Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study

Abstract

HCAP accounts for one-fifth of cases of severe pneumonia in patients admitted to Spanish ICUs. The empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP in our population, and consequently the decision to include coverage of multidrug-resistant pathogens for HCAP should be cautiously judged in order to prevent the overuse of antimicrobials.

Co-infection in severe influenza: a new epidemiology?

“…This potential overestimation could also explain the high rate of P. aeruginosa co-infection observed in that study (14.1%): in another recent study in patients with influenza-related infection, the authors found a 1.3% rate of P. aeruginosa co-infection in patients with CAP and 8.3% in patients with healthcare-associated pneumonia (HCAP) [9]. The high incidence found in the present study cannot be explained by a local (national) feature, since same authors reported lower rates of P. aeruginosa CAP and HCAP in Spain during this same time [10,11]. Either false positives (patients diagnosed as pneumonia whereas only colonized) or a specific, not yet described, influenza-P. aeruginosa co-infection (Shah at al., found similar incidence of P. aeruginosa [12]) could explain such high rates of P. aeruginosa pneumonia, especially if they truly are community acquired.…”

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

“…20 However, several authors have criticized the use of the term HCAP, suggesting that it could result in the needless administration of broad-spectrum antibiotics to individuals with COP not infected with antibiotic-resistant pathogens. 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.…”

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

“…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.…”

“…While Pseudomonas infections are more likely to develop in patients with structurally damaged lungs, including chronic obstructive pulmonary disease (especially in the setting of prior antibiotic exposure), cerebrovascular disease and during the second episode of ventilator-associated pneumonia [16], MRSA pneumonia seems to preferentially affect elderly nursing home residents with previous hospitalizations and patients having received courses of antibiotics or tube feeds [10]. Moreover, it is important to recognize that, even in countries with low rates of MDR pneumonia, the presence of immunosuppression significantly increases the likelihood of infection with MDR Gram-negative bacteria and MRSA [12].…”