title: Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug-Resistant Pseudomonas aeruginosa.
abstract: BACKGROUND
  Pseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa.
  
  
  METHODS
  Prospective observational study of 2,023 consecutive adult patients with CAP with definitive etiology.
  
  
  RESULTS
  P aeruginosa was found in 77 (4%) of the 2,023 cases with microbial etiology. In 22 (32%) of the 68 cases of P aeruginosa with antibiogram data, the isolates were MDR. Inappropriate therapy was present in 49 (64%) cases of P aeruginosa CAP, including 17/22 (77%) cases of MDR P aeruginosa CAP. Male sex, chronic respiratory disease, C-reactive protein <12.35 mg/dL, and pneumonia severity index risk class IV to V were independently associated with P aeruginosa CAP. Prior antibiotic treatment was more frequent in MDR P aeruginosa CAP compared with non-MDR P aeruginosa (58% vs 29%, P = .029), and was the only risk factor associated with CAP resulting from MDR P aeruginosa. In the multivariate analysis, age ≥65 years, CAP resulting from P aeruginosa, chronic liver disease, neurologic disease, nursing home, criteria of ARDS, acute renal failure, ICU admission, and inappropriate empiric treatment were the factors associated with 30-day mortality.
  
  
  CONCLUSIONS
  P aeruginosa is an individual risk factor associated with mortality in CAP. The risk factors described can help clinicians to suspect P aeruginosa and MDR P aeruginosa.
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cillóniz
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Department of Microbiology, Hospital Clinic, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Puig de la Bellacasa
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rinaudo
authors.affiliation: Department of Infectious Disease, Hospital Clinic, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Pseudomonas aeruginosa; community-acquired pneumonia; multidrug-resistant; pneumonia