Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia

Abstract

Background/Aims:Healthcare-associated pneumonia (HCAP) was proposed asa new pneumonia category in 2005, and treatment recommendations includebroad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens.However, this concept continues to be controversial, and microbiological data arelacking for HCAP patients in the intensive care unit (ICU). This study was conductedto determine the rate and type of antibiotic-resistant organisms and theclinical outcomes in patients with HCAP in the ICU, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).Methods:We conducted a retrospective cohort analysis of patients with pneumonia(n = 195) who admitted to medical ICU in tertiary teaching hospital fromMarch 2011 to February 2013. Clinical characteristics, microbiological distributions,treatment outcomes, and prognosis of HCAP (n = 74) were compared tothose of CAP (n = 75) and HAP (n = 46).Results:MDR pathogens were significantly higher in HCAP patients (39.1%) thanin CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriateantibiotic treatment occurred more frequently in the HCAP (32.6%) andHAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differencesin clinical outcomes. The significant prognostic factors were pneumoniaseverity and treatment response.Conclusions:MDR pathogens were isolated in HCAP patients requiring ICU admissionat intermediate rates between those of CAP and HAP.

Clinical characteristics and prognostic risk factors of healthcare-associated pneumonia in a Korean tertiary teaching hospital

“…[ 2 , 6 , 10 , 19 ] Moreover, increased mortality in HCAP patients was also shown to be related to underlying patient-related factors and the severity of illness, rather than the presence of CAP-DRPs or IIAT. [ 11 , 19 , 20 ] A cohort study conducted at 346 United States hospitals found no evidence that guideline-based antimicrobial therapy reduced mortality in HCAP patients. [ 21 ] It is increasingly recognized that comorbidities account for a large proportion of mortality in patients with HCAP and a significant proportion of this mortality cannot be prevented by antibiotic treatment.…”

“…However, our pathogen identification rate (38.3%) was higher than those reported previously. [ 13 , 20 ] Third, the microbiologic data were obtained mainly from sputum cultures, and were semiquantitative. Hence, their accuracy is uncertain.…”

Multi-level analysis of bacteria isolated from inpatients in respiratory departments in China

“…In this study, the distribution of multi-drug resistant bacteria in RICU was significantly higher than that in the non-ICU respiratory departments. On one hand, the patients in RICU with severe disease, including cancer, kidney failure, heart disease, chronic obstructive pulmonary disease, etc., were commonly prescribed broad-spectrum antibiotics for empirical therapy, posing the risk of MDR bacterial infections to patients (21)(22)(23). On the other hand, the risk of ventilator-associated pneumonia (VAP) increased due to the prolonged hospitalization in ICU and routine invasive procedures such as intubation and respiratory support.…”

Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines

“…Traditionally, causative agents of CAP were identified using conventional culture methods, so microorganisms were identified in less than 30% of CAP cases during the pre-PCV7 period [3940414243]. With advances in serological and molecular diagnostic tests, the diagnostic yield has improved by up to 40-50%, yet around 50% of CAP pathogens are still unidentified (Table 2) [744454647]. Prior antibiotic use is one of the important reasons for test-negative results.…”

“…Among CAP cases caused by identified bacterial pathogens, S. pneumoniae is the most important causative species, accounting for 26.9–69.4% of pneumonia cases in South Korea (Table 2) [48], and the proportion of pneumococcal pneumonia was higher in studies confined to older adults [749]. However, in a study of severe CAP cases admitted to intensive care units (ICUs), S. aureus infection was more common compared to S. pneumoniae (37.8% vs. 13.5%) [46]. Etiologic distribution might be affected by disease severity, age, and underlying medical conditions.…”