Stratifying Risk Factors for Multidrug-Resistant Pathogens in Hospitalized Patients Coming From the Community With Pneumonia
Stratifying Risk Factors for Multidrug-Resistant Pathogens in Hospitalized Patients Coming From the Community With Pneumonia
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DOI：
10.1093/cid/cir840
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发表时间：
2012-02-15
影响因子：
11.8
通讯作者：
Blasi, Francesco
中科院分区：
文献类型：
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作者：
Aliberti, Stefano;Di Pasquale, Marta;Blasi, Francesco
背景并非所有获得多药耐药（MDR）微生物的风险因素在预测社区耐药病原体引起的肺炎方面都是等效的。我们评估了来自社区的肺炎住院患者获得MDR细菌的风险因素。我们的评估是基于住院期间耐药病原体的实际感染和临床结果。对来自社区的因肺炎住院的连续患者进行了一项观察性、前瞻性研究。收集入院和住院期间的数据。Logistic回归模型用于评估获得MDR细菌的危险因素，这些因素与耐药病原体的实际存在和住院死亡率独立相关。在入组研究的935例患者中，473例（51%）在入院时至少有1个获得MDR细菌的风险因素。在所有危险因素中，住院前90天（比值比[OR]，4.87 95%置信区间{CI}，1.90-12.4]; P = .001）和居住在疗养院（OR，3.55 [95%CI，1.12-11.24]; P = .031）是耐药病原体实际感染的独立预测因素。计算能够预测耐药病原体引起的肺炎的评分，包括合并症和MDR的风险因素。住院前90天内住院和在疗养院居住也是院内死亡率的独立预测因素。获得MDR细菌的风险因素应进行不同的加权，并应采用概率方法来识别来自肺炎社区的患者中的耐药病原体。
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.