An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistanceReportar como inadecuado




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Critical Care

, 19:219

First Online: 06 May 2015Received: 26 January 2015Accepted: 15 April 2015

Abstract

IntroductionPseudomonas aeruginosa nosocomial pneumonia Pa-NP is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality.

MethodsWe 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.

ResultsOf 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.

ConclusionsAmong 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.

AbbreviationsAIATappropriate initial antibiotic therapy

AORadjusted odds ratio

BALbronchoalveolar lavage

BSIbloodstream infection

CDCCenters for Disease Control and Prevention

CLSIClinical Laboratory and Standards Institute

ECDCEuropean Center for Disease Prevention and Control

ESBLsextended spectrum β-lactamases

EUCASTEuropean Committee on Antimicrobial Susceptibility Testing

HRhazard ratio

IIATinappropriate initial antibiotic therapy

MALDI-TOFmatrix-assisted laser desorption-ionization time-of-flight

MDRmultidrug-resistant

NPnosocomial pneumonia

Pa-NPPseudomonas aeruginosa nosocomial pneumonia

XDRextensively drug-resistant

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Autor: Scott T Micek - Richard G Wunderink - Marin H Kollef - Catherine Chen - Jordi Rello - Jean Chastre - Massimo Antonelli -

Fuente: https://link.springer.com/



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