title: Intensive care unit-acquired pneumonia due to Pseudomonas aeruginosa with and without multidrug resistance.
abstract: Pseudomonas aeruginosa often presents multi-drug resistance (MDR) in intensive care unit (ICU)-acquired pneumonia (ICUAP), possibly resulting in inappropriate empiric treatment and worse outcomes. We aimed to identify patients with ICUAP at risk for these pathogens in order to improve treatment selection and outcomes.
  
  
  
  We prospectively assessed 222 consecutive immunocompetent ICUAP patients confirmed microbiologically. We determined the characteristics, risk factors, systemic inflammatory response and outcomes of P. aeruginosa pneumonia (Pa-ICUAP), compared to other aetiologies. We also compared patients with MDR vs. non-MDR Pa-ICUAP.
  
  
  
  Pseudomonas aeruginosa was the most frequent aetiology (64, 29%); 22 (34%) cases had MDR. Independent predictors for Pa-ICUAP were prior airway colonization by P. aeruginosa, previous antibiotic treatment, solid cancer and shock; alcohol abuse and pleural effusion were independently associated to lower risk for Pa-ICUAP. Chronic liver disease independently predicted MDR among Pa-ICUAP. The inflammatory biomarkers were similar between all groups. Patients with Pa-ICUAP had lower unadjusted 90-day survival (p = 0.049). However, the 90-day survival adjusted for confounding factors using a propensity score did not differ between all groups.
  
  
  
  Pseudomonas aeruginosa remains the most frequent aetiology of ICUAP, with high prevalence of MDR. These risk factors should be taken into account to avoid inappropriate empiric antibiotics for Pa-ICUAP. Pseudomonas aeruginosa, regardless multidrug resistance, was not associated with different propensity-adjusted survival.
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Fernández-Barat
authors.affiliation: Department of Pneumology, Respiratory Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain. Electronic address: miferrer@clinic.ub.es.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Dipartmento di Anestesia e Rianimazione, Università degli studi di Milano, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Rosa
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Esperatti
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terraneo
authors.affiliation: Department of Pneumology, Respiratory Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rinaudo
authors.affiliation: Department of Pneumology, Respiratory Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Li Bassi
authors.affiliation: Department of Pneumology, Respiratory Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
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; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: ICU-acquired pneumonia; Inflammatory response; Multidrug resistant pathogens; Pseudomonas aeruginosa; Ventilator-associated pneumonia