[HTML][HTML] An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance

ST Micek, RG Wunderink, MH Kollef, C Chen, J Rello… - Critical Care, 2015 - Springer
ST Micek, RG Wunderink, MH Kollef, C Chen, J Rello, J Chastre, M Antonelli, T Welte…
Critical Care, 2015Springer
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 …
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.
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