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Pseudomonas aeruginosa Nosocomial Pneumonia: Impact of Pneumonia Classification

Published online by Cambridge University Press:  20 July 2015

Scott T. Micek*
Affiliation:
St. Louis College of Pharmacy, St. Louis, Missouri
Marin H. Kollef
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Antoni Torres
Affiliation:
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona–Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)–SGR 911–Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain
Catherine Chen
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Jordi Rello
Affiliation:
Hospital Vall D’Hebron, Barcelona, Spain
Jean Chastre
Affiliation:
Groupe Hospitalier Pitie-Salpetriere, Paris, France
Massimo Antonelli
Affiliation:
Policlinico Universitario A. Gemelli, Rome, Italy
Tobias Welte
Affiliation:
Medizinische Hochschule Hannover, Hannover, Germany
Bernard Clair
Affiliation:
Hôpital Raymond Poincaré, Garches, France
Helmut Ostermann
Affiliation:
University Hospital of Munich, Munich, Germany
Esther Calbo
Affiliation:
Hospital Universitari Mutua de Terrassa, Barcelona, Spain
Richard Wunderink
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Francesco Menichetti
Affiliation:
Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
Garrett Schramm
Affiliation:
Mayo Clinic, Rochester, Minnesota
Vandana Menon
Affiliation:
Cubist Pharmaceuticals, Lexington, Massachusetts
*
Address correspondence to Scott T. Micek, PharmD, St. Louis College of Pharmacy, 4588 Parkview Pl, St. Louis, Missouri 63110-1088 (scott.micek@stlcop.edu).

Abstract

OBJECTIVE

To 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]).

DESIGN

We 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).

SETTING

Twelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).

PATIENTS/PARTICIPANTS

A total of 742 patients with Pa-NP.

RESULTS

Hospital 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.

CONCLUSIONS

Among 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

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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