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Original Research: Chest Infections |

Community-Acquired Pneumonia Due to Multidrug- and Non–Multidrug-Resistant Pseudomonas aeruginosa

Catia Cillóniz, PhD; Albert Gabarrús, MSc; Miquel Ferrer, MD; Jorge Puig de la Bellacasa, MD; Mariano Rinaudo, MD, PhD; Josep Mensa, MD; Michael S. Niederman, MD; Antoni Torres, MD
Author and Funding Information

FUNDING/SUPPORT: The study was funded by Ciber de Enfermedades Respiratorias (CibeRes CB06/06/0028) and by 2009 Support to Research Groups of Catalonia 911.

aDepartment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain

bDepartment of Microbiology, Hospital Clinic, Barcelona, Spain

cDepartment of Infectious Disease, Hospital Clinic, Barcelona, Spain

dDivision of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York

CORRESPONDENCE TO: Antoni Torres, MD, Department of Pneumology, Hospital Clinic of Barcelona, c/ Villarroel 170, 08036 Barcelona, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):415-425. doi:10.1016/j.chest.2016.03.042
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Background  Pseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa.

Methods  Prospective observational study of 2,023 consecutive adult patients with CAP with definitive etiology.

Results  P aeruginosa was found in 77 (4%) of the 2,023 cases with microbial etiology. In 22 (32%) of the 68 cases of P aeruginosa with antibiogram data, the isolates were MDR. Inappropriate therapy was present in 49 (64%) cases of P aeruginosa CAP, including 17/22 (77%) cases of MDR P aeruginosa CAP. Male sex, chronic respiratory disease, C-reactive protein <12.35 mg/dL, and pneumonia severity index risk class IV to V were independently associated with P aeruginosa CAP. Prior antibiotic treatment was more frequent in MDR P aeruginosa CAP compared with non-MDR P aeruginosa (58% vs 29%, P = .029), and was the only risk factor associated with CAP resulting from MDR P aeruginosa. In the multivariate analysis, age ≥65 years, CAP resulting from P aeruginosa, chronic liver disease, neurologic disease, nursing home, criteria of ARDS, acute renal failure, ICU admission, and inappropriate empiric treatment were the factors associated with 30-day mortality.

Conclusions  P aeruginosa is an individual risk factor associated with mortality in CAP. The risk factors described can help clinicians to suspect P aeruginosa and MDR P aeruginosa.

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