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

Authors

Scott T. Micek, St. Louis College of Pharmacy
Richard G. Wunderink, Northwestern University Feinberg School of Medicine
Marin H. Kollef, Washington University School of Medicine in St. Louis
Catherine Chen, Washington University School of Medicine in St. Louis
Jordi Rello, Hospital Universitari Vall d'Hebron
Jean Chastre, Hôpital Universitaire Pitié Salpêtrière
Massimo Antonelli, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Tobias Welte, Hannover Medical School
Bernard Clair, Hopital Raymond Poincare
Helmut Ostermann, Klinikum der Universität München
Esther Calbo, Hospital Universitari Mútua Terrassa
Antoni Torres, Clinic Institute of Thorax
Francesco Menichetti, Azienda Ospedaliero Universitaria Pisana
Garrett E. Schramm, Mayo Clinic
Vandana Menon, Cubist Pharmaceuticals, Inc.

Document Type

Article

Publication Title

Critical Care

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.

DOI

10.1186/s13054-015-0926-5

Publication Date

5-6-2015

Recommended Citation

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.; and Menon, Vandana, "An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: Impact of multidrug resistance" (2015). Pharmacy Practice Faculty Publications. 70. https://doi.org/10.1186/s13054-015-0926-5
https://collections.uhsp.edu/pharm-practice_pubs/70