1. Pseudomonas aeruginosa nosocomial pneumonia: impact of pneumonia classification.
- Author
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Micek ST, Kollef MH, Torres A, Chen C, Rello J, Chastre J, Antonelli M, Welte T, Clair B, Ostermann H, Calbo E, Wunderink R, Menichetti F, Schramm G, and Menon V
- Subjects
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Community-Acquired Infections drug therapy, Community-Acquired Infections etiology, Community-Acquired Infections mortality, Cross Infection drug therapy, Cross Infection etiology, Europe, Female, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Pneumonia, Ventilator-Associated drug therapy, Pneumonia, Ventilator-Associated etiology, Pseudomonas Infections drug therapy, Pseudomonas Infections etiology, Retrospective Studies, Risk Factors, United States, Cross Infection mortality, Hospital Mortality, Pneumonia, Ventilator-Associated mortality, Pseudomonas Infections mortality, Pseudomonas aeruginosa
- Abstract
Objective: To describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP])., Design: We conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT)., Setting: Twelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3)., Patients/participants: A total of 742 patients with Pa-NP., Results: Hospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP., Conclusions: Among patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.
- Published
- 2015
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