title: Pseudomonas aeruginosa nosocomial pneumonia: impact of pneumonia classification.
abstract: OBJECTIVE
  To describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).
  
  
  METHODS
  We conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).
  
  
  METHODS
  Twelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).
  
  
  METHODS
  A total of 742 patients with Pa-NP.
  
  
  RESULTS
  Hospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.
  
  
  CONCLUSIONS
  Among patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.
authors.affiliation: 1St. Louis College of Pharmacy,St. Louis,Missouri.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: 2Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.affiliation: 3Department of Pneumology,Institut Clinic del Tórax,Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes) Barcelona,Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: 2Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chen
authors.affiliation: 4Hospital Vall D'Hebron,Barcelona,Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: 5Groupe Hospitalier Pitie-Salpetriere,Paris,France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: 6Policlinico Universitario A. Gemelli,Rome,Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: 7Medizinische Hochschule Hannover,Hannover,Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: 8Hôpital Raymond Poincaré,Garches,France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Clair
authors.affiliation: 9University Hospital of Munich,Munich,Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostermann
authors.affiliation: 10Hospital Universitari Mutua de Terrassa,Barcelona,Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.affiliation: 11Northwestern University Feinberg School of Medicine,Chicago,Illinois.
authors.forename: Richard
authors.initials: R
authors.lastname: Wunderink
authors.affiliation: 12Azienda Ospedaliera Universitaria Pisana,Pisa,Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: 13Mayo Clinic,Rochester,Minnesota.
authors.forename: Garrett
authors.initials: G
authors.lastname: Schramm
authors.affiliation: 14Cubist Pharmaceuticals,Lexington,Massachusetts.
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents