Risk Factors for Drug-Resistant Pathogens in Community-acquired and Healthcare-associated Pneumonia
Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia. To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2013-10, Vol.188 (8), p.985-995 |
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| creator | SHINDO, Yuichiro ITO, Ryota YAMAGUCHI, Ikuo YAGI, Tetsuya TANIKAWA, Yoshimasa SUGINO, Yasuteru SHINDOH, Joe OGASAWARA, Tomohiko NOMURA, Fumio SAKA, Hideo YAMAMOTO, Masashi TANIGUCHI, Hiroyuki KOBAYASHI, Daisuke SUZUKI, Ryujiro SAITO, Hiroshi KAWAMURA, Takashi HASEGAWA, Yoshinori ANDO, Masahiko ICHIKAWA, Motoshi SHIRAKI, Akira GOTO, Yasuhiro FUKUI, Yasutaka IWAKI, Mai OKUMURA, Junya |
| description | Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia.
To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.
A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs).
In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84).
The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306. |
| doi_str_mv | 10.1164/rccm.201301-0079oc |
| format | Article |
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To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.
A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs).
In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84).
The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201301-0079oc</identifier><identifier>PMID: 23855620</identifier><language>eng</language><publisher>New York, NY: American Thoracic Society</publisher><subject>Activities of Daily Living ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Biological and medical sciences ; Community-Acquired Infections - drug therapy ; Community-Acquired Infections - etiology ; Community-Acquired Infections - microbiology ; Cross Infection - drug therapy ; Cross Infection - etiology ; Cross Infection - microbiology ; Drug resistance ; Drug Resistance, Multiple, Bacterial ; Enteral nutrition ; Enteral Nutrition - adverse effects ; Female ; General aspects ; Hemodialysis ; Hospitalization ; Hospitalization - statistics & numerical data ; Hospitals ; Human infectious diseases. Experimental studies and models ; Humans ; Immunosuppression - adverse effects ; Infectious diseases ; Intensive care medicine ; Japan ; Laboratories ; Male ; Medical sciences ; Nosocomial infections ; Nursing homes ; Observational studies ; Pathogens ; Pneumology ; Pneumonia ; Pneumonia, Bacterial - drug therapy ; Pneumonia, Bacterial - etiology ; Pneumonia, Bacterial - microbiology ; Prospective Studies ; Risk Factors ; ROC Curve ; Staphylococcus infections</subject><ispartof>American journal of respiratory and critical care medicine, 2013-10, Vol.188 (8), p.985-995</ispartof><rights>2014 INIST-CNRS</rights><rights>Copyright American Thoracic Society Oct 15, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-db97d408c05b562ce6e2686fd48c75ec9cc33153e018c41e6fee65c28ff73b443</citedby><cites>FETCH-LOGICAL-c427t-db97d408c05b562ce6e2686fd48c75ec9cc33153e018c41e6fee65c28ff73b443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,4011,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27860667$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23855620$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SHINDO, Yuichiro</creatorcontrib><creatorcontrib>ITO, Ryota</creatorcontrib><creatorcontrib>YAMAGUCHI, Ikuo</creatorcontrib><creatorcontrib>YAGI, Tetsuya</creatorcontrib><creatorcontrib>TANIKAWA, Yoshimasa</creatorcontrib><creatorcontrib>SUGINO, Yasuteru</creatorcontrib><creatorcontrib>SHINDOH, Joe</creatorcontrib><creatorcontrib>OGASAWARA, Tomohiko</creatorcontrib><creatorcontrib>NOMURA, Fumio</creatorcontrib><creatorcontrib>SAKA, Hideo</creatorcontrib><creatorcontrib>YAMAMOTO, Masashi</creatorcontrib><creatorcontrib>TANIGUCHI, Hiroyuki</creatorcontrib><creatorcontrib>KOBAYASHI, Daisuke</creatorcontrib><creatorcontrib>SUZUKI, Ryujiro</creatorcontrib><creatorcontrib>SAITO, Hiroshi</creatorcontrib><creatorcontrib>KAWAMURA, Takashi</creatorcontrib><creatorcontrib>HASEGAWA, Yoshinori</creatorcontrib><creatorcontrib>ANDO, Masahiko</creatorcontrib><creatorcontrib>ICHIKAWA, Motoshi</creatorcontrib><creatorcontrib>SHIRAKI, Akira</creatorcontrib><creatorcontrib>GOTO, Yasuhiro</creatorcontrib><creatorcontrib>FUKUI, Yasutaka</creatorcontrib><creatorcontrib>IWAKI, Mai</creatorcontrib><creatorcontrib>OKUMURA, Junya</creatorcontrib><title>Risk Factors for Drug-Resistant Pathogens in Community-acquired and Healthcare-associated Pneumonia</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia.
To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.
A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs).
In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84).
The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306.</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Biological and medical sciences</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Community-Acquired Infections - etiology</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - etiology</subject><subject>Cross Infection - microbiology</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Enteral nutrition</subject><subject>Enteral Nutrition - adverse effects</subject><subject>Female</subject><subject>General aspects</subject><subject>Hemodialysis</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Human infectious diseases. Experimental studies and models</subject><subject>Humans</subject><subject>Immunosuppression - adverse effects</subject><subject>Infectious diseases</subject><subject>Intensive care medicine</subject><subject>Japan</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nosocomial infections</subject><subject>Nursing homes</subject><subject>Observational studies</subject><subject>Pathogens</subject><subject>Pneumology</subject><subject>Pneumonia</subject><subject>Pneumonia, Bacterial - drug therapy</subject><subject>Pneumonia, Bacterial - etiology</subject><subject>Pneumonia, Bacterial - microbiology</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Staphylococcus infections</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpd0c9rFTEQB_Agiq3Vf8CDLIjgJTW_kz3Kq7VCoaUoeFvyZmfb1N2kTbKH_vfm8Z4KnhLIZ4aZfAl5y9kp50Z9ygDLqWBcMk4Zs32CZ-SYa6mp6i173u7MSqpU__OIvCrlnjEuHGcvyZGQTmsj2DGBm1B-deceasqlm1LuzvJ6S2-whFJ9rN21r3fpFmPpQuw2aVnWGOoT9fC4hoxj5-PYXaCf6x34jNSXkiD42l6uI65LisG_Ji8mPxd8czhPyI_zL983F_Ty6uu3zedLCkrYSsdtb0fFHDC9bcMBGhTGmWlUDqxG6AGkbOsh4w4URzMhGg3CTZOVW6XkCfm47_uQ0-OKpQ5LKIDz7COmtQy8GcW10aLR9__R-7Tm2KbbqZ47IZluSuwV5FRKxml4yGHx-WngbNhFMOwiGPYRDLsIrjat6N2h9bpdcPxb8ufPG_hwAL6An6fsI4Tyz1lnmDFW_gZb6pA4</recordid><startdate>20131015</startdate><enddate>20131015</enddate><creator>SHINDO, Yuichiro</creator><creator>ITO, Ryota</creator><creator>YAMAGUCHI, Ikuo</creator><creator>YAGI, Tetsuya</creator><creator>TANIKAWA, Yoshimasa</creator><creator>SUGINO, Yasuteru</creator><creator>SHINDOH, Joe</creator><creator>OGASAWARA, Tomohiko</creator><creator>NOMURA, Fumio</creator><creator>SAKA, Hideo</creator><creator>YAMAMOTO, Masashi</creator><creator>TANIGUCHI, Hiroyuki</creator><creator>KOBAYASHI, Daisuke</creator><creator>SUZUKI, Ryujiro</creator><creator>SAITO, Hiroshi</creator><creator>KAWAMURA, Takashi</creator><creator>HASEGAWA, Yoshinori</creator><creator>ANDO, Masahiko</creator><creator>ICHIKAWA, Motoshi</creator><creator>SHIRAKI, Akira</creator><creator>GOTO, Yasuhiro</creator><creator>FUKUI, Yasutaka</creator><creator>IWAKI, Mai</creator><creator>OKUMURA, Junya</creator><general>American Thoracic Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20131015</creationdate><title>Risk Factors for Drug-Resistant Pathogens in Community-acquired and Healthcare-associated Pneumonia</title><author>SHINDO, Yuichiro ; ITO, Ryota ; YAMAGUCHI, Ikuo ; YAGI, Tetsuya ; TANIKAWA, Yoshimasa ; SUGINO, Yasuteru ; SHINDOH, Joe ; OGASAWARA, Tomohiko ; NOMURA, Fumio ; SAKA, Hideo ; YAMAMOTO, Masashi ; TANIGUCHI, Hiroyuki ; KOBAYASHI, Daisuke ; SUZUKI, Ryujiro ; SAITO, Hiroshi ; KAWAMURA, Takashi ; HASEGAWA, Yoshinori ; ANDO, Masahiko ; ICHIKAWA, Motoshi ; SHIRAKI, Akira ; GOTO, Yasuhiro ; FUKUI, Yasutaka ; IWAKI, Mai ; OKUMURA, Junya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-db97d408c05b562ce6e2686fd48c75ec9cc33153e018c41e6fee65c28ff73b443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Biological and medical sciences</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Community-Acquired Infections - etiology</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - etiology</topic><topic>Cross Infection - microbiology</topic><topic>Drug resistance</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Enteral nutrition</topic><topic>Enteral Nutrition - adverse effects</topic><topic>Female</topic><topic>General aspects</topic><topic>Hemodialysis</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Human infectious diseases. Experimental studies and models</topic><topic>Humans</topic><topic>Immunosuppression - adverse effects</topic><topic>Infectious diseases</topic><topic>Intensive care medicine</topic><topic>Japan</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nosocomial infections</topic><topic>Nursing homes</topic><topic>Observational studies</topic><topic>Pathogens</topic><topic>Pneumology</topic><topic>Pneumonia</topic><topic>Pneumonia, Bacterial - drug therapy</topic><topic>Pneumonia, Bacterial - etiology</topic><topic>Pneumonia, Bacterial - microbiology</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Staphylococcus infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SHINDO, Yuichiro</creatorcontrib><creatorcontrib>ITO, Ryota</creatorcontrib><creatorcontrib>YAMAGUCHI, Ikuo</creatorcontrib><creatorcontrib>YAGI, Tetsuya</creatorcontrib><creatorcontrib>TANIKAWA, Yoshimasa</creatorcontrib><creatorcontrib>SUGINO, Yasuteru</creatorcontrib><creatorcontrib>SHINDOH, Joe</creatorcontrib><creatorcontrib>OGASAWARA, Tomohiko</creatorcontrib><creatorcontrib>NOMURA, Fumio</creatorcontrib><creatorcontrib>SAKA, Hideo</creatorcontrib><creatorcontrib>YAMAMOTO, Masashi</creatorcontrib><creatorcontrib>TANIGUCHI, Hiroyuki</creatorcontrib><creatorcontrib>KOBAYASHI, Daisuke</creatorcontrib><creatorcontrib>SUZUKI, Ryujiro</creatorcontrib><creatorcontrib>SAITO, Hiroshi</creatorcontrib><creatorcontrib>KAWAMURA, Takashi</creatorcontrib><creatorcontrib>HASEGAWA, Yoshinori</creatorcontrib><creatorcontrib>ANDO, Masahiko</creatorcontrib><creatorcontrib>ICHIKAWA, Motoshi</creatorcontrib><creatorcontrib>SHIRAKI, Akira</creatorcontrib><creatorcontrib>GOTO, Yasuhiro</creatorcontrib><creatorcontrib>FUKUI, Yasutaka</creatorcontrib><creatorcontrib>IWAKI, Mai</creatorcontrib><creatorcontrib>OKUMURA, Junya</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SHINDO, Yuichiro</au><au>ITO, Ryota</au><au>YAMAGUCHI, Ikuo</au><au>YAGI, Tetsuya</au><au>TANIKAWA, Yoshimasa</au><au>SUGINO, Yasuteru</au><au>SHINDOH, Joe</au><au>OGASAWARA, Tomohiko</au><au>NOMURA, Fumio</au><au>SAKA, Hideo</au><au>YAMAMOTO, Masashi</au><au>TANIGUCHI, Hiroyuki</au><au>KOBAYASHI, Daisuke</au><au>SUZUKI, Ryujiro</au><au>SAITO, Hiroshi</au><au>KAWAMURA, Takashi</au><au>HASEGAWA, Yoshinori</au><au>ANDO, Masahiko</au><au>ICHIKAWA, Motoshi</au><au>SHIRAKI, Akira</au><au>GOTO, Yasuhiro</au><au>FUKUI, Yasutaka</au><au>IWAKI, Mai</au><au>OKUMURA, Junya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Drug-Resistant Pathogens in Community-acquired and Healthcare-associated Pneumonia</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2013-10-15</date><risdate>2013</risdate><volume>188</volume><issue>8</issue><spage>985</spage><epage>995</epage><pages>985-995</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia.
To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.
A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs).
In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84).
The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306.</abstract><cop>New York, NY</cop><pub>American Thoracic Society</pub><pmid>23855620</pmid><doi>10.1164/rccm.201301-0079oc</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2013-10, Vol.188 (8), p.985-995 |
| issn | 1073-449X 1535-4970 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1443415652 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; American Thoracic Society (ATS) Journals Online; Alma/SFX Local Collection |
| subjects | Activities of Daily Living Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Bacterial Agents - therapeutic use Antibiotics Biological and medical sciences Community-Acquired Infections - drug therapy Community-Acquired Infections - etiology Community-Acquired Infections - microbiology Cross Infection - drug therapy Cross Infection - etiology Cross Infection - microbiology Drug resistance Drug Resistance, Multiple, Bacterial Enteral nutrition Enteral Nutrition - adverse effects Female General aspects Hemodialysis Hospitalization Hospitalization - statistics & numerical data Hospitals Human infectious diseases. Experimental studies and models Humans Immunosuppression - adverse effects Infectious diseases Intensive care medicine Japan Laboratories Male Medical sciences Nosocomial infections Nursing homes Observational studies Pathogens Pneumology Pneumonia Pneumonia, Bacterial - drug therapy Pneumonia, Bacterial - etiology Pneumonia, Bacterial - microbiology Prospective Studies Risk Factors ROC Curve Staphylococcus infections |
| title | Risk Factors for Drug-Resistant Pathogens in Community-acquired and Healthcare-associated Pneumonia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T02%3A15%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20Factors%20for%20Drug-Resistant%20Pathogens%20in%20Community-acquired%20and%20Healthcare-associated%20Pneumonia&rft.jtitle=American%20journal%20of%20respiratory%20and%20critical%20care%20medicine&rft.au=SHINDO,%20Yuichiro&rft.date=2013-10-15&rft.volume=188&rft.issue=8&rft.spage=985&rft.epage=995&rft.pages=985-995&rft.issn=1073-449X&rft.eissn=1535-4970&rft_id=info:doi/10.1164/rccm.201301-0079oc&rft_dat=%3Cproquest_cross%3E3120390451%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1449182305&rft_id=info:pmid/23855620&rfr_iscdi=true |