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Observational Study
. 2021 Apr;40(4):683-690.
doi: 10.1007/s10096-020-04046-9. Epub 2020 Oct 7.

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Yuyao Yin  1 , Chunjiang Zhao  1 , Henan Li  1 , Longyang Jin  1 , Qi Wang  1 , Ruobing Wang  1 , Yawei Zhang  1 , Jiangang Zhang  1 , Hui Wang  2 ; CARES network
Collaborators, Affiliations
Observational Study

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Yuyao Yin et al. Eur J Clin Microbiol Infect Dis. 2021 Apr.

Abstract

Hospital-acquired pneumonia (HAP) is a significant nosocomial infection; data on the distribution and antimicrobial resistance profiles of HAP in China are limited. We included 2827 adult patients with HAP from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections network admitted in 15 Chinese teaching hospitals between 2007 and 2016. Clinical data and antimicrobial susceptibility of isolated pathogens were obtained from the medical records and central laboratory, respectively. Multivariable logistic regression was performed to determine the risk factors for mortality and multidrug resistance (MDR). A total of 386 (13.7%) patients died in the hospital, while 1181 (41.8%) developed ventilator-associated pneumonia (VAP). Active immunosuppressant therapy (OR 1.915 (95% CI 1.475-2.487)), solid tumor (OR 1.860 (95% CI 1.410-2.452)), coma (OR 1.783 (95% CI 1.364-2.333)), clinical pulmonary infection score ≥7 (OR 1.743 (95% CI 1.373-2.212)), intensive care unit stay (OR 1.652 (95% CI 1.292-2.111)), age ≥65 years (OR 1.621 (95% CI 1.282-2.049)), and tracheal cannula insertion (OR 1.613 (95% CI 1.169-2.224)) were independent risk factors for in-hospital mortality. Liver cirrhosis (OR 3.120 (95% CI 1.436-6.780)) and six other variables were independent predictors of MDR. Acinetobacter baumannii (25.6%), Pseudomonas aeruginosa (20.1%), Klebsiella pneumoniae (15.4%), and Staphylococcus aureus (12.6%) were the most common pathogens (MDR prevalence 64.9%). Isolates from VAP patients showed more A. baumannii and less K. pneumoniae and E. coli strains (p < 0.001, respectively) than those from patients without VAP. The proportion of methicillin-resistant S. aureus strains decreased; that of carbapenem-resistant A. baumannii and Enterobacterales strains increased. There had been changes in the antibiotic resistance profiles of HAP pathogens in China. Risk factors for mortality and MDR are important for the selection of antimicrobials for HAP in China.

Keywords: Antimicrobial resistance; Hospital-acquired pneumonia; Mortality; Multidrug resistance; Risk factor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of CRAB, CRPA, CRE, and MRSA in HAP patients from 2007 to 2016. CRAB, carbapenem-resistant Acinetobacter baumannii; CRPA carbapenem-resistant Pseudomonas aeruginosa; CRE, carbapenem-resistant Enterobacterales; MRSA, methicillin-resistant Staphylococcus aureus
See this image and copyright information in PMC

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