Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia.

Autor: Villafuerte D; Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health - San Antonio, San Antonio, TX, USA.; Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA., Aliberti S; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Soni NJ; Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health - San Antonio, San Antonio, TX, USA.; Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA., Faverio P; Cardio-Thoracic-Vascular Department, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy., Marcos PJ; 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., Wunderink RG; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA., Rodriguez A; Hospital Universitari Joan XXIII, Critical Care Medicine, Rovira and Virgili University and CIBERes (Biomedical Research Network of Respiratory Disease), Tarragona, Spain., Sibila O; Servei de Pneumologia, Departamento de Medicina, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Sanz F; Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain., Martin-Loeches I; St. James's Hospital, Trinity Centre for Health Sciences, CIBERES, Dublin, Ireland., Menzella F; Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy., Reyes LF; Department of Microbiology, Universidad de la Sabana, Bogota, Colombia., Jankovic M; School of Medicine, Clinic for Respiratory Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia., Spielmanns M; Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of Medicine, University Witten-Herdecke, St. Remigius-Hospital, Leverkusen, Germany., Restrepo MI; Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health - San Antonio, San Antonio, TX, USA.; Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.
Jazyk: angličtina
Zdroj: Respirology (Carlton, Vic.) [Respirology] 2020 May; Vol. 25 (5), pp. 543-551. Date of Electronic Publication: 2019 Aug 05.
DOI: 10.1111/resp.13663
Abstrakt: 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.)
Databáze: MEDLINE
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