An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: Impact of multidrug resistance

Scott T. Micek, Richard G. Wunderink, Marin H. Kollef, Catherine Chen, Jordi Rello, Jean Chastre, Massimo Antonelli, Tobias Welte, Bernard Clair, Helmut Ostermann, Esther Calbo, Antoni Torres, Francesco Menichetti, Garrett E. Schramm, Vandana Menon

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Abstract

Introduction: Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality. Methods: We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death. Twelve hospitals in 5 countries (United States, n = 3; France, n = 2; Germany, n = 2; Italy, n = 2; and Spain, n = 3) participated. We compared characteristics of patients who had MDR strains to those who did not and derived regression models to identify predictors of MDR and hospital mortality. Results: Of 740 patients with Pa-NP, 226 patients (30.5%) were infected with MDR strains. In multivariable analyses, independent predictors of multidrug-resistance included decreasing age (adjusted odds ratio [AOR] 0.91, 95% confidence interval [CI] 0.96-0.98), diabetes mellitus (AOR 1.90, 95% CI 1.21-3.00) and ICU admission (AOR 1.73, 95% CI 1.06-2.81). Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis. Conclusions: Among patients with Pa-NP the presence of infection with a MDR strain is associated with increased in-hospital mortality. Identification of patients at risk of MDR Pa-NP could facilitate appropriate empiric antibiotic decisions that in turn could lead to improved hospital survival.

Original languageEnglish (US)
Article number219
JournalCritical Care
Volume19
Issue number1
DOIs
StatePublished - May 6 2015

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ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Micek, S. T., Wunderink, R. G., Kollef, M. H., Chen, C., Rello, J., Chastre, J., Antonelli, M., Welte, T., Clair, B., Ostermann, H., Calbo, E., Torres, A., Menichetti, F., Schramm, G. E., & Menon, V. (2015). An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: Impact of multidrug resistance. Critical Care, 19(1), [219]. https://doi.org/10.1186/s13054-015-0926-5