Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital

Jeong, Byeong‐Ho; Koh, Won‐Jung; Yoo, Hongseok; Park, Hye Yun; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung; Jeon, Kyeongman

doi:10.1159/000362673

Cited by 7 publications

(6 citation statements)

References 40 publications

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“…Table 1 shows risk factors associated with CAP owing to MDRO. 72,75,76 No consensus exists as to which is the most reliable combination of risk factors predicting the likelihood of patients hospitalized for CAP owing to MDROs. Brito and Niederman 77 reviewed several studies that evaluated patients with HCAP and proposed an algorithm that combined severity of illness and number of risk factors.…”

Section: Staphylococcus Aureus Including Methicillin-resistant Staphymentioning

confidence: 99%

Bacterial Pneumonia in Older Adults

Henig

Kaye

2017

Infectious Disease Clinics of North America

102

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The incidence of pneumonia increases with age, and is particularly high in patients who reside in long-term care facilities (LTCFs). Mortality rates for pneumonia in older adults are high and have not decreased in the last decade. Atypical symptoms and exacerbation of underlying illnesses should trigger clinical suspicion of pneumonia. Risk factors for multidrug-resistant organisms are more common in older adults, particularly among LTCF residents, and should be considered when making empiric treatment decisions. Monitoring of clinical stability and underlying comorbid conditions, potential drug-drug interactions, and drug-related adverse events are important factors in managing elderly patients with pneumonia.

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Section: Staphylococcus Aureus Including Methicillin-resistant Staphymentioning

confidence: 99%

Bacterial Pneumonia in Older Adults

Henig

Kaye

2017

Infectious Disease Clinics of North America

102

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“…Also, new ATS/IDSA guidelines stated that HCAP could be included in the upcoming CAP guidelines because patients with HCAP frequently presented from the community and were initially cared for in emergency departments [4]. Several studies revealed that HCAP and drug-resistant bacterial pneumonia may not share identical risk factors for PDR pathogens, and the broad-spectrum antibiotic treatment targeting PDR pathogens in patients with HCAP may not be adequate and can even lead to overtreatment [11].…”

Section: Discussionmentioning

confidence: 99%

The association of prior hospitalization with clinical outcomes among patients admitted with pneumonia: a propensity score matching study

et al. 2019

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Background Although prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited. We aimed to elucidate the clinical impact of PH on these patients. Methods PH was defined as hospitalization for two or more days in the preceding 90 days. Patients with PH-associated pneumonia (PHAP) or community-acquired pneumonia (CAP) were matched using the propensity score matching method, and the clinical outcomes were compared. We also conducted subgroup analyses based on intravenous antibiotic use during PH, duration of PH, and time to re-admission. Results A total of 704 patients were identified; the PHAP group included 97 patients (13.7%). After matching according to propensity scores, the baseline characteristics of the PHAP group were similar to those of the CAP group. The isolation rate of PDR pathogens as well as the 30-day and total in-hospital mortality did not differ between propensity score-matched PHAP and CAP patients (13.6% vs. 10.2%, P = 0.485; 10.2% vs. 14.8%, P = 0.362; and 13.6% vs. 15.9%, P = 0.671, respectively). In subgroup analyses, only intravenous antibiotic use during PH was associated with the isolation rate of PDR pathogens (adjusted OR: 5.066; 95% CI: 1.231–20.845). Conclusions PH itself might not be related with higher isolation rates of PDR pathogens or mortality in patients admitted with pneumonia. Therefore, it seems reasonable that broad spectrum antibiotic therapy for PDR pathogens should be selectively applied to PHAP patients with intravenous antibiotic use during PH.

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“…The risk factors for multidrug-resistant pathogens are dealt with more extensively in another review in this series but are strongly linked to age; multimorbidity; comorbidities such as respiratory disease, dementia, and renal failure; and antibiotic use. [33][34][35]…”

Section: What Is Community-acquired Pneumonia?mentioning

confidence: 99%

The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults

Chalmers

2016

Semin Respir Crit Care Med

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Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a ?U?-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis. Advances in diagnosis have been slow, and although there are increasing data on the value of computed tomography or lung ultrasound as more sensitive diagnostic methodologies, they are not widely used as initial diagnostic tests. There are a wide range of differential diagnoses and pneumonia ?mimics? which should be considered in patients presenting with CAP. Once the diagnosis of CAP has been made, identifying the causative microorganism is the next stage in the diagnostic process. Traditional culture-based approaches are relatively insensitive and achieve a positive diagnosis in only 30 to 70% of cases, even when rigorously applied. Urinary antigen tests, polymerase chain reaction assays, and even next-generation sequencing technologies have become available and are increasing the rates of positive diagnosis. In an era of increasing antimicrobial resistance, the accurate diagnosis of CAP and determining the causative pathogen are ever more important. Getting these both right is key in reducing both morbidity and mortality from CAP, and appropriate antimicrobial stewardship which is now an international healthcare priority.

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Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital

Cited by 7 publications

References 40 publications

Bacterial Pneumonia in Older Adults

Bacterial Pneumonia in Older Adults

The association of prior hospitalization with clinical outcomes among patients admitted with pneumonia: a propensity score matching study

The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults

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