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

Research output: Contribution to journalArticle

76 Citations (Scopus)

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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Multiple Drug Resistance
Pseudomonas aeruginosa
Multicenter Studies
Pneumonia
Retrospective Studies
Hospital Mortality
Odds Ratio
Confidence Intervals
Bacteremia
Artificial Respiration
Proportional Hazards Models
Spain
Italy
France
Germany
Diabetes Mellitus
Hospitalization
Cohort Studies
Heart Failure
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia : Impact of multidrug resistance. / Micek, Scott T.; Wunderink, Richard G.; Kollef, Marin H.; Chen, Catherine; Rello, Jordi; Chastre, Jean; Antonelli, Massimo; Welte, Tobias; Clair, Bernard; Ostermann, Helmut; Calbo, Esther; Torres, Antoni; Menichetti, Francesco; Schramm, Garrett E.; Menon, Vandana.

In: Critical Care, Vol. 19, No. 1, 219, 06.05.2015.

Research output: Contribution to journalArticle

Micek, ST, Wunderink, RG, Kollef, MH, Chen, C, Rello, J, Chastre, J, Antonelli, M, Welte, T, Clair, B, Ostermann, H, Calbo, E, Torres, A, Menichetti, F, Schramm, GE & Menon, V 2015, 'An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: Impact of multidrug resistance', Critical Care, vol. 19, no. 1, 219. https://doi.org/10.1186/s13054-015-0926-5
Micek, Scott T. ; Wunderink, Richard G. ; Kollef, Marin H. ; Chen, Catherine ; Rello, Jordi ; Chastre, Jean ; Antonelli, Massimo ; Welte, Tobias ; Clair, Bernard ; Ostermann, Helmut ; Calbo, Esther ; Torres, Antoni ; Menichetti, Francesco ; Schramm, Garrett E. ; Menon, Vandana. / An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia : Impact of multidrug resistance. In: Critical Care. 2015 ; Vol. 19, No. 1.
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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.",
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AU - Micek, Scott T.

AU - Wunderink, Richard G.

AU - Kollef, Marin H.

AU - Chen, Catherine

AU - Rello, Jordi

AU - Chastre, Jean

AU - Antonelli, Massimo

AU - Welte, Tobias

AU - Clair, Bernard

AU - Ostermann, Helmut

AU - Calbo, Esther

AU - Torres, Antoni

AU - Menichetti, Francesco

AU - Schramm, Garrett E.

AU - Menon, Vandana

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N2 - 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.

AB - 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.

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