Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug-Resistant Pseudomonas aeruginosa

• Published in: Chest Vol. 150; no. 2; p. 415
• Main Authors: Cillóniz, Catia, Gabarrús, Albert, Ferrer, Miquel, Puig de la Bellacasa, Jorge, Rinaudo, Mariano, Mensa, Josep, Niederman, Michael S, Torres, Antoni
• Format: Journal Article
• Language: English
• Published: United States 01.08.2016
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; C-Reactive Protein - metabolism; Chronic Disease; Cohort Studies; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-Acquired Infections - mortality; Drug Resistance, Multiple, Bacterial - physiology; Female; Humans; Liver Diseases - epidemiology; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Nervous System Diseases - epidemiology; Nursing Homes; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - epidemiology; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - mortality; Prevalence; Prospective Studies; Pseudomonas aeruginosa - physiology; Pseudomonas Infections - drug therapy; Pseudomonas Infections - epidemiology; Pseudomonas Infections - microbiology; Pseudomonas Infections - mortality; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Tract Diseases - epidemiology; Risk Factors; Severity of Illness Index; Sex Factors; Pseudomonas aeruginosa; pneumonia; community-acquired pneumonia; multidrug-resistant
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2016.03.042

Pseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa. Prospective observational study of 2,023 consecutive adult patients with CAP with definitive etiology. P aeruginosa was found in 77 (4%) of the 2,023 cases with microbial etiology. In 22 (32%) of the 68 cases of P aeruginosa with antibiogram data, the isolates were MDR. Inappropriate therapy was present in 49 (64%) cases of P aeruginosa CAP, including 17/22 (77%) cases of MDR P aeruginosa CAP. Male sex, chronic respiratory disease, C-reactive protein <12.35 mg/dL, and pneumonia severity index risk class IV to V were independently associated with P aeruginosa CAP. Prior antibiotic treatment was more frequent in MDR P aeruginosa CAP compared with non-MDR P aeruginosa (58% vs 29%, P = .029), and was the only risk factor associated with CAP resulting from MDR P aeruginosa. In the multivariate analysis, age ≥65 years, CAP resulting from P aeruginosa, chronic liver disease, neurologic disease, nursing home, criteria of ARDS, acute renal failure, ICU admission, and inappropriate empiric treatment were the factors associated with 30-day mortality. P aeruginosa is an individual risk factor associated with mortality in CAP. The risk factors described can help clinicians to suspect P aeruginosa and MDR P aeruginosa.