Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community‐acquired pneumonia

Abstract

Backgroundand objective: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.Chronic lung diseases include asthma, bronchiectasis, COPD, chronic aspiration, tracheostomy present at the time of admission and long-term oxygen therapy. ‡ Cardiovascular diseases included coronary artery disease, hypertension and heart failure.CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; EB, Enterobacteriaceae spp.; ESBL, extended-spectrum beta-lactamase; IV, intravenous; MDR, multidrug resistant; OR, odds ratio.

Treatment of Community-Acquired Pneumonia in Immunocompromised Adults

“…History of colonization or infection with a drug-resistant gram-negative bacillus in the previous 12 months, previous hospitalization with exposure to broadspectrum antibiotics, the presence of a tracheostomy, neutropenia, a history of pulmonary comorbidity (eg, cystic fibrosis, bronchiectasis, or recurrent exacerbations of COPD requiring glucocorticoid and antibiotic use) have been reported in the literature to increase the risk of resistant gram-negative bacilli. [37][38][39][40][41][42] Patients with any of these risk factors should be considered for initial empirical therapy against resistant gram-negative bacilli including P aeruginosa. b-Lactam antibiotics with activity against P aeruginosa, such as piperacillintazobactam or a carbapenem, should be used as core therapy.…”

Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators

“…Approximately 6% of cases of CAP with etiological diagnosis are caused by multidrug-resistant (MDR) pathogens, the most frequently described being S. aureus and P. aeruginosa [19][20][21]. A recent multinational point prevalence study reported that the prevalence rates of drug-resistant S. pneumoniae and MDR Enterobacteriaceae in CAP were 1.3% and 1.2%, respectively [22,23]. MDR pathogens make the clinical management of CAP a real challenge for physicians.…”

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

“…Among the 21 eligible articles, nine were prospective studies [ 14 , 16 , 17 , 19 , 32 , 37 , 39 – 41 ] and twelve were retrospective studies [ 26 – 31 , 33 – 36 , 38 ]. Three articles [ 16 , 17 , 31 ] were conducted at multiple centers. Except for an international multicenter study [ 16 , 17 ], all other studies [ 14 , 15 , 19 , 26 – 41 ] were confined to one country.…”

“…We summarized the baseline characteristics of the included studies in Table 1 . The 21 eligible articles involved 7,650 patients and 1,360 MDR organisms, of which ten reported the risk factors for MDR GPB and GNB [ 15 , 19 , 26 , 28 , 31 , 33 , 34 , 38 , 39 , 41 ], ten for MDR GNB [ 14 , 16 , 17 , 27 , 29 , 30 , 32 , 35 , 36 , 40 ], and one for MDR GPB [ 37 ].…”

“…Prior antibiotic treatment is the most frequently reported risk factor that is correlated with the acquisition of MDR bacteria [ 14 – 16 , 19 , 26 , 28 , 30 , 34 , 36 – 38 , 41 ]. Six of the included studies [ 14 , 19 , 30 , 36 , 38 , 41 ] defined prior antibiotic treatment as the antibiotic use within 30 days before admission, while another two studies [ 15 , 26 ] as 90 days before diagnosis and one study [ 16 ] as 12 months before diagnosis. The remaining three studies [ 28 , 34 , 37 ] did not specify the period between the diagnosis and the last antibiotic treatment.…”