Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia
Respirology 2016 Jan 21:157
Mark L. Metersky1,*, Christopher R. Frei2,3 andEric M. Mortensen4
1The Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
2Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, USA
3Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center School of Medicine, San Antonio, USA
4VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
*Correspondence: Mark L. Metersky, Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1321, USA. Email: firstname.lastname@example.org
Conflict of Interest Statement: CRF has received research grants to his institution for investigator-initiated cancer and infectious diseases research from Bristol Myers Squibb, Forest, Ortho-McNeil Janssen and Pfizer in the past three years.
Background and objective
Patients with healthcare-associated pneumonia (HCAP) are at high risk of infection with multidrug-resistant (MDR) pathogens. Factors discriminating infection with MDR Gram-negative (MDR-GN) organism from infection with methicillin-resistant Staphylococcus aureus (MRSA) are not well understood and patients are often treated for both organisms. This study was performed to determine risk factors predicting pneumonia due to Pseudomonas versus MRSA.
Veterans age ≥65 hospitalized with HCAP between 2002 and 2012 were identified from the Veterans Affairs administrative databases. Patients were identified with Pseudomonas pneumonia, MRSA pneumonia or neither according to the International Classification of Diseases, 9th Revision, Clinical Modification codes. We assessed unadjusted and adjusted associations of patient characteristics and HCAP due to Pseudomonas or MRSA.
Of the 61651 patients with HCAP, 1156 (1.9%) were diagnosed with Pseudomonas pneumonia, 641 (1.0%) with MRSA pneumonia and 59 854 (97.1%) with neither. MRSA pneumonia was positively associated with male gender, age >74, diabetes, chronic obstructive pulmonary disease (COPD), recent nursing home or hospital stay, recent exposure to fluoroquinolone or antibiotics treating Gram-positive organisms, and severe pneumonia. MRSA pneumonia was negatively associated with complicated diabetes. Pseudomonas pneumonia was positively associated with recent hospital stay, immunocompromise, COPD, hemiplegia, recent exposure to inhaled corticosteroids, β-lactam/cephalosporin/carbapenem antibiotics, antibiotics against Gram-positive organisms, ‘other antibiotics’ and severe pneumonia. Pseudomonas pneumonia was negatively associated with age >84, higher socioeconomic status, drug abuse and diabetes.
Patient characteristics may assist in identifying patients at risk for HCAP due to Pseudomonas or MRSA.
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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones respiratorias, Metodos diagnosticos, Resistencia bacteriana, Update.