title: Risk factors to predict drug-resistant pathogens in hemodialysis-associated pneumonia.
abstract: After the concept of healthcare associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA), pneumonia in hemodialysis patients has been classified as HCAP. Even though there are several risk factors and scoring systems of drug-resistant pathogens (DRPs) in HCAP, the risk factors for DRPs in hemodialysis-associated pneumonia are unclear.
  
  
  
  Patients who were admitted to our tertiary care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia. Patients were enrolled if they fulfilled the definition of HCAP according to the 2005 ATS/IDSA guidelines.
  
  
  
  A total of 530 subjects were diagnosed with HCAP, of whom 48 (9.1 %) received regular hemodialysis (HD group) and the other 482 did not (non-HD group). The most common pathogens in HD group were Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus (MRSA). There was a similar distribution of Gram-negative bacilli infections between the two groups except for Haemophilus influenzae and Citrobacter species. The incidence of DRPs was not significantly different between the two groups (HD vs. non-HD, 35.4 vs. 39.2 %, p = 0.607). Wound care, severe pneumonia and an age of more than 70 years were significant risk factors for DRPs. The area under the operating cure of predicting DRPs was 0.727 (0.575-0.879, p = 0.01).
  
  
  
  P. aeruginosa and MRSA were the most important pathogens in hemodialysis-associated pneumonia. Wound care, severe pneumonia and old age were significant risk factors for DRPs.
authors: Division of Thoracic Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.|Oriental Institute of Technology, New Taipei City, Taiwan.
authors: Ping-Huai
authors: PH
authors: Wang
authors: Division of Thoracic Medicine, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, Taiwan. haochienwang@gmail.com.
authors: Hao-Chien
authors: HC
authors: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002954:Citrobacter; D003428:Cross Infection / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006193:Haemophilus influenzae; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Drug resistant pathogens; Hemodialysis; Pneumonia