CHEST
Original Research: Chest InfectionsCommunity-Acquired Pneumonia Due to Multidrug- and Non–Multidrug-Resistant Pseudomonas aeruginosa
Section snippets
Study Design and Patients
We performed an observational cohort study of consecutive patients admitted to Hospital Clinic, Barcelona, Spain, between January 1999 and December 2014 with a diagnosis of CAP. The exclusion criteria were: (1) patients without a positive microbiologic diagnosis, (2) severe immunosuppression (AIDS, chemotherapy, immunosuppressive drugs [e.g., oral corticosteroid ≥10 mg prednisone or equivalent per day for at least 2 weeks]), (3) health-care–associated pneumonia cases, (4) active tuberculosis,
Patient Characteristics
A total of 5,384 consecutive patients with CAP were enrolled during the study period. The final study population consisted of 2,023 patients with an established microbial etiology (Fig 1). There were 1,253 (62%) males and the mean (SD) age was 65 (19) years. CAP was the result of P aeruginosa in 77 of 2,023 cases (4%). Sixty-eight of the 77 (88%) cases had susceptibility data; 22 (32%) were MDR P aeruginosa and 46 (68%) were non-MDR P aeruginosa. We did not find XDR or pandrug-resistant strains
Discussion
The main findings of this study are the following: (1) The prevalence of CAP resulting from P aeruginosa in this large series of consecutive patients with CAP was 4% of patients with a defined etiology, and 32% of these patients had MDR P aeruginosa. (2) We identified several risk factors associated with CAP resulting from P aeruginosa in general and for CAP resulting from MRD P aeruginosa. (3) CAP resulting from P aeruginosa was associated with a significantly higher rate of inappropriate
Conclusions
In summary, we found that, although not common, P aeruginosa was a cause of CAP and one that is often treated inappropriately (64% of patients). Some 32% of cases are MDR, and these patients need to be identified because we found that 77% received inappropriate empiric therapy. Compared with other forms of CAP, patients with P aeruginosa had severe disease more commonly (62% vs 28%). In this series, as in others, inappropriate empiric antibiotic therapy was a mortality risk for all patients
Acknowledgments
Author contributions: A. T. is the guarantor of the entire manuscript and is responsible for the content of the manuscript, including the data collected and its analysis. C. C. is the main author of the paper; she reviewed the study data, edited the main body of the manuscript, contributed to supervising the collection of clinical, radiological, and microbiological data, and approved the final manuscript. M. S. N. contributed to the design of the project, analysis and interpretation of the
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FUNDING/SUPPORT: The study was funded by Ciber de Enfermedades Respiratorias (CibeRes CB06/06/0028) and by 2009 Support to Research Groups of Catalonia 911.