Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia
Published 2019. This article is a U.S. Government work and is in the public domain in the USA Background and objective: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.
Villafuerte, D; Aliberti, S; Soni, NJ; Faverio, P; Marcos, PJ; Wunderink, RG; Rodriguez, A; Sibila, O; Sanz, F; Martin-Loeches, I; Menzella, F; Reyes, LF; Jankovic, M; Spielmanns, M; Restrepo, MI; Aruj, PK; Attorri, S; Barimboim, E; Caeiro, JP; Garzón, MI; Cambursano, VH; Ceccato, A; Chertcoff, J; Cordon Díaz, A; de Vedia, L; Ganaha, MC; Lambert, S; Lopardo, G; Luna, CM; Malberti, AG; Morcillo, N; Tartara, S; Pensotti, C; Pereyra, B; Scapellato, PG; Stagnaro, JP; Shah, S; Lötsch, F; Thalhammer, F; Anseeuw, K; Francois, CA; Van Braeckel, E; Vincent, JL; Djimon, MZ; Nouér, SA; Chipev, P; Encheva, M; Miteva, D; Petkova, D; Balkissou, AD; Yone, EWP; Ngahane, BHM; Shen, N; Xu, JF; Rico, CAB; Buitrago, R; Paternina, FJP; Ntumba, JMK; Carevic, VV; Jakopovic, M; Matkovic, Z; Mitrecic, I; Jacobsson, MLB; Christensen, AB; Heitmann Bødtger, UC; Meyer, CN; Jensen, AV; El-Said Abd El-Wahhab, I; Morsy, NE; Shafiek, H; Sobh, E; Abdulsemed, KA; Bertrand, F; Brun-Buisson, C; Montmollin, ED; Fartoukh, M; Messika, J; Tattevin, P; Khoury, A; Ebruke, B; Dreher, M; Kolditz, M; Meisinger, M; Pletz, MW; Hagel, S; Rupp, J; Schaberg, T; Creutz, P; Suttorp, N; Siaw-Lartey, B; Dimakou, K; Papapetrou, D; Tsigou, E; Ampazis, D; Kaimakamis, E; Bhatia, M; Dhar, R; D'Souza, G
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