title: Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia.
abstract: BACKGROUND
  Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia.
  
  
  OBJECTIVE
  To elucidate clinical features of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors for drug-resistant pathogens in patients with CAP and HCAP.
  
  
  METHODS
  A prospective observational study was conducted in hospitalized patients with pneumonia at 10 institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam, macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs).
  
  
  RESULTS
  In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibiotic use (AOR, 2.45; 95% CI, 1.51-3.98), use of gastric acid-suppressive agents (AOR, 2.22; 95% CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiver operating characteristic curve for counting the number of risk factors was 0.79 (95% CI, 0.74-0.84).
  
  
  CONCLUSIONS
  The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with either CAP or HCAP by taking account of the cumulative number of the risk factors. Clinical trial registered with https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000004001&language=E ; number UMIN000003306.
authors.affiliation: 1 Institute for Advanced Research, Nagoya University, Nagoya, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shindo
authors.forename: Ryota
authors.initials: R
authors.lastname: Ito
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.forename: Motoshi
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Shiraki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Goto
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Fukui
authors.forename: Mai
authors.initials: M
authors.lastname: Iwaki
authors.forename: Junya
authors.initials: J
authors.lastname: Okumura
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yamaguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yagi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Tanikawa
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Sugino
authors.forename: Joe
authors.initials: J
authors.lastname: Shindoh
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ogasawara
authors.forename: Fumio
authors.initials: F
authors.lastname: Nomura
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Ryujiro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007564:Japan; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents