Risk factors for drug-resistant pathogens in immunocompetent patients with pneumonia: Evaluation of PES pathogens

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2017-01, Vol.23 (1), p.23-28
• Main Authors: Ishida, Tadashi, Ito, Akihiro, Washio, Yasuyoshi, Yamazaki, Akio, Noyama, Maki, Tokioka, Fumiaki, Arita, Machiko
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; beta-Lactamases - metabolism; Community-Acquired Infections - etiology; Community-Acquired Infections - microbiology; Cross Infection - drug therapy; Cross Infection - etiology; Cross Infection - microbiology; Drug Resistance, Bacterial - drug effects; Drug-resistant pathogen; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Female; Hematology, Oncology and Palliative Medicine; Hospitalization; Humans; Immunocompetent patients; Immunocompromised Host - drug effects; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Pneumonia; Pneumonia - drug therapy; Pneumonia - etiology; Pneumonia - microbiology; Prospective Studies; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - isolation & purification; Retrospective Studies; Risk Factors
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2016.09.002

Abstract Rationale The new acronym, PES pathogens ( Pseudomonas aeruginosa , Enterobacteriaceae extended-spectrum beta-lactamase-positive, and methicillin-resistant Staphylococcus aureus ), was recently proposed to identify drug-resistant pathogens associated with community-acquired pneumonia. Objectives To evaluate the risk factors for antimicrobial-resistant pathogens in immunocompetent patients with pneumonia and to validate the role of PES pathogens. Methods A retrospective analysis of a prospective observational study of immunocompetent patients with pneumonia between March 2009 and June 2015 was conducted. We clarified the risk factors for PES pathogens. Results Of the total 1559 patients, an etiological diagnosis was made in 705 (45.2%) patients. PES pathogens were identified in 51 (7.2%) patients, with 53 PES pathogens ( P. aeruginosa, 34; ESBL-positive Enterobacteriaceae , 6; and MRSA, 13). Patients with PES pathogens had tendencies toward initial treatment failure, readmission within 30 days, and a prolonged hospital stay. Using multivariate analysis, female sex (adjusted odds ratio [AOR] 1.998, 95% confidence interval [CI] 1.047–3.810), admission within 90 days (AOR 2.827, 95% CI 1.250–6.397), poor performance status (AOR 2.380, 95% CI 1.047–5.413), and enteral feeding (AOR 5.808, 95% CI 1.813–18.613) were independent risk factors for infection with PES pathogens. The area under the receiver operating characteristics curve for the risk factors was 0.66 (95% CI 0.577–0.744). Conclusions We believe the definition of PES pathogens is an appropriate description of drug-resistant pathogens associated with pneumonia in immunocompetent patients. The frequency of PES pathogens is quite low. However, recognition is critical because they can cause refractory pneumonia and different antimicrobial treatment is required.