Scott T Micek1, Marin H Kollef2, Antoni Torres3, Catherine Chen2, Jordi Rello4, Jean Chastre5, Massimo Antonelli6, Tobias Welte7, Bernard Clair8, Helmut Ostermann9, Esther Calbo10, Richard Wunderink11, Francesco Menichetti12, Garrett Schramm13, Vandana Menon14. 1. 1St. Louis College of Pharmacy,St. Louis,Missouri. 2. 2Washington University School of Medicine,St. Louis,Missouri. 3. 3Department 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. 4. 4Hospital Vall D'Hebron,Barcelona,Spain. 5. 5Groupe Hospitalier Pitie-Salpetriere,Paris,France. 6. 6Policlinico Universitario A. Gemelli,Rome,Italy. 7. 7Medizinische Hochschule Hannover,Hannover,Germany. 8. 8Hôpital Raymond Poincaré,Garches,France. 9. 9University Hospital of Munich,Munich,Germany. 10. 10Hospital Universitari Mutua de Terrassa,Barcelona,Spain. 11. 11Northwestern University Feinberg School of Medicine,Chicago,Illinois. 12. 12Azienda Ospedaliera Universitaria Pisana,Pisa,Italy. 13. 13Mayo Clinic,Rochester,Minnesota. 14. 14Cubist Pharmaceuticals,Lexington,Massachusetts.
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.
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.
Authors: Ghady Haidar; Nathan J Philips; Ryan K Shields; Daniel Snyder; Shaoji Cheng; Brian A Potoski; Yohei Doi; Binghua Hao; Ellen G Press; Vaughn S Cooper; Cornelius J Clancy; M Hong Nguyen Journal: Clin Infect Dis Date: 2017-07-01 Impact factor: 9.079
Authors: Cristina Vazquez Guillamet; Rodrigo Vazquez; Jonas Noe; Scott T Micek; Marin H Kollef Journal: Medicine (Baltimore) Date: 2016-08 Impact factor: 1.889
Authors: Gennaro De Pascale; Otavio T Ranzani; Saad Nseir; Jean Chastre; Tobias Welte; Massimo Antonelli; Paolo Navalesi; Eugenio Garofalo; Andrea Bruni; Luis Miguel Coelho; Szymon Skoczynski; Federico Longhini; Fabio Silvio Taccone; David Grimaldi; Helmut J F Salzer; Christoph Lange; Filipe Froes; Antoni Artigas; Emili Díaz; Jordi Vallés; Alejandro Rodríguez; Mauro Panigada; Vittoria Comellini; Luca Fasano; Paolo M Soave; Giorgia Spinazzola; Charles-Edouard Luyt; Francisco Alvarez-Lerma; Judith Marin; Joan Ramon Masclans; Davide Chiumello; Angelo Pezzi; Marcus Schultz; Hafiz Mohamed; Menno Van Der Eerden; Roger A S Hoek; D A M P J Gommers; Marta Di Pasquale; Rok Civljak; Marko Kutleša; Matteo Bassetti; George Dimopoulos; Stefano Nava; Fernando Rios; Fernando G Zampieri; Pedro Povoa; Lieuwe D Bos; Stefano Aliberti; Antoni Torres; Ignacio Martín-Loeches Journal: ERJ Open Res Date: 2017-11-17