Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia

Oriol Sibila, Elena Laserna, Diego Jose Maselli, Juan Felipe Fernandez, Eric M. Mortensen, Antonio Anzueto, Grant Waterer, Marcos I. Restrepo

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background and objective Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. Methods We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. Results Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95% CI: 0.21-0.76). Conclusions Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa. Risk factors recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Not administrating antibiotics active against P. aeruginosa in the first 48 h increases 30-day mortality.

Original languageEnglish (US)
Pages (from-to)660-666
Number of pages7
JournalRespirology
Volume20
Issue number4
DOIs
StatePublished - May 1 2015

Fingerprint

Pseudomonas aeruginosa
Pneumonia
Anti-Bacterial Agents
Therapeutics
Guidelines
Mortality
Confidence Intervals
Cerebrovascular Disorders
Immunosuppression
Dementia
Multivariate Analysis
Delivery of Health Care

Keywords

  • antibiotic treatment
  • community-acquired pneumonia
  • Pseudomonas aeruginosa
  • risk factor

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Sibila, O., Laserna, E., Maselli, D. J., Fernandez, J. F., Mortensen, E. M., Anzueto, A., ... Restrepo, M. I. (2015). Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. Respirology, 20(4), 660-666. https://doi.org/10.1111/resp.12506

Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. / Sibila, Oriol; Laserna, Elena; Maselli, Diego Jose; Fernandez, Juan Felipe; Mortensen, Eric M.; Anzueto, Antonio; Waterer, Grant; Restrepo, Marcos I.

In: Respirology, Vol. 20, No. 4, 01.05.2015, p. 660-666.

Research output: Contribution to journalArticle

Sibila, O, Laserna, E, Maselli, DJ, Fernandez, JF, Mortensen, EM, Anzueto, A, Waterer, G & Restrepo, MI 2015, 'Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia', Respirology, vol. 20, no. 4, pp. 660-666. https://doi.org/10.1111/resp.12506
Sibila O, Laserna E, Maselli DJ, Fernandez JF, Mortensen EM, Anzueto A et al. Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. Respirology. 2015 May 1;20(4):660-666. https://doi.org/10.1111/resp.12506
Sibila, Oriol ; Laserna, Elena ; Maselli, Diego Jose ; Fernandez, Juan Felipe ; Mortensen, Eric M. ; Anzueto, Antonio ; Waterer, Grant ; Restrepo, Marcos I. / Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. In: Respirology. 2015 ; Vol. 20, No. 4. pp. 660-666.
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abstract = "Background and objective Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. Methods We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. Results Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1{\%}). Of these, 402 patients (0.6{\%}) were included in the study and 379 (0.5{\%}) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8{\%}) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95{\%} confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95{\%} CI: 0.21-0.76). Conclusions Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa. Risk factors recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Not administrating antibiotics active against P. aeruginosa in the first 48 h increases 30-day mortality.",
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AU - Sibila, Oriol

AU - Laserna, Elena

AU - Maselli, Diego Jose

AU - Fernandez, Juan Felipe

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AU - Anzueto, Antonio

AU - Waterer, Grant

AU - Restrepo, Marcos I.

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N2 - Background and objective Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. Methods We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. Results Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95% CI: 0.21-0.76). Conclusions Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa. Risk factors recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Not administrating antibiotics active against P. aeruginosa in the first 48 h increases 30-day mortality.

AB - Background and objective Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. Methods We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. Results Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95% CI: 0.21-0.76). Conclusions Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa. Risk factors recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Not administrating antibiotics active against P. aeruginosa in the first 48 h increases 30-day mortality.

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