Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

GLIMP investigators, D. Villafuerte, S. Aliberti, N.J. Soni, P. Faverio, P.J. Marcos, R.G. Wunderink, A. Rodriguez, O. Sibila, F. Sanz, I. Martin-Loeches, F. Menzella, L.F. Reyes, M. Jankovic, M. Spielmanns, M.I. Restrepo

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objective: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.

Original languageEnglish
Pages (from-to)543-551
Number of pages9
JournalRespirology
Volume25
Issue number5
DOIs
Publication statusPublished - 2020

Keywords

  • community-acquired pneumonia
  • Enterobacteriaceae
  • multidrug-resistance
  • prevalence
  • risk factors
  • adult
  • aged
  • antibiotic resistance
  • Article
  • bacterium culture
  • bacterium identification
  • body mass
  • cardiovascular disease
  • cohort analysis
  • community acquired pneumonia
  • controlled study
  • disease severity
  • Enterobacteriaceae infection
  • Escherichia coli
  • extended spectrum beta lactamase producing Enterobacteriaceae
  • female
  • geographic distribution
  • hospital patient
  • hospitalization
  • human
  • Klebsiella pneumoniae
  • major clinical study
  • male
  • multidrug resistant Enterobacteriaceae
  • nonhuman
  • priority journal
  • risk assessment
  • risk factor
  • sex difference
  • underweight

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