title: Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia.
abstract: BACKGROUND
  Not all risk factors for acquiring multidrug-resistant (MDR) organisms are equivalent in predicting pneumonia caused by resistant pathogens in the community. We evaluated risk factors for acquiring MDR bacteria in patients coming from the community who were hospitalized with pneumonia. Our evaluation was based on actual infection with a resistant pathogen and clinical outcome during hospitalization.
  
  
  METHODS
  An observational, prospective study was conducted on consecutive patients coming from the community who were hospitalized with pneumonia. Data on admission and during hospitalization were collected. Logistic regression models were used to evaluate risk factors for acquiring MDR bacteria independently associated with the actual presence of a resistant pathogen and in-hospital mortality.
  
  
  RESULTS
  Among the 935 patients enrolled in the study, 473 (51%) had at least 1 risk factor for acquiring MDR bacteria on admission. Of all risk factors, hospitalization in the preceding 90 days (odds ratio [OR], 4.87 95% confidence interval {CI}, 1.90-12.4]; P = .001) and residency in a nursing home (OR, 3.55 [95% CI, 1.12-11.24]; P = .031) were independent predictors for an actual infection with a resistant pathogen. A score able to predict pneumonia caused by a resistant pathogen was computed, including comorbidities and risk factors for MDR. Hospitalization in the preceding 90 days and residency in a nursing home were also independent predictors for in-hospital mortality.
  
  
  CONCLUSIONS
  Risk factors for acquiring MDR bacteria should be weighted differently, and a probabilistic approach to identifying resistant pathogens among patients coming from the community with pneumonia should be embraced.
authors: Dipartimento di Medicina Clinica e Prevenzione, University of Milan-Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy. stefano.aliberti@unimib.it
authors: Stefano
authors: S
authors: Aliberti
authors: Marta
authors: M
authors: Di Pasquale
authors: Anna Maria
authors: AM
authors: Zanaboni
authors: Roberto
authors: R
authors: Cosentini
authors: Anna Maria
authors: AM
authors: Brambilla
authors: Sonia
authors: S
authors: Seghezzi
authors: Paolo
authors: P
authors: Tarsia
authors: Marco
authors: M
authors: Mantero
authors: Francesco
authors: F
authors: Blasi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents