David Villafuerte1,2, Stefano Aliberti3,4, Nilam J Soni1,2, Paola Faverio5, Pedro J Marcos6, Richard G Wunderink7, Alejandro Rodriguez8, Oriol Sibila9, Francisco Sanz10, Ignacio Martin-Loeches11, Francesco Menzella12, Luis F Reyes13, Mateja Jankovic14, Marc Spielmanns15, Marcos I Restrepo1,2. 1. Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health - San Antonio, San Antonio, TX, USA. 2. Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA. 3. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy. 4. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 5. Cardio-Thoracic-Vascular Department, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy. 6. Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), A Coruña, Spain. 7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 8. Hospital Universitari Joan XXIII, Critical Care Medicine, Rovira and Virgili University and CIBERes (Biomedical Research Network of Respiratory Disease), Tarragona, Spain. 9. Servei de Pneumologia, Departamento de Medicina, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 10. Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain. 11. St. James's Hospital, Trinity Centre for Health Sciences, CIBERES, Dublin, Ireland. 12. Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 13. Department of Microbiology, Universidad de la Sabana, Bogota, Colombia. 14. School of Medicine, Clinic for Respiratory Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia. 15. Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of Medicine, University Witten-Herdecke, St. Remigius-Hospital, Leverkusen, Germany.
Abstract
BACKGROUND AND OBJECTIVE: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. METHODS: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. RESULTS: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. CONCLUSION: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
BACKGROUND AND OBJECTIVE: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. METHODS: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. RESULTS: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. CONCLUSION: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Julio A Ramirez; Daniel M Musher; Scott E Evans; Charles Dela Cruz; Kristina A Crothers; Chadi A Hage; Stefano Aliberti; Antonio Anzueto; Francisco Arancibia; Forest Arnold; Elie Azoulay; Francesco Blasi; Jose Bordon; Steven Burdette; Bin Cao; Rodrigo Cavallazzi; James Chalmers; Patrick Charles; Jean Chastre; Yann-Erick Claessens; Nathan Dean; Xavier Duval; Muriel Fartoukh; Charles Feldman; Thomas File; Filipe Froes; Stephen Furmanek; Martin Gnoni; Gustavo Lopardo; Carlos Luna; Takaya Maruyama; Rosario Menendez; Mark Metersky; Donna Mildvan; Eric Mortensen; Michael S Niederman; Mathias Pletz; Jordi Rello; Marcos I Restrepo; Yuichiro Shindo; Antoni Torres; Grant Waterer; Brandon Webb; Tobias Welte; Martin Witzenrath; Richard Wunderink Journal: Chest Date: 2020-06-16 Impact factor: 9.410
Authors: Mathias W Pletz; Francesco Blasi; James D Chalmers; Charles S Dela Cruz; Charles Feldman; Carlos M Luna; Julio A Ramirez; Yuichiro Shindo; Daiana Stolz; Antoni Torres; Brandon Webb; Tobias Welte; Richard Wunderink; Stefano Aliberti Journal: Chest Date: 2020-08-25 Impact factor: 9.410