Highlights
- •-Some community-onset pneumonias are caused by drug resistant pathogens.
- •-There is no consensual rule to identify patients who need wider spectrum antibiotics.
- •-In a prospective cohort study, we aim to identify risk factors for resistant agents.
- •-Previous antibiotic use and being bed-ridden were independent risk factors.
- •-Our multivariable model has a discriminative power of 0.832, 95%CI [0.756–0.908].
Abstract
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.
Keywords
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Article info
Publication history
Published online: October 18, 2021
Accepted:
October 7,
2021
Received in revised form:
September 30,
2021
Received:
August 5,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
