title: Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia.
abstract: OBJECTIVE
  To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients.
  
  
  METHODS
  This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria.
  
  
  RESULTS
  Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002).
  
  
  CONCLUSIONS
  In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Department of Internal Medicine, Porto Alegre, Brazil. reseligman@hcpa.ufrgs.br
authors.forename: Renato
authors.initials: R
authors.lastname: Seligman
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Ramos-Lima
authors.forename: Vivian do Amaral
authors.initials: Vdo A
authors.lastname: Oliveira
authors.forename: Carina
authors.initials: C
authors.lastname: Sanvicente
authors.forename: Juliana
authors.initials: J
authors.lastname: Sartori
authors.forename: Elyara Fiorin
authors.initials: EF
authors.lastname: Pacheco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D015780:Carbapenems / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011237:Predictive Value of Tests; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D010406:Penicillins; D015363:Quinolones