Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

Abstract

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

Comparison of viral infection in healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP)

“…2), and found that HCAP is the most important predictor for MDROs (OR 14.2, 95% CI 1.734-115.9, p = 0.013) unlike previous studies [6][7][8][9]. Recently, the number of elderly patients with frequent hospital contacts has increased rapidly and many of these individuals are residing in nursing homes or long-term care facilities, especially in Korea [47], and those HCAP patients might be prone to MDR bacterial infection [48][49][50]. Such recent trends may explain why this study has shown results that are different from previous studies.…”

A Case-Control Study Assessing the Impact of Nonventilated Hospital-Acquired Pneumonia on Patient Outcomes

“…21 MDR infection in NVHAP is increasingly common in many parts of the world, resulting in the delayed administration of appropriate antibiotic therapy. [22][23][24] Moreover, attributable mortality from HAP may be greater than that associated with VAP because of the lower severity of illness existing at baseline in patients with HAP compared with those with VAP. 25 Several limitations of our study should be recognized.…”

Analysis of multidrug-resistant bacteria in 3223 patients with hospital-acquired infections (HAI) from a tertiary general hospital in China

“…In the same paper, pandrug-resistant (PDR) was defined as 'non-susceptibility to all agents in all antimicrobial categories' [5]. Common bacteria that show MDR/PDR are methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing bacteria, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (A. baumannii, CRAB), MDR/PDR Pseudomonas aeruginosa (P. aeruginosa, MDR/PDRPA), and MDR Mycobacterium tuberculosis [6][7][8]. A high prevalence of nosocomial infections attributable to MDR strains has been reported in countries worldwide [8][9][10][11][12].…”