title: Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective.
abstract: BACKGROUND
  Probabilistic scores have been recently suggested to identify pneumonia caused by multidrug-resistant (MDR) bacteria. The aim of the study was to validate both Aliberti and Shorr scores in predicting MDR pneumonia, comparing them with healthcare associated pneumonia (HCAP) classification.
  
  
  METHODS
  Two independent European cohorts of consecutive patients hospitalised with pneumonia were prospectively evaluated in Barcelona, Spain (BC) and Edinburgh, UK (EC). Data on admission and during hospitalisation were collected. The predictive value of the three scores was explored for correctly indicating the presence of MDR pneumonia via a receiver-operating characteristic (ROC) curve.
  
  
  RESULTS
  A total of 1591 patients in the BC and 1883 patients in the EC were enrolled. The prevalence of patients with MDR pathogen among those with isolated bacteria was 7.6% in the BC and 3.3% in the EC. The most common MDR pathogen found in both cohorts was MRSA, followed by MDR P aeruginosa. A significantly higher prevalence of MDR bacteria was found among patients in the intensive care unit (ICU). The two probabilistic scores, and particularly the Aliberti one, showed an area under the ROC curve higher than the HCAP classification in predicting MDR pneumonia, especially in the ICU.
  
  
  CONCLUSIONS
  Risk scores able to identify MDR pneumonia could help in developing strategies for antimicrobial stewardship.
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, , Monza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.forename: James D
authors.initials: JD
authors.lastname: Chalmers
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Zanaboni
authors.forename: Roberto
authors.initials: R
authors.lastname: Cosentini
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarsia
authors.forename: Alberto
authors.initials: A
authors.lastname: Pesci
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Bacterial Infection; Pneumonia; Respiratory Infection