Chest Infections: Pneumonia Diagnosis and Outcomes |

Factors Associated With Drug-Resistant Pathogens in Critically Ill Patients With Pneumonia FREE TO VIEW

Nobuhiro Ariyoshi, MD; James Davis, PhD; Ivy Melgarejo, MD; Gehan Devendra, MD
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John A. Burns School of Medicine University of Hawaii, Honolulu, HI

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

Chest. 2016;150(4_S):143A. doi:10.1016/j.chest.2016.08.152
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SESSION TITLE: Pneumonia Diagnosis and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM

PURPOSE: To determine factors associated with the presence of drug-resistant pathogens (DRPs) and create a risk scoring model of DRPs in critically ill patients with pneumonia.

METHODS: We conducted a retrospective study of adult patients with culture-positive pneumonia in a medical intensive care unit at a tertiary academic medical center from January 1, 2010 to December 31, 2014. Factors, currently published 8 clinical prediction models including HCAP criteria, and clinical impact associated with the presence of DRPs were assessed. A logistic regression model was used for analysis. We evaluated the predictive value of the score by determining areas under the receiver-operating characteristic (AUROC) curves.

RESULTS: In total, 132 patients were analyzed and DRPs were isolated in 37.9%. The most common organisms included Pseudomonas aeruginosa (22.7%), Streptococcus pneumoniae (15.2%), and Klebsiella pneumonia (13.6%). Independent risk factors for the presence of DRPs included nonambulatory status (OR, 7.06; 95% CI, 2.49- 19.98; p<0.05), previous episode of DRPs (OR, 6.08; 95% CI, 2.32-15.95; p<0.05), and immunosuppression (OR, 19.22; 95% CI, 5.60-66.01; p<0.05). Based on the logistic regression, we created a scoring model using the cumulative number of the risk factors, resulting in a maximum of 3 possible points. The AUROC for the scoring model was 0.83 that was better than 8 clinical prediction models. DRPs were associated with hospital-free days (p<0.05) and ventilator-free days (p<0.05), but not ICU-free days (p=0.17) or death (p=0.24).

CONCLUSIONS: Nonambulatory status, previous episode of DRPs, and immunosuppression were associated with the presence of DRPs. The new scoring model may predict DRPs better than the other clinical prediction models.

CLINICAL IMPLICATIONS: Using this model, physicians can predict DRPs in critically ill patients with pneumonia.

DISCLOSURE: The following authors have nothing to disclose: Nobuhiro Ariyoshi, James Davis, Ivy Melgarejo, Gehan Devendra

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