Drug-resistant pathogens in community-acquired pneumonia

DRPs in CAP

Authors

  • Ane Uranga Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Vizcaya, Spain
  • Marcos I Restrepo Division of Pulmonary Diseases and Critical Care, South Texas Veterans Health Care System, University of Texas Health Science Center, San Antonio, Texas, USA
  • James D Chalmers Tayside Respiratory Research Group, University of Dundee, Dundee, UK
  • Francesco Blasi Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Stefano Aliberti School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Via Pergolesi 33, 20052, Monza Italy

Keywords:

Community-acquired pneumonia (CAP), drug-resistant pathogens (DRPs), health care-associated pneumonia (HCAP), prediction models

Abstract

An increasing prevalence of pneumonia caused by drug-resistant pathogens (DRPs) has been identifi ed. The 2005 American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines proposed the health care-associated pneumonia (HCAP) model in order to identify an increased risk of DRPs in patients coming from the community. These patients are known to have a worse prognosis, mostly due to poor functional status and treatment restrictions. New useful scores have been developed to help physicians in predicting DRPs. This manuscript is a review of currently published literature concerning the impact of CAP caused by DRPs and the different predictive models available.

References

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al.; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27-72.

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.

World Health Organization. WHO Global Strategy for Containment of Antimicrobial Resistance. Switzerland: World Health Organization; 2001. p. 1-99.

Summary of the lates data on antibiotic consumption in the European Union. Stockholm: European Centre for Disease Prevention and Control; 2014. p. 1-12.

Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care — associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791-7.

Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: Results from a large US database of culture-positive pneumonia. Chest 2005;128:3854-62.

Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013;188:985-95.

Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: A single-center experience. Antimicrob Agents Chemother 2007;51:3568-73.

Venditti M, Falcone M, Corrao S, Licata G, Serra P; Study Group of the Italian Society of Internal Medicine. Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med 2009;150:19-26.

DalBen MF, Basso M, Garcia CP, Costa SF, Toscano CM, Jarvis WR, et al. Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbape- nem-resistant Pseudomonas aeruginosa in an inten-sive care unit. Clinics (Sao Paulo) 2013;68:1128-33.

Niederman MS. Gram-negative colonization of the respiratory tract: Pathogenesis and clinical consequences. Semin Respir Infect 1990;5:173-84.

Lim WS, Macfarlane JT. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. Eur Respir J 2001;18:362-8.

El-Solh AA, Pietrantoni C, Bhat A, Bhora M, Berbary E. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis 2004;39:474-80.

Calfee DP. Multidrug-resistant organisms in dialysis patients. Semin Dial 2013;26:447-56.

Slinin Y, Foley RN, Collins AJ. Clinical epidemiology of pneumonia in hemodialysis patients: The USRDS waves 1, 3, and 4 study. Kidney Int 2006;70:1135-41.

Rello J, Lujan M, Gallego M, Valles J, Belmonte Y, Fontanals D, et al.; PROCORNEU Study Group. Why mortality is increased in health-care-associated pneumonia: Lessons from pneumococcal bacteremic pneumonia. Chest 2010;137:1138-44.

Cecere LM, Rubenfeld GD, Park DR, Root RK, Goss CH. Long-term survival after hospitalization for community-acquired and healthcare-associated pneumonia. Respiration 2010;79:128-36.

Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 2008;168:2205-10.

Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 2012;54:470-8.

Attridge RT, Frei CR. Health care-associated pneumonia: An evidence-based review. Am J Med 2011;124:689-97.

Murri R, De Pascale G. The challenge of identifying resistant-organism pneumonia in the emergency department: Still navigating on the erie canal? Clin Infect Dis 2012;54:199-201.

Shorr AF, Zilberberg MD. Role for risk-scoring tools in identifying resistant pathogens in pneumonia: Reassessing the value of healthcare-associated pneumonia as a concept. Curr Opin Pulm Med 2015;21:232-8.

Ewig S, Welte T, Torres A. Is healthcare-associated pneumonia a distinct entity needing specific therapy? Curr Opin Infect Dis 2012;25:166-75.

Lee B, Boucher HW. Targeting antimicrobial-resistant bacterial respiratory tract pathogens: It is time to 'get smart'. Curr Opin Pulm Med 2015;21:293-303.

Jung JY, Park MS, Kim YS, Park BH, Kim SK, Chang J, et al. Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital. BMC Infect Dis 2011;11:61.

Koh SJ, Lee JH. Clinical characteristics of nursing home-acquired pneumonia in elderly patients admitted to a Korean teaching hospital. Korean J Intern Med 2015;30:638-47.

Ewig S, Torres A. Healthcare-associated pneumonia: Meeting the yeti. Eur Respir J 2011;38:755-7.

Garcia-Vidal C, Viasus D, Roset A, Adamuz J, Verdaguer R, Dorca J, et al. Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect 2011;17:1659-65.

Carratala J, Mykietiuk A, Fernandez-Sabe N, Suarez C, Dorca J, Verdaguer R, et al. Health care-associated pneumonia requiring hospital admission: Epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med 2007;167:1393-9.

Chalmers JD, Taylor JK, Singanayagam A, Fleming GB, Akram AR, Mandal P, et al. Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: A UK cohort study. Clin Infect Dis 2011;53:107-13.

Ewig S, Klapdor B, Pletz MW, Rohde G, Schutte H, Schaberg T, et al.; CAPNETZ study group. Nursing-home-acquired pneumonia in Germany: An 8-year prospective multicentre study. Thorax 2012;67:132-8.

Liapikou A, Polverino E, Cilloniz C, Peyrani P, Ramirez J, Menendez R, et al.; Community-Acquired Pneumonia Organization (CAPO) Investigators. A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia. Respir Care 2014;59:1078-85.

Polverino E, Torres A, Menendez R, Cilloniz C, Valles JM, Capelastegui A, et al.; HCAP Study investigators. Microbial aetiology of healthcare associated pneumonia in Spain: A prospective, multicentre, case-control study. Thorax 2013;68:1007-14.

Valles J, Martín-Loeches I, Torres A, Díaz E, Seijas I, López MJ, et al. Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: A Spanish cohort study. Intensive Care Med 2014;40:572-81.

Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: A systematic review and meta-analysis. Clin Infect Dis 2014;58:330-9.

Webb BJ, Dascomb K, Stenehjem E, Dean N. Predicting risk of drug-resistant organisms in pneumonia: Moving beyond the HCAP model. Respir Med 2015;109:1-10.

Brito V, Niederman MS. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Curr Opin Infect Dis 2009;22:316-25.

Maruyama T, Fujisawa T, Okuno M, Toyoshima H, Tsutsui K, Maeda H, et al. A new strategy for healthcare-associated pneumonia: A 2-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clin Infect Dis 2013;57:1373-83.

Aliberti S, Cilloniz C, Chalmers JD, Zanaboni AM, Cosentini R, Tarsia P, et al. Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: A European perspective. Thorax 2013;68:997-9.

Park SC, Kang YA, Park BH, Kim EY, Park MS, Kim YS, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia. Respir Med 2012;106:1311-9.

Schreiber MP, Chan CM, Shorr AF. Resistant pathogens in nonnosocomial pneumonia and respiratory failure: Is it time to refine the definition of health-care-associated pneumonia? Chest 2010;137:1283-8.

Madaras-Kelly K, Remington RE, Fan VS, Sloan KL. Predicting antibiotic resistance to community-acquired pneumonia antibiotics in culture-positive patients with healthcare associated pneumonia. J Hosp Med 2012;7:195-202.

Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, et al. Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis 2012;54:193-8.

Wang PH, Wang HC, Cheng SL, Chang HT, Laio CH. Selection of empirical antibiotics for health care-associated pneumonia via integration of pneumonia severity index and risk factors of drug-resistant pathogens. J Formos Med Assoc 2015. [Epub ahead of print].

Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc 2015;12:153-60.

Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman M, et al. Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginos: Incidence, risk, and prognosis. Arch Intern Med 2002;162:1849-58.

Von Baum H, Welte T, Marre R, Suttorp N, Ewig S; CAPNETZ Stusy Group. Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: Diagnosis, incidence and predictors. Eur Respir J 2010;35:598-605.

Sibila O, Laserna E, Maselli DJ, Fernandez JF, Mortensen EM, Anzueto A, et al. Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. Respirology 2015;20:660-6.

Minejima E, Lou M, Nieberg P, Wong-Beringer A. Patients presenting to the hospital with MRSA pneumonia: Differentiating characteristics and outcomes with empiric treatment. BMC Infect Dis 2014;14:252.

Lewis SS, Walker VJ, Lee MS, Chen L, Moehring RW, Cox CE, et al. Epidemiology of methicillin-resistant Staphylococcus aureus pneumonia in community hospitals. Infect Control Hosp Epidemiol 2014;35:1452-7.

Shorr AF, Myers DE, Huang DB, Nathanson BH, Emons MF, Kollef MH. A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia. BMC Infect Dis 2013;13:268.

Teshome BF, Lee GC, Reveles KR, Attridge RT, Koeller J, Wang CP, et al. Application of a methicillin-resistant Staphylococcus aureus risk score for community-onset pneumonia patients and outcomes with initial treatment. BMC Infect Dis 2015;15:380.

Downloads

Published

2015-12-24

How to Cite

1.
Uranga A, Restrepo MI, Chalmers JD, Blasi F, Aliberti S. Drug-resistant pathogens in community-acquired pneumonia: DRPs in CAP. Community Acquir Infect. 2015;2. Accessed May 3, 2025. https://www.hksmp.com/journals/cai/article/view/254

Issue

Vol. 2 (2015)

Section

Review Articles

Downloads

Download data is not yet available.

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.