Prediction of Infection Due to Antibiotic-Resistant Bacteria by Select Risk Factors for Health Care–Associated Pneumonia
Open Access
- 10 November 2008
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 168 (20), 2205-2210
- https://doi.org/10.1001/archinte.168.20.2205
Abstract
Background Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa now cause pneumonia in patients presenting to the hospital. The concept of health care–associated pneumonia (HCAP) attempts to capture this, but its predictive value is unclear. Methods We examined patients admitted with pneumonia; infection with a resistant pathogen served as the study end point. Health care–associated pneumonia was present if a patient met one of the following criteria: recent hospitalization, nursing home residence, long-term hemodialysis, or immunosuppression. We compared rates of resistant infection among patients meeting any criteria for HCAP with those who did not have HCAP and explored the individual components of the definition. Results Among the cohort (n = 639), resistant pathogens were recovered in 289 (45.2%). Although each component of HCAP occurred more frequently in persons with resistant infections, the broad definition had a specificity of only 48.6% and misclassified one-third of the subjects. Logistic regression showed 4 variables associated with resistant pneumonia: recent hospitalization, nursing home residence, hemodialysis, and intensive care unit admission. A scoring system assigning 4, 3, 2, and 1 points, respectively, for each variable had moderate predictive power for segregating those with and without resistant bacteria. Among patients with fewer than 3 points, the prevalence of resistant pathogens was less than 20% compared with 55% and more than 75% in persons with scores ranging from 3 to 5 and more than 5 points, respectively (P < .001). Conclusions Although resistance is common in HCAP, not all component criteria for HCAP convey similar risk. Simple scoring tools may facilitate more accurate identification of persons with pneumonia caused by resistant pathogens.Keywords
This publication has 13 references indexed in Scilit:
- Bloodstream infections in adults: Importance of healthcare-associated infectionsJournal of Infection, 2008
- Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United StatesJAMA, 2007
- Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center ExperienceAntimicrobial Agents and Chemotherapy, 2007
- Health Care–Associated Pneumonia Requiring Hospital AdmissionArchives of Internal Medicine, 2007
- Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in AdultsClinical Infectious Diseases, 2007
- Impact of Antibiotic Guideline Compliance on Duration of Mechanical Ventilation in Critically Ill Patients With Community-Acquired PneumoniaChest, 2006
- A Prediction Rule to Identify Low-Risk Patients With Pulmonary EmbolismArchives of Internal Medicine, 2006
- Epidemiology and Outcomes of Health-care–Associated PneumoniaChest, 2005
- Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated PneumoniaAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Assessing Clinical Probability of Pulmonary Embolism in the Emergency Ward: A Simple ScoreJournal of General Internal Medicine, 2000