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Risk factors for community-onset pneumonia caused by drug-resistant pathogens: A prospective cohort study
J Vasco Barreto1, Cláudia Camila Dias2, Teresa Cardoso3
1Internal Medicine Service, Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal; ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
Introduction:
There is no consensual definition of risk factors for drug resistant pathogens (DRP) in community-onset pneumonia (COP). Healthcare-associated pneumonia criteria have been abandoned because they were found to have weak discriminative power. Our aim was to identify risk factors for DRP in COP.
Methods:
Prospective cohort study, conducted over a two years' period, in a community-based hospital, including all adult patients with COP criteria. Univariate and multivariate logistic regression modeling were performed to understand the association of risk factors (demographic, clinical and epidemiological) with COP by a DRP (PES: Pseudomonas aeruginosa, extended-spectrum ß-lactamase producing Enterobacteriaceae, Methicillin-resistant Staphylococcus aureus; and other non-fermenting gram-negative bacteria, namely Acinetobacter baumannii).
Results:
A total of 660 cases of COP were included, with a mean (±SD) age of 74±15 years and 58.9% of males. Microbiological documentation was possible in 32.6% of the cases. There were 197 cases selected for further analysis, of which 37 were cases of PES. The multivariate logistic regression model retained antibiotic use in the previous 90 days (adjusted OR=4.411, 95%CI [1.745-11.148]) and being bed-ridden (adjusted OR=5.492, 95%CI [2.121-14.222]), adjusted for Charlson's Index, CURB 65 and provenience from a long-term care facility. The area under the ROC curve for this model was 0.832, 95%CI [0.756-0.908], higher than the application of the HCAP criteria (AUROC = 0.676, 95%CI [0.582-0.770]).
Conclusion:
In this study, antibiotic use in the previous 90 days and being bed-ridden were independently associated with COP caused by DRP, after adjustment for Charlson's Index, CURB 65 and provenience from a long-term care facility.
Insights
Recent antibiotic use and being bed-ridden are key risk factors for drug-resistant pathogens in community-onset pneumonia. Identifying these factors improves diagnosis and management of resistant infections.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Lack of a standardized definition for risk factors of drug-resistant pathogens (DRP) in community-onset pneumonia (COP).
- Outdated healthcare-associated pneumonia (HCAP) criteria show limited effectiveness in identifying DRP.
- Need for precise risk factor identification for DRP in COP.
Purpose of the Study:
- To identify independent risk factors for drug-resistant pathogens (DRP) in community-onset pneumonia (COP).
- To develop a more accurate model for predicting DRP in COP compared to existing criteria.
Main Methods:
- Prospective cohort study over two years in a community hospital.
- Inclusion of adult patients meeting COP criteria.
- Multivariate logistic regression analysis to identify risk factors associated with DRP (Pseudomonas aeruginosa, extended-spectrum ß-lactamase producing Enterobacteriaceae, Methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii).
Main Results:
- 660 COP cases analyzed; 37 cases involved DRP.
- Antibiotic use within 90 days (adjusted OR=4.411) and being bed-ridden (adjusted OR=5.492) were significant risk factors.
- The developed model demonstrated superior predictive power (AUROC=0.832) compared to HCAP criteria (AUROC=0.676).
Conclusions:
- Antibiotic use in the prior 90 days is a significant risk factor for DRP in COP.
- Being bed-ridden is independently associated with DRP in community-onset pneumonia.
- These findings aid in better risk stratification and management of DRP in COP.
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