 99%

Characterization by phenotypic and genotypic methods of metallo-β-lactamase-producing Pseudomonas aeruginosa isolated from patients with cystic fibrosis

Zhang

Wang

et al. 2014

Molecular Medicine Reports

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Abstract.Pseudomonas aeruginosa continues to be a predominant cause of infections with high intrinsic resistance to antibiotics, resulting in treatment failure. P. aeruginosa is the leading cause of respiratory infections among cystic fibrosis (CF) patients. Resistance to carbapenem antibiotics among P. aeruginosa has been reported. Thus, this study was undertaken to characterize the metallo-β-lactamase (MBL) production of P. aeruginosa by phenotypic and genotypic methods. A total of 572 sputum samples were collected from cystic fibrosis patients along with the patient demographic details in a questionnaire. In total, 217 P. aeruginosa isolates were collected and an antibiogram revealed that 159 (73.3%) and 141 (64.9%) of these colonies exhibited resistance to imipenem and meropenem, respectively. Ceftazidime and tobramycin resistance were both identified in 112 (51.6%) isolates, and resistance to piperacillin-tazobactam, gatifloxacin and netilmicin was detected in 96 (44.2%) respective samples. A total of 62 (28.6%) respective samples were resistant to cefoperazone, cefepime and ceftriaxone. The least antibiotic resistance was shown to amikacin and ceftizoxime with 51 (23.5%) and 32 (14.7%) respective colonies resistant to the antibiotics. The minimum inhibitory concentration (MIC) for imipenem revealed a reduction in the MIC values. MBL screening by the zone enhancement method using ceftazidime plus EDTA discs demonstrated that 63 (56.25%) of the colonies were positive for MBL. A total of 53 (84.1%) samples expressed blaVIM and 48 (76.1%) expressed blaIMP genes, as detected by duplex polymerase chain reaction. In conclusion, carbapenem resistance is of great clinical concern in cystic fibrosis patients with P. aeruginosa infection. Therefore, mandatory regular screening and monitoring the resistance in P. aeruginosa among CF patients is required.

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Community-Acquired Pneumonia Due to Gram-Negative Bacteria and Pseudomonas aeruginosa

Cited by 369 publications

References 37 publications

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Characterization by phenotypic and genotypic methods of metallo-β-lactamase-producing Pseudomonas aeruginosa isolated from patients with cystic fibrosis

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