Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization

Abstract

Healthcare-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. Although limited prospective data exist, it has been suggested that all patients with HCAP should receive empirical therapy with a multidrug regimen directed against drug-resistant organisms. We aimed to determine the differences in aetiology and outcomes between HCAP groups and a community-acquired pneumonia (CAP) group, and to assess the presence of antibiotic-resistant bacteria. All consecutive non-immunocompromised adults hospitalized with pneumonia were prospectively included from 2001 to 2009. Patients who had had recent contact with the health system through nursing homes, home healthcare programmes, haemodialysis clinics or prior hospitalization were considered to have HCAP. A total of 2245 patients with pneumonia were hospitalized through the emergency room, of whom 577 (25.7%) had HCAP. Significant differences in causative pathogens were found between groups. Antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, resistant strains of Pseudomonas aeruginosa, and extended-spectrum β-lactamase-producing Enterobacteriaceae, were scarce in all groups. In contrast, aspiration pneumonia was particularly frequent. No differences were found regarding inappropriate initial empirical antibiotic therapy between groups. Overall mortality was higher in patients who attended a hospital or haemodialysis clinic or received intravenous chemotherapy in the 30 days before pneumonia, and among patients who resided in a nursing home or long-term-care facility. In conclusion, most HCAP patients could be treated in the same way as patients with CAP, after carefully ruling out the presence of aspiration pneumonia.

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

“…6 The validity of these antimicrobial guidelines for the treatment of nursing home patients has been most challenging because the microbiology of NHAP varies widely among published reports, according to study design, severity of illness, and colonization with resistant organisms due to prior hospitalization. 15 Our results confirm the previously published etiologic difference between NHAP from the United States and Europe. 7 In particular, Staphylococcus species were identified as the prominent pathogen in the United States (52%) as opposed to S. pneumoniae in Europe (46%) and Latin America (25%).…”

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

“…pneumoniae was the most frequent pathogen of HCAP, and the frequency of atypical pathogens was 9.0 , results compatible with those of previous reports 3,4,[9][10][11][12] . Although the frequency of atypical pathogens was lower in HCAP than in CAP, the 9.0 incidence of atypical pathogens should not be ignored.…”

“…In the present study, urinary antigen tests, serological analysis, and RIDT were also used in the etiological diagnosis, with cases of unknown etiology also included. More recent studies have revealed that the most frequent pathogen is S. pneumoniae, and atypical pathogens have been detected in 0.7 to 16.1 of cases 3,4,[9][10][11][12] . In the present study, S.…”

“Does this patient have…” “Is this patient at risk for infection with multidrug resistant bacteria?”

“…Studies attempting to validate the Table 1 have demonstrated limited accuracy in the precision of these models when applied to an independent population, indicating again that local ecology and case mix drive the rates of MDR infection in differing regions and countries [5,13,14]. Similarly, specific HCAP risk factors and the presence of multiple HCAP risk factors have been linked to increased risk of pneumonia attributed to S.aureus and P. aeruginosa, respectively [15]. However, the clinical utility of these specific risk factor profiles for improving the prescription of antibiotics to patients with pneumonia has not been demonstrated.…”