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. 2022 Jul 14;11(1):95.
doi: 10.1186/s13756-022-01137-4.

Clinical risk factors for admission with Pseudomonas and multidrug-resistant Pseudomonas community-acquired pneumonia

Adeniyi J Idigo  1 , J Michael Wells  2   3   4 , Matthew L Brown  5 , Howard W Wiener  6 , Russell L Griffin  6 , Gary Cutter  7 , Sadeep Shrestha #  6 , Rachael A Lee #  4   8
Affiliations

Clinical risk factors for admission with Pseudomonas and multidrug-resistant Pseudomonas community-acquired pneumonia

Adeniyi J Idigo et al. Antimicrob Resist Infect Control. .

Abstract

Background: Microbial etiology for community-acquired pneumonia (CAP) is evolving with pathogens known for high CAP mortality e.g., Pseudomonas species. Chronic obstructive pulmonary disease (COPD) patients are at risk for hospitalization for CAP. Understanding regional patterns and risk factors for multidrug-resistant (MDR) Pseudomonas acquisition has implications for antimicrobial stewardship.

Objectives: To evaluate the regional epidemiology of MDR Pseudomonas CAP and its association with COPD.

Methods: We queried the electronic medical records of the University of Alabama at Birmingham Healthcare System to identify patients hospitalized for CAP with Pseudomonas positive respiratory samples between 01/01/2013-12/31/2019. Log binomial regression models were used to examine associations between COPD diagnosis and risk of Pseudomonas/MDR Pseudomonas CAP.

Results: Cohort consisted of 913 culture positive CAP cases aged 59-year (IQR:48-68), 61% (560) male, 60% (547) white, 65% (580) current/past smokers, and 42% (384) COPD. Prevalence of Pseudomonas CAP in culture positive CAP was 18% (167), MDR Pseudomonas CAP in Pseudomonas CAP was 22% (36), and yearly incidence of MDR Pseudomonas CAP was stable (p = 0.169). COPD was associated with Pseudomonas CAP (RR 1.39; 95% CI 1.01, 1.91; p = 0.041) but not with MDR Pseudomonas CAP (0.71; 95% CI 0.35, 1.45; p = 0.349). Stroke (RR 2.64; 95% CI 1.51, 4.61; p = 0.0006) and use of supplemental oxygen (RR 2.31; 95% CI 1.30, 4.12; p = 0.005) were associated with MDR Pseudomonas CAP.

Conclusion: Incidence of MDR Pseudomonas CAP was stable over time. COPD was associated with Pseudomonas CAP but not with MDR Pseudomonas CAP. Larger cohort studies are needed to confirm findings.

Keywords: Chronic obstructive pulmonary disease; Community-acquired pneumonia; Multidrug-resistant Pseudomonas; Pseudomonas.

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Conflict of interest statement

No conflicts of interest exist for AJI, MLB, HWW, RLG, SS, and RAL.

Figures

Fig. 1
Fig. 1
Cohort’s flowchart for Pseudomonas isolates. Base cohort: Hospital inpatients aged 18 years or older admitted from a physician’s office or a non-healthcare facility and who had bacterial pneumonia diagnosis. Patients must have bacterial pneumonia diagnosis recorded in the electronic medical records to be present on admission. In cases where there was bacterial pneumonia diagnosis but no information about it being present on admission, the patient must have a microbiology culture sample collected within 48 h of admission. PI: Pseudomonas isolate; hrs: hours; CAP: community-acquired pneumonia
See this image and copyright information in PMC

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