An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance.

Autor: Micek ST; St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110-1088, USA. scott.micek@stlcop.edu., Wunderink RG; Northwestern University Feinberg School of Medicine, McGaw Pavilion Suite M-300, 240 E Huron, Chicago, IL, 60611, USA. r-wunderink@northwestern.edu., Kollef MH; Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. mkollef@dom.wustl.edu., Chen C; Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. cxchen@dom.wustl.edu., Rello J; Vall d'Hebron University Hospital, Passeig Vall d'Hebron, 119, Barcelona, 08035, Spain. jrello@crips.es., Chastre J; Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. jean.chastre@psl.aphp.fr., Antonelli M; Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, Rome, 00168, Italy. m.antonelli@rm.unicatt.it., Welte T; Medizinische Hochschule, Carl-Neuberg-Str. 1, Hannover, 30625, Germany. welte.tobias@mh-hannover.de., Clair B; Hôpital Raymond Poincaré, 104 boulevard Raymond Poincaré, Garches, 92380, France. Bernard.clair@rpc.ap-hop-paris.fr., Ostermann H; Department of Hematology, University Hospital Grosshadern, Marchioninistr 15, Munich, D-81377, Germany. helmut.ostermann@med.uni-muenchen.de., Calbo E; Hospital Universitari MútuaTerrassa, Plaça Dr. Robert, 5, Terrassa, 08221, Spain. ecalbo@mutuaterrassa.es., Torres A; Pneumology Department, Clinic Institute of Thorax, Villarroel 170, Barcelona, 08036, Spain. ATORRES@clinic.ub.es., Menichetti F; Malattie Infettive, Az. Ospedaliera Universitaria Pisana, Via Paradisa 2 - Cisanello, Pisa, 56100, Italy. menichettifrancesco@gmail.com., Schramm GE; Pharmacy Services, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. schramm.garrett@mayo.edu., Menon V; Cubist Pharmaceuticals, Inc., 65 Hayden Avenue, Lexington, MA, 02421, USA. Vandana.Menon@cubist.com.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2015 May 06; Vol. 19, pp. 219. Date of Electronic Publication: 2015 May 06.
DOI: 10.1186/s13054-015-0926-5
Abstrakt: Introduction: Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality.
Methods: We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death. Twelve hospitals in 5 countries (United States, n = 3; France, n = 2; Germany, n = 2; Italy, n = 2; and Spain, n = 3) participated. We compared characteristics of patients who had MDR strains to those who did not and derived regression models to identify predictors of MDR and hospital mortality.
Results: Of 740 patients with Pa-NP, 226 patients (30.5%) were infected with MDR strains. In multivariable analyses, independent predictors of multidrug-resistance included decreasing age (adjusted odds ratio [AOR] 0.91, 95% confidence interval [CI] 0.96-0.98), diabetes mellitus (AOR 1.90, 95% CI 1.21-3.00) and ICU admission (AOR 1.73, 95% CI 1.06-2.81). Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis.
Conclusions: Among patients with Pa-NP the presence of infection with a MDR strain is associated with increased in-hospital mortality. Identification of patients at risk of MDR Pa-NP could facilitate appropriate empiric antibiotic decisions that in turn could lead to improved hospital survival.
Databáze: MEDLINE
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