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New approach needed to identify MDR pathogens in CAP

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Researchers from Italy identified risk factors for multidrug-resistant pathogens in more than half of all patients hospitalized with community-acquired pneumonia, and they suggest that each risk factor should be weighed differently.

“Physicians should embrace a probabilistic approach in evaluating different risk factors for MDR pathogens in patients with pneumonia coming from the community,” Stefano Aliberti, MD,of the University of Milan, told Infectious Disease News.

For the observational, prospective study, Aliberti and colleagues examined risk factors for acquiring MDR bacteria among 935 patients admitted to the Policlinico Hospital in Milan with community-acquired pneumonia (CAP) between April 2008 and April 2010.

Stefano Aliberti, MD

Patient data were collected upon admission and throughout hospital stay. Logistic regression models were used to assess risk factors for independent associations with the actual presence of a resistant pathogen and in-hospital mortality, and patients were stratified into different classes based on the probability of having MDR pneumonia.

Results indicated that 51% of patients had at least one risk factor for acquiring MDR bacteria on admission. The researchers identified a hospitalization in the preceding 90 days (OR=4.87; 95% CI, 1.90-12.4) and residency in a nursing home (OR=3.55; 95% CI, 1.12-11.24) as the strongest independent predictors for infection with MDR pathogens.

In an accompanying editorial, Marin H. Kollef, MD, of Washington University School of Medicine, and Scott T. Micek, PharmD, of Barnes-Jewish Hospital in St. Louis, wrote: “Physicians should be aware of the risk factor profile of the patients they are treating as well as the local patterns of MDR infection. Absence of risk factors for infection with MDR bacteria should result in the primary use of more narrow-spectrum empiric antibiotic regimens for hospitalized patients with pneumonia.”

For more information:

• Aliberti S. Clin Infect Dis. 2012;54:470-478.
• Kollef MH. Clin Infect Dis. 2012;54:479-482.

Disclosure: The researchers report no relevant financial disclosures.

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