Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia

Stefano Aliberti, Marta Di Pasquale, Anna Maria Zanaboni, Roberto Cosentini, Anna Maria Brambilla, Sonia Seghezzi, Paolo Tarsia, Marco Mantero, Francesco Blasi

Research output: Contribution to journalArticle

Abstract

(See the Editorial Commentary by Kollef, on pages 479-82.)Background. Not all risk factors for acquiring multidrug-resistant (MDR) organisms are equivalent in predicting pneumonia caused by resistant pathogens in the community. We evaluated risk factors for acquiring MDR bacteria in patients coming from the community who were hospitalized with pneumonia. Our evaluation was based on actual infection with a resistant pathogen and clinical outcome during hospitalization. Methods. An observational, prospective study was conducted on consecutive patients coming from the community who were hospitalized with pneumonia. Data on admission and during hospitalization were collected. Logistic regression models were used to evaluate risk factors for acquiring MDR bacteria independently associated with the actual presence of a resistant pathogen and in-hospital mortality.Results.Among the 935 patients enrolled in the study, 473 (51%) had at least 1 risk factor for acquiring MDR bacteria on admission. Of all risk factors, hospitalization in the preceding 90 days (odds ratio [OR], 4.87 95% confidence interval {CI}, 1.90-12.4]; P =. 001) and residency in a nursing home (OR, 3.55 [95% CI, 1.12-11.24]; P =. 031) were independent predictors for an actual infection with a resistant pathogen. A score able to predict pneumonia caused by a resistant pathogen was computed, including comorbidities and risk factors for MDR. Hospitalization in the preceding 90 days and residency in a nursing home were also independent predictors for in-hospital mortality. Conclusions. Risk factors for acquiring MDR bacteria should be weighted differently, and a probabilistic approach to identifying resistant pathogens among patients coming from the community with pneumonia should be embraced.

Original languageEnglish
Pages (from-to)470-478
Number of pages9
JournalClinical Infectious Diseases
Volume54
Issue number4
DOIs
Publication statusPublished - Feb 15 2012

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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