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2016 ; 95
(35
): e4708
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A cohort study of bacteremic pneumonia: The importance of antibiotic resistance
and appropriate initial therapy?
#MMPMID27583907
Guillamet CV
; Vazquez R
; Noe J
; Micek ST
; Kollef MH
Medicine (Baltimore)
2016[Aug]; 95
(35
): e4708
PMID27583907
show ga
Bacteremic pneumonia is usually associated with greater mortality. However, risk
factors associated with hospital mortality in bacteremic pneumonia are
inadequately described.The study was a retrospective cohort study, conducted in
Barnes-Jewish Hospital (2008-2015). For purposes of this investigation,
antibiotic susceptibility was determined according to ceftriaxone susceptibility,
as ceftriaxone represents the antimicrobial agent most frequently recommended for
hospitalized patients with community-acquired pneumonia as opposed to nosocomial
pneumonia. Two multivariable analyses were planned: the first model included
resistance to ceftriaxone as a variable, whereas the second model included the
various antibiotic-resistant species (methicillin-resistant Staphylococcus
aureus, Pseudomonas aeruginosa, and Enterobacteriaceae).In all, 1031 consecutive
patients with bacteremic pneumonia (mortality 37.1%) were included. The most
common pathogens associated with infection were S aureus (34.1%; methicillin
resistance 54.0%), Enterobacteriaceae (28.0%), P aeruginosa (10.6%), anaerobic
bacteria (7.3%), and Streptococcus pneumoniae (5.6%). Compared with
ceftriaxone-susceptible pathogens (46.8%), ceftriaxone-resistant pathogens
(53.2%) were significantly more likely to receive inappropriate initial
antibiotic treatment (IIAT) (27.9% vs 7.1%; P?0.001) and to die during
hospitalization (41.5% vs 32.0%; P?=?0.001). The first logistic regression
analysis identified IIAT with the greatest odds ratio (OR) for mortality (OR 2.2,
95% confidence interval [CI] 1.5-3.2, P?0.001). Other independent predictors of
mortality included age, mechanical ventilation, immune suppression, prior
hospitalization, prior antibiotic administration, septic shock, comorbid
conditions, and severity of illness. In the second multivariable analysis that
included the antibiotic-resistant species, IIAT was still associated with excess
mortality, and P aeruginosa infection was identified as an independent predictor
of mortality (OR 1.6, 95% CI 1.1-2.2, P?=?0.047), whereas infection with
ceftriaxone-resistant Enterobacteriaceae (OR 0.6, 95% CI 0.4-1.0, P?=?0.050) was
associated with lower mortality.More than one-third of our patients hospitalized
with bacteremic pneumonia died. IIAT was identified as the most important risk
factor for hospital mortality and the only risk factor amenable to potential
intervention. Specific antibiotic-resistant pathogen species were also associated
with mortality.