title: Antimicrobial drug-resistant microbes associated with hospitalized community-acquired and healthcare-associated pneumonia: a multi-center study in Taiwan.
abstract: OBJECTIVE
  Community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) may be caused by potential antimicrobial drug-resistant (PADR) microbes. The aims of this study were to evaluate the incidences and risk factors associated with PADR microbes observed in patients with pneumonia occurring outside the hospital setting in Taiwan.
  
  
  METHODS
  We conducted a retrospective study of patients with CAP or HCAP admitted to six medical centers in the northern, central, and southern regions of Taiwan in 2007. The pathogens were evaluated by microbiological specimens within 72 hours after admission. The patients' comorbidities, pathogens, and outcomes were evaluated. The risk factors of PADR microbes were identified by logistic regression analysis.
  
  
  RESULTS
  The enrolled patients exhibited HCAP (n=713) and CAP (n=933). The pathogens associated with HCAP (n=383) and CAP (n=441) included Pseudomonas spp. (29%vs. 10%, p<0.001), Klebsiella spp. (24% vs. 25%, p=0.250), Escherichia coli (6% vs. 8%, p=0.369), Haemophilus influnezae (3% vs. 7%, p=0.041), Streptococcus pneumoniae (2% vs. 6%, p=0.003) and methicillin-resistant Staphylococcus aureus (MRSA) (8% vs. 4%, p=0.008). The core pathogens of CAP and HCAP differed among the three regions of Taiwan. PADR microbes, including Pseudomonas spp. (n=191), Acinetobacter spp. (n=41), MRSA (n=49) and cefotaxime- or ceftazidime-resistant Enterbacteriaceae (n=25), were isolated from 13% of patients with CAP and 23% of patients with HCAP. Previous hospitalization, and neoplastic and neurological diseases were significant risk factors for acquiring PADR microbes.
  
  
  CONCLUSIONS
  PADR microbes were common in patients with HCAP and CAP in Taiwan. Broad-spectrum antibiotics targeting PADR microbes should be administered to patients who have undergone previous hospitalization and who exhibit neurological disorders and/or malignancies.
authors: Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Chieh-Liang
authors: CL
authors: Wu
authors: Shih-Chi
authors: SC
authors: Ku
authors: Kuang-Yao
authors: KY
authors: Yang
authors: Wen-Feng
authors: WF
authors: Fang
authors: Chih-Yen
authors: CY
authors: Tu
authors: Chang-Wen
authors: CW
authors: Chen
authors: Kuo-Hsuan
authors: KH
authors: Hsu
authors: Wen-Chien
authors: WC
authors: Fan
authors: Meng-Chih
authors: MC
authors: Lin
authors: Wei
authors: W
authors: Chen
authors: Chih-Ying
authors: CY
authors: Ou
authors: Chong-Jen
authors: CJ
authors: Yu
mesh_terms: D000150:Acinetobacter; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae; D004926:Escherichia coli; D005260:Female; D006193:Haemophilus influenzae; D006760:Hospitalization; D006801:Humans; D007709:Klebsiella; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009422:Nervous System Diseases / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology / Q000382:microbiology*; D011549:Pseudomonas; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae; D013624:Taiwan / Q000453:epidemiology