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Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia.
Arch Intern Med. 2008 Nov 10; 168(20):2205-10.AI

Abstract

BACKGROUND

Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa now cause pneumonia in patients presenting to the hospital. The concept of health care-associated pneumonia (HCAP) attempts to capture this, but its predictive value is unclear.

METHODS

We examined patients admitted with pneumonia; infection with a resistant pathogen served as the study end point. Health care-associated pneumonia was present if a patient met one of the following criteria: recent hospitalization, nursing home residence, long-term hemodialysis, or immunosuppression. We compared rates of resistant infection among patients meeting any criteria for HCAP with those who did not have HCAP and explored the individual components of the definition.

RESULTS

Among the cohort (n = 639), resistant pathogens were recovered in 289 (45.2%). Although each component of HCAP occurred more frequently in persons with resistant infections, the broad definition had a specificity of only 48.6% and misclassified one-third of the subjects. Logistic regression showed 4 variables associated with resistant pneumonia: recent hospitalization, nursing home residence, hemodialysis, and intensive care unit admission. A scoring system assigning 4, 3, 2, and 1 points, respectively, for each variable had moderate predictive power for segregating those with and without resistant bacteria. Among patients with fewer than 3 points, the prevalence of resistant pathogens was less than 20% compared with 55% and more than 75% in persons with scores ranging from 3 to 5 and more than 5 points, respectively (P < .001).

CONCLUSIONS

Although resistance is common in HCAP, not all component criteria for HCAP convey similar risk. Simple scoring tools may facilitate more accurate identification of persons with pneumonia caused by resistant pathogens.

Authors+Show Affiliations

Pulmonary and Critical Care Section, Room 2A-38D, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA. afshorr@dnamail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19001196

Citation

Shorr, Andrew F., et al. "Prediction of Infection Due to Antibiotic-resistant Bacteria By Select Risk Factors for Health Care-associated Pneumonia." Archives of Internal Medicine, vol. 168, no. 20, 2008, pp. 2205-10.
Shorr AF, Zilberberg MD, Micek ST, et al. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med. 2008;168(20):2205-10.
Shorr, A. F., Zilberberg, M. D., Micek, S. T., & Kollef, M. H. (2008). Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Archives of Internal Medicine, 168(20), 2205-10. https://doi.org/10.1001/archinte.168.20.2205
Shorr AF, et al. Prediction of Infection Due to Antibiotic-resistant Bacteria By Select Risk Factors for Health Care-associated Pneumonia. Arch Intern Med. 2008 Nov 10;168(20):2205-10. PubMed PMID: 19001196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. AU - Shorr,Andrew F, AU - Zilberberg,Marya D, AU - Micek,Scott T, AU - Kollef,Marin H, PY - 2008/11/13/pubmed PY - 2008/12/17/medline PY - 2008/11/13/entrez SP - 2205 EP - 10 JF - Archives of internal medicine JO - Arch Intern Med VL - 168 IS - 20 N2 - BACKGROUND: Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa now cause pneumonia in patients presenting to the hospital. The concept of health care-associated pneumonia (HCAP) attempts to capture this, but its predictive value is unclear. METHODS: We examined patients admitted with pneumonia; infection with a resistant pathogen served as the study end point. Health care-associated pneumonia was present if a patient met one of the following criteria: recent hospitalization, nursing home residence, long-term hemodialysis, or immunosuppression. We compared rates of resistant infection among patients meeting any criteria for HCAP with those who did not have HCAP and explored the individual components of the definition. RESULTS: Among the cohort (n = 639), resistant pathogens were recovered in 289 (45.2%). Although each component of HCAP occurred more frequently in persons with resistant infections, the broad definition had a specificity of only 48.6% and misclassified one-third of the subjects. Logistic regression showed 4 variables associated with resistant pneumonia: recent hospitalization, nursing home residence, hemodialysis, and intensive care unit admission. A scoring system assigning 4, 3, 2, and 1 points, respectively, for each variable had moderate predictive power for segregating those with and without resistant bacteria. Among patients with fewer than 3 points, the prevalence of resistant pathogens was less than 20% compared with 55% and more than 75% in persons with scores ranging from 3 to 5 and more than 5 points, respectively (P < .001). CONCLUSIONS: Although resistance is common in HCAP, not all component criteria for HCAP convey similar risk. Simple scoring tools may facilitate more accurate identification of persons with pneumonia caused by resistant pathogens. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19001196/Prediction_of_infection_due_to_antibiotic_resistant_bacteria_by_select_risk_factors_for_health_care_associated_pneumonia_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.168.20.2205 DB - PRIME DP - Unbound Medicine ER -