Details

Autor(en) / Beteiligte

• Maruyama, Takaya
• Fujisawa, Takao
• Okuno, Masataka
• Toyoshima, Hirokazu
• Tsutsui, Kiyoyuki
• Maeda, Hikaru
• Yuda, Hisamichi
• Yoshida, Masamichi
• Kobayashi, Hiroyasu
• Taguchi, Osamu
• Gabazza, Esteban C.
• Takei, Yoshiyuki
• Miyashita, Naoyuki
• Ihara, Toshiaki
• Brito, Veronica
• Niederman, Michael S.

Titel

A New Strategy for Healthcare-Associated Pneumonia: A 2-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-Resistant Pathogens to Select Initial Empiric Therapy

Ist Teil von

• Clinical infectious diseases, 2013-11, Vol.57 (10), p.1373-1383

Ort / Verlag

Oxford: OXFORD UNIVERSITY PRESS

Erscheinungsjahr

2013

Quelle

Electronic Journals Library

Beschreibungen/Notizen

• Background. Optimal empiric therapy for hospitalized patients with healthcare-associated pneumonia (HCAP) is uncertain. Methods. We prospectively applied a therapeutic algorithm, based on the presence of risk factors for multidrug-resistant (MDR) pathogens in a multicenter cohort study of 445 pneumonia patients, including both community-acquired pneumonia (CAP; n = 124) and HCAP (n = 321). Results. MDR pathogens were more common (15.3% vs 0.8%, P < .001) in HCAP patients than in CAP patients, including Staphylococcus aureus (11.5% vs 0.8%, P < .001); methicillin-resistant S. aureus (6.9% vs 0%, P = .003); Enterobacteriaceae (7.8% vs 2.4%, P = .037); and Pseudomonas aeruginosa (6.9% vs 0.8%, P = .01). Using the proposed algorithm, HCAP patients with ≥2 MDR risk factors, one of which was severity of illness (n = 170), vs HCAP patients with 0–1 risk factor (n = 151) had a significantly higher frequency of MDR pathogens (27.1% vs 2%, P < .001). In total, 93.1% of HCAP patients were treated according to the therapy algorithm, with only 53% receiving broad-spectrum empiric therapy, yet 92.9% received appropriate therapy for the identified pathogen. Thirty-day mortality was significantly higher for HCAP than for CAP (13.7% vs 5.6%, P = .017), but among HCAP patients with 0–1 MDR risk factor, mortality was lower than with ≥2 MDR risk factors (8.6% vs 18.2%, P = .012). In multivariate analysis, initial treatment failure, but not inappropriate empiric antibiotic therapy, was a mortality risk factor (odds ratio, 72.0). Conclusions. Basing empiric HCAP therapy on its severity and the presence of risk factors for MDR pathogens is a potentially useful approach that achieves good outcomes without excessive use of broad-spectrum antibiotic therapy. Clinical Trials Registration. Japan Medical Association Center for Clinical Trials, JMA-IIA00054.