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- Title
A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy.
- Authors
Maruyama, Takaya; Fujisawa, Takao; Ishida, Tadashi; Ito, Akihiro; Oyamada, Yoshitaka; Fujimoto, Kazuyuki; Yoshida, Masamichi; Maeda, Hikaru; Miyashita, Naoyuki; Nagai, Hideaki; Imamura, Yoshifumi; Shime, Nobuaki; Suzuki, Shoji; Amishima, Masaru; Higa, Futoshi; Kobayashi, Hiroyasu; Suga, Shigeru; Tsutsui, Kiyoyuki; Kohno, Shigeru; Brito, Veronica
- Abstract
Background Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition. Methods We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP). Results Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0–1 MDR risk (25.8% vs 5.3%, P <.001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0–1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P <.001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit <30%, malnutrition, dehydration, and chronic liver disease), as well as hypotension and inappropriate therapy were significantly correlated with 30-day mortality, whereas the classification of pneumonia type (VAP, HAP, HCAP, CAP) was not. Conclusions Individual MDR risk factors can be used in a unified algorithm to guide and simplify empiric therapy for all pneumonia patients, and were more important than the classification of site of pneumonia acquisition in determining 30-day mortality. Clinical Trials Registration JMA-IIA00146.
- Subjects
LIVER failure -- Risk factors; MALNUTRITION risk factors; DEHYDRATION -- Risk factors; PNEUMONIA-related mortality; AGE distribution; ALGORITHMS; HEMATOCRIT; HYPOTENSION; LONGITUDINAL method; MEDICAL cooperation; MULTIDRUG resistance; MULTIVARIATE analysis; NOSOCOMIAL infections; PNEUMONIA; RESEARCH; RISK assessment; LOGISTIC regression analysis; COMMUNITY-acquired pneumonia; VENTILATOR-associated pneumonia
- Publication
Clinical Infectious Diseases, 2019, Vol 68, Issue 7, p1080
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy631