Risk factors to predict drug-resistant pathogens in hemodialysis-associated pneumonia

• Published in: BMC infectious diseases Vol. 16; no. 1; p. 377
• Main Authors: Wang, Ping-huai, Wang, Hao-chien
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.08.2016; BioMed Central
• Subjects: Age Factors; Aged; Aged, 80 and over; Analysis; Anti-Bacterial Agents - therapeutic use; Bacterial pneumonia; Case-Control Studies; Citrobacter; Cross Infection - epidemiology; Drug Resistance, Bacterial; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Female; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Haemophilus Infections - drug therapy; Haemophilus Infections - epidemiology; Haemophilus Infections - microbiology; Haemophilus influenzae; Hemodialysis; Hospitalization; Humans; Infectious diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pathogenic microorganisms; Pneumonia; Pneumonia - drug therapy; Pneumonia - epidemiology; Pneumonia - microbiology; Pneumonia, Staphylococcal - drug therapy; Pneumonia, Staphylococcal - epidemiology; Pneumonia, Staphylococcal - microbiology; Pseudomonas aeruginosa; Pseudomonas Infections - drug therapy; Pseudomonas Infections - epidemiology; Pseudomonas Infections - microbiology; Renal Dialysis; Retrospective Studies; Risk Factors; Severity of Illness Index; Taiwan - epidemiology; Wounds and Injuries - epidemiology; Wounds and Injuries - therapy; Hemodialysis; Drug resistant pathogens; Pneumonia
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-016-1701-1

After the concept of healthcare associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA), pneumonia in hemodialysis patients has been classified as HCAP. Even though there are several risk factors and scoring systems of drug-resistant pathogens (DRPs) in HCAP, the risk factors for DRPs in hemodialysis-associated pneumonia are unclear. Patients who were admitted to our tertiary care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia. Patients were enrolled if they fulfilled the definition of HCAP according to the 2005 ATS/IDSA guidelines. A total of 530 subjects were diagnosed with HCAP, of whom 48 (9.1 %) received regular hemodialysis (HD group) and the other 482 did not (non-HD group). The most common pathogens in HD group were Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus (MRSA). There was a similar distribution of Gram-negative bacilli infections between the two groups except for Haemophilus influenzae and Citrobacter species. The incidence of DRPs was not significantly different between the two groups (HD vs. non-HD, 35.4 vs. 39.2 %, p = 0.607). Wound care, severe pneumonia and an age of more than 70 years were significant risk factors for DRPs. The area under the operating cure of predicting DRPs was 0.727 (0.575-0.879, p = 0.01). P. aeruginosa and MRSA were the most important pathogens in hemodialysis-associated pneumonia. Wound care, severe pneumonia and old age were significant risk factors for DRPs.