title: An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance.
abstract: BACKGROUND
  Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality.
  
  
  METHODS
  We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death. Twelve hospitals in 5 countries (United States, n = 3; France, n = 2; Germany, n = 2; Italy, n = 2; and Spain, n = 3) participated. We compared characteristics of patients who had MDR strains to those who did not and derived regression models to identify predictors of MDR and hospital mortality.
  
  
  RESULTS
  Of 740 patients with Pa-NP, 226 patients (30.5%) were infected with MDR strains. In multivariable analyses, independent predictors of multidrug-resistance included decreasing age (adjusted odds ratio [AOR] 0.91, 95% confidence interval [CI] 0.96-0.98), diabetes mellitus (AOR 1.90, 95% CI 1.21-3.00) and ICU admission (AOR 1.73, 95% CI 1.06-2.81). Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis.
  
  
  CONCLUSIONS
  Among patients with Pa-NP the presence of infection with a MDR strain is associated with increased in-hospital mortality. Identification of patients at risk of MDR Pa-NP could facilitate appropriate empiric antibiotic decisions that in turn could lead to improved hospital survival.
authors.affiliation: St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110-1088, USA. scott.micek@stlcop.edu.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: Northwestern University Feinberg School of Medicine, McGaw Pavilion Suite M-300, 240 E Huron, Chicago, IL, 60611, USA. r-wunderink@northwestern.edu.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wunderink
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. mkollef@dom.wustl.edu.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. cxchen@dom.wustl.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chen
authors.affiliation: Vall d'Hebron University Hospital, Passeig Vall d'Hebron, 119, Barcelona, 08035, Spain. jrello@crips.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. jean.chastre@psl.aphp.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Policlinico Universitario A Gemelli, Largo Agostino Gemelli 8, Rome, 00168, Italy. m.antonelli@rm.unicatt.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: Medizinische Hochschule, Carl-Neuberg-Str. 1, Hannover, 30625, Germany. welte.tobias@mh-hannover.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Hôpital Raymond Poincaré, 104 boulevard Raymond Poincaré, Garches, 92380, France. Bernard.clair@rpc.ap-hop-paris.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Clair
authors.affiliation: Department of Hematology, University Hospital Grosshadern, Marchioninistr 15, Munich, D-81377, Germany. helmut.ostermann@med.uni-muenchen.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostermann
authors.affiliation: Hospital Universitari MútuaTerrassa, Plaça Dr. Robert, 5, Terrassa, 08221, Spain. ecalbo@mutuaterrassa.es.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Villarroel 170, Barcelona, 08036, Spain. ATORRES@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Malattie Infettive, Az. Ospedaliera Universitaria Pisana, Via Paradisa 2 - Cisanello, Pisa, 56100, Italy. menichettifrancesco@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: Pharmacy Services, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. schramm.garrett@mayo.edu.
authors.forename: Garrett E
authors.initials: GE
authors.lastname: Schramm
authors.affiliation: Cubist Pharmaceuticals, Inc., 65 Hayden Avenue, Lexington, MA, 02421, USA. Vandana.Menon@cubist.com.
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents