Resistant Pathogens in Nonnosocomial Pneumonia and Respiratory Failure
| Autor: | Matthew P. Schreiber, Andrew F. Shorr, Chee M. Chan |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty ARDS business.industry Respiratory disease Retrospective cohort study Odds ratio Drug resistance Critical Care and Intensive Care Medicine medicine.disease Pneumonia Respiratory failure Internal medicine Cohort medicine Cardiology and Cardiovascular Medicine business Intensive care medicine |
| Zdroj: | Chest. 137:1283-1288 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.09-2434 |
| Popis: | Background The concept of health-care-associated pneumonia (HCAP) exists to identify patients infected with highly resistant pathogens. It is unclear how precise this concept is and how well it performs as a screening tool for resistance. Methods We retrospectively identified patients presenting to the hospital with pneumonia complicated by respiratory failure. We examined the microbiology of these infections based on pneumonia type and determined the sensitivity and specificity of HCAP as a screen for resistance. Through logistic regression and modeling, we created a scoring tool for determining who may be infected with resistant pathogens. Results The cohort included 190 subjects (37% with ARDS) and we noted resistant pathogens in 33%. Resistance was more common in HCAP (78% vs 44%, P = .001). HCAP alone performed poorly as a screening test (sensitivity and specificity 78.3% and 56.2%, respectively). Variables independently associated with a resistant organism included immunosuppression (adjusted odds ratio [AOR] 4.85, P Conclusions HCAP is common in patients presenting to the hospital with pneumonia leading to respiratory failure. The HCAP concept does not correlate well with the presence of infection due to a resistant pathogen. A simpler clinical decision rule based on select HCAP criteria performs as well as the HCAP concept for potentially guiding antibiotic decision making. |
| Databáze: | OpenAIRE |
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