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Risk factors for multidrug-resistant pathogens in bronchiectasis exacerbations.

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Non-cystic fibrosis bronchiectasis patients with prior hospitalization, chronic renal disease, or previous multidrug-resistant pathogen isolation face higher risks of resistant infections during exacerbations. Identifying these risk factors aids targeted antibiotic selection.

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Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Non-cystic fibrosis bronchiectasis is a chronic lung disease characterized by recurrent infectious exacerbations.
  • Frequent antibiotic use in these patients increases susceptibility to antibiotic-resistant pathogens.

Purpose of the Study:

  • To identify risk factors associated with the isolation of multidrug-resistant (MDR) pathogens during bronchiectasis exacerbations.

Main Methods:

  • A prospective observational study was conducted in two tertiary-care hospitals.
  • Patients were enrolled at their first exacerbation, and multidrug-resistance was classified using European Centre for Diseases Prevention and Control criteria.

Main Results:

  • Of 233 exacerbations, microorganisms were isolated in 159. MDR pathogens were identified in 20.1% of episodes.
  • Key MDR pathogens included Pseudomonas aeruginosa (48.5%) and methicillin-resistant Staphylococcus aureus (18.2%).
  • Independent risk factors for MDR pathogens were chronic renal disease (OR 7.60), prior year hospitalization (OR 3.88), and previous MDR isolation (OR 5.58).

Conclusions:

  • Hospitalization in the previous year, chronic renal disease, and prior MDR isolation are significant risk factors for MDR pathogen identification in bronchiectasis exacerbations.
  • This knowledge can guide clinicians in selecting empirical antibiotic therapy.
  • The proportion of MDR pathogens increased significantly with the number of risk factors present (53.6% with ≥2 factors).