Predictive Performance of Risk Factors for Multidrug-Resistant Pathogens in Nosocomial Pneumonia
Cristina Dominedò1,2, Adrian Ceccato3, Michael Niederman4
1Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Abstract:
Rationale: In 2017, the International European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Latin American Thoracic Society (European) guidelines defined new risk factors for multidrug-resistant (MDR) pathogens in patients with nosocomial pneumonia.Objectives: To assess the predictive performance of these newly defined risk factors for MDR pathogens.Methods: We enrolled 507 adult patients with nosocomial pneumonia who were treated in six intensive care units at the Hospital Clinic of Barcelona in Spain. Of the 503 patients at high MDR pathogen and mortality risk, 275 (54%) had no septic shock and 228 (46%) had septic shock.Results: Admission to hospital settings with high rates of MDR pathogens (n = 421; 83%) and prior antibiotic use (n = 399; 79%) showed the highest prevalence in the overall population, with sensitivities of 92% and 85% and negative predictive values of 85% and 82%, respectively. However, low specificities and low positive predictive values were found. Previous respiratory MDR pathogen isolation was less common (n = 17; 3%) but presented a specificity and positive predictive value of 100%. The area under the receiver operating characteristic curve was less than 0.6 for all risk factors and combinations.Conclusions: The risk factors proposed by the European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Latin American Thoracic Society showed low accuracy for predicting MDR pathogens in intensive care unit acquired pneumonia (ICU-AP). Admission to hospital settings with high rates of MDR pathogens and prior antibiotic use were the most prevalent risk factors, with a high sensitivity for predicting these microorganisms; prior positive cultures for MDR pathogens showed high specificity but very low sensitivity. Combinations of risk factors did not show any great accuracy for predicting these microorganisms. Further studies assessing combined strategies of risk stratification and complementary methods are now warranted.
Insights
New guidelines for predicting multidrug-resistant (MDR) pathogens in nosocomial pneumonia showed low accuracy. Hospital setting and prior antibiotic use were common but not precise predictors. Further research is needed for better risk stratification.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Microbiology
Background:
- The European guidelines established new risk factors for multidrug-resistant (MDR) pathogens in nosocomial pneumonia in 2017.
- Accurate prediction of MDR pathogens is crucial for effective treatment of hospital-acquired pneumonia.
Purpose of the Study:
- To evaluate the predictive performance of the newly defined European risk factors for MDR pathogens in intensive care unit-acquired pneumonia (ICU-AP).
Main Methods:
- A study involving 507 adult patients with nosocomial pneumonia in six intensive care units.
- Analysis of risk factors including hospital setting, prior antibiotic use, and previous MDR pathogen isolation.
- Assessment of predictive accuracy using sensitivity, specificity, positive predictive value, and area under the receiver operating characteristic curve.
Main Results:
- Admission to high MDR pathogen rate settings (83%) and prior antibiotic use (79%) were most prevalent, with high sensitivity but low specificity.
- Previous MDR pathogen isolation (3%) had 100% specificity and positive predictive value but very low sensitivity.
- All assessed risk factors and their combinations demonstrated an area under the receiver operating characteristic curve less than 0.6, indicating low accuracy.
Conclusions:
- The European guidelines' risk factors showed limited accuracy in predicting MDR pathogens in ICU-acquired pneumonia.
- While some factors are prevalent and sensitive, they lack specificity, and others have high specificity but low sensitivity.
- Combined strategies and complementary methods are necessary for improved risk stratification in ICU-acquired pneumonia.
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