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Chest Infections |

Risk Factors of Resistant Pathogens for β-Lactam Plus Macrolide, or Fluoroquinolone in Patients With CAP and HCAP: A Multicenter Prospective Observational Study Among Hospitalized Patients With CAP, HCAP, and HAP in Japan (CJLSG 0911)

Yuichiro Shindo*, PhD; Ryota Ito, MD; Daisuke Kobayashi, MD; Masahiko Ando, PhD; Motoshi Ichikawa, PhD; Tetsuya Yagi, PhD; Yasuteru Sugino, PhD; Joe Shindoh, MD; Tomohiko Ogasawara, PhD; Fumio Nomura, PhD; Hideo Saka, PhD; Masashi Yamamoto, PhD; Hiroyuki Taniguchi, PhD; Ryujiro Suzuki, PhD; Hiroshi Saito, PhD; Takashi Kawamura, PhD; Yoshinori Hasegawa, PhD
Author and Funding Information

The Institute for Advanced Research, Nagoya University, Nagoya, Japan


Chest. 2012;142(4_MeetingAbstracts):150A. doi:10.1378/chest.1386107
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Abstract

SESSION TYPE: Pneumonia Treatment and Antibiotic Resistance

PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM

PURPOSE: To achieve appropriate initial empirical antibiotic treatment for patients with pneumonia, the assessment methods of risk factors (RFs) for drug-resistant pathogens, which are useful to prescribe antibiotics, need to be developed. The aims of the present study are to compare the epidemiology of community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP), and to clarify the RFs of resistant pathogens for commonly-used antibiotics for CAP in patients with CAP and HCAP.

METHODS: A prospective observational study was conducted on hospitalized patients with pneumonia (March-December, 2010; UMIN000003306). Identified pathogens which were not susceptible to β-lactams (CTRX or SBT/ABPC), macrolides (AZM or CAM), and fluoroquinolones (LVFX, MFLX, or GRNX) were defined as CAP-ABXs-resistant pathogens. We focused on assessing their RFs in CAP and HCAP patients.

RESULTS: A total of 1591 patients (CAP: 898, HCAP: 586, and HAP: 107) were enrolled. In patients with identified pathogens, the proportion of CAP-ABXs-resistant pathogens in CAP, HCAP, and HAP were 9.7%, 31.4%, and 34.4%, respectively. Independent RFs for CAP-ABXs-resistant pathogens in combined patients with CAP and HCAP were prior hospitalization (OR: 2.5, 95% CI: 1.6-4.0), previous use of antibiotics (3.1, 2.0-4.9), use of gastric antacid (2.0, 1.3-3.1), tube feeding (2.3, 1.2-4.5), and poor functional status (2.8, 1.7-4.5). These RFs were almost identical in each CAP and HCAP group, except immunosuppression in CAP patients. The 88% of CAP patients and 30% of HCAP had ≤1 of the above 5 RFs, and their proportion of CAP-ABXs-resistant pathogens were less than 10%.

CONCLUSIONS: The proportion of CAP-ABXs-resistant pathogens in HCAP is close to that in HAP. However, there are common RFs for CAP-ABXs-resistant pathogens in CAP and HCAP patients. If the number of these RFs is ≤1, administration of unnecessary broad-spectrum antibiotics could be avoided in CAP and HCAP patients.

CLINICAL IMPLICATIONS: From the point of view of RFs for CAP-ABXs-resistant pathogens, the assessment methods of their RFs could be unified in CAP and HCAP patients.

DISCLOSURE: The following authors have nothing to disclose: Yuichiro Shindo, Ryota Ito, Daisuke Kobayashi, Masahiko Ando, Motoshi Ichikawa, Tetsuya Yagi, Yasuteru Sugino, Joe Shindoh, Tomohiko Ogasawara, Fumio Nomura, Hideo Saka, Masashi Yamamoto, Hiroyuki Taniguchi, Ryujiro Suzuki, Hiroshi Saito, Takashi Kawamura, Yoshinori Hasegawa

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The Institute for Advanced Research, Nagoya University, Nagoya, Japan

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