Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are lethal nosocomial infections. Identifying patients at risk for drug-resistant pathogens (DRPs) is important to achieve appropriate antibiotic therapy and to reduce overuse of broad-spectrum antibiotics. The aim of this study is to clarify the risk factors for DRPs in patients with HAP and VAP at diagnosis.
This prospective observational study was conducted in adult patients with HAP and VAP at Nagoya University Hospital from March, 2010 through October, 2016. P. aeruginosa, methicillin-resistant S. aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, S. maltophilia, and multidrug-resistant A. baumannii were defined as DRPs. Multivariate logistic regression analysis was performed to assess risk factors for DRPs.
In total, 504 patients (417: HAP, and 87: VAP) were analyzed. DRPs were identified in 127 (39%) of 327 culture-positive patients. Prevalence of DRPs in patients with and without history of prior DRP infection/colonization during the past year was 65% (60/92) and 29% (67/235), respectively. In patients without prior DRP history, Significant risk factors for DRPs were peripheral intravenous catheter (adjusted OR: 2.3, 95% CI: 1.2–4.4) and non-ambulatory status (2.0, 1.0–3.9). The following factors tended to increase the DRP risk: current hospitalization of ≥5 days (3.2, 0.9–11.8), chronic renal failure (2.1, 0.9–4.5), and hematocrit <30% (1.8, 0.9–3.3).
The prevalence of DRPs was ~40% in patients with HAP and VAP, and the risk factors for DRPs were elucidated. These factors should be considered for initial antibiotic selection.