Advertisement

Impact of Pseudomonas aeruginosa coverage on the prognosis of elderly patients with community-acquired pneumonia

Published:September 28, 2022DOI:https://doi.org/10.1016/j.jiac.2022.09.016

      Abstract

      Background

      Although the 2019 American Thoracic Society and Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) recommend the use of antibiotics with Pseudomonas aeruginosa coverage for patients with prior sputum isolation of P. aeruginosa, further research is needed to confirm its clinical outcomes. This study aimed to assess the impact of the use of antibiotics with P. aeruginosa coverage on mortality in elderly CAP patients with sputum isolation of P. aeruginosa.

      Methods

      We retrospectively included consecutive elderly patients who were hospitalized for CAP and P. aeruginosa-positive sputum culture. The association between the use of antibiotics with P. aeruginosa coverage and 28-day mortality was assessed based on propensity score to reduce selection bias.

      Results

      A total of 216 patients were included, and 68 (31%) of them were treated with antibiotics with P. aeruginosa coverage. The number of patients treated with antibiotics with P. aeruginosa coverage was significantly higher among nonsurvivors than among survivors. After adjustment using propensity score, the association between the use of antibiotics with P. aeruginosa coverage and the 28-day mortality was found to be statistically nonsignificant (odds ratio 2.182, 95% confidence interval 0.732–6.508, p = 0.162).

      Conclusions

      The use of antibiotics with P. aeruginosa coverage in elderly CAP patients with sputum isolation of P. aeruginosa did not improve their prognosis. A randomized control study is required to identify cases that should be treated with antibiotics covering P. aeruginosa.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Infection and Chemotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jim Oʼ Neill
        Antimicrobial resistance tackling a crisis for the health and wealth of nations.
        Rev. Antimicrob. Resist. Dec 2014; 20: 1-16
        • WHO
        Global action plan on antimicrobial resistance.
        2015
        • Arancibia F.
        • Bauer T.T.
        • Ewig S.
        • Mensa J.
        • Gonzalez J.
        • Niederman M.S.
        • et al.
        Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis.
        Arch Intern Med. 2002; 162: 1849-1858https://doi.org/10.1001/archinte.162.16.1849
        • Willyard C.
        The drug-resistant bacteria that pose the greatest health threats.
        Nature. 2017; 543: 15https://doi.org/10.1038/nature.2017.21550
        • Cillóniz C.
        • Gabarrús A.
        • Ferrer M.
        • Puig de la Bellacasa J.
        • Rinaudo M.
        • Mensa J.
        • et al.
        Community-acquired pneumonia due to multidrug- and non-multidrug-resistant Pseudomonas aeruginosa.
        Chest. 2016; 150: 415-425https://doi.org/10.1016/j.chest.2016.03.042
        • Metlay J.P.
        • Waterer G.W.
        • Long A.C.
        • Anzueto A.
        • Brozek J.
        • Crothers K.
        • et al.
        Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America.
        Am J Respir Crit Care Med. 2019; 200: e45-e67https://doi.org/10.1164/rccm.201908-1581ST
        • Mandell L.A.
        • Wunderink R.G.
        • Anzueto A.
        • Bartlett J.G.
        • Campbell G.D.
        • Dean N.C.
        • et al.
        Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
        Clin Infect Dis. 2007; 44: S27-S72https://doi.org/10.1086/511159
        • Yamamoto T.
        • Komiya K.
        • Fujita N.
        • Okabe E.
        • Hiramatsu K.
        • Kadota J.I.
        COVID-19 pandemic and the incidence of community-acquired pneumonia in elderly people.
        Respir Investig. 2020; 58: 435-436https://doi.org/10.1016/j.resinv.2020.09.001
        • Yoshikawa H.
        • Komiya K.
        • Yamamoto T.
        • Fujita N.
        • Oka H.
        • Okabe E.
        • et al.
        Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia.
        Sci Rep. 2021; 11: 4319https://doi.org/10.1038/s41598-021-83995-3
        • Goto A.
        • Komiya K.
        • Yamasue M.
        • Yoshikawa H.
        • Umeki K.
        • Hiramatsu K.
        • et al.
        Methicillin-resistant Staphylococcus aureus among elderly patients with community-acquired pneumonia.
        J Infect Chemother. 2022; 28: 1138-1142https://doi.org/10.1016/j.jiac.2022.04.012
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel index.
        Md State Med J. 1965; 14: 61-65
        • Granger C.V.
        • Dewis L.S.
        • Peters N.C.
        • Sherwood C.C.
        • Barrett J.E.
        Stroke rehabilitation: analysis of repeated Barthel index measures.
        Arch Phys Med Rehabil. 1979; 60: 14-17
        • Miyashita N.
        • Matsushima T.
        • Oka M.
        • Japanese Respiratory S.
        The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations.
        Intern Med. 2006; 45: 419-428https://doi.org/10.2169/internalmedicine.45.1691
        • Kohno S.
        • Seki M.
        • Takehara K.
        • Yamada Y.
        • Kubo K.
        • Ishizaka A.
        • et al.
        Prediction of requirement for mechanical ventilation in community-acquired pneumonia with acute respiratory failure: a multicenter prospective study.
        Respiration. 2013; 85: 27-35https://doi.org/10.1159/000335466
        • Okada F.
        • Ando Y.
        • Honda K.
        • Nakayama T.
        • Ono A.
        • Tanoue S.
        • et al.
        Acute Klebsiella pneumoniae pneumonia alone and with concurrent infection: comparison of clinical and thin-section CT findings.
        Br J Radiol. 2010; 83: 854-860https://doi.org/10.1259/bjr/28999734
        • Komiya K.
        • Ishii H.
        • Umeki K.
        • Mizunoe S.
        • Okada F.
        • Johkoh T.
        • et al.
        Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: a multicenter retrospective cohort study.
        Respirology. 2013; 18: 514-521https://doi.org/10.1111/resp.12029
        • Komiya K.
        • Yamamoto T.
        • Yoshikawa H.
        • Goto A.
        • Umeki K.
        • Johkoh T.
        • et al.
        Factors associated with gravity-dependent distribution on chest CT in elderly patients with community-acquired pneumonia: a retrospective observational study.
        Sci Rep. 2022; 12: 8023https://doi.org/10.1038/s41598-022-12092-w
        • Seymann G.B.
        • Di Francesco L.
        • Sharpe B.
        • Rohde J.
        • Fedullo P.
        • Schneir A.
        • et al.
        The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia.
        Clin Infect Dis. 2009; 49: 1868-1874https://doi.org/10.1086/648429
        • Sando E.
        • Suzuki M.
        • Ishida M.
        • Yaegashi M.
        • Aoshima M.
        • Ariyoshi K.
        • et al.
        Definitive and indeterminate Pseudomonas aeruginosa infection in adults with community-acquired pneumonia: a prospective observational study.
        Ann Am Thorac Soc. 2021; 18: 1475-1481https://doi.org/10.1513/AnnalsATS.201906-459OC
        • Rea-Neto A.
        • Youssef N.C.
        • Tuche F.
        • Brunkhorst F.
        • Ranieri V.M.
        • Reinhart K.
        • et al.
        Diagnosis of ventilator-associated pneumonia: a systematic review of the literature.
        Crit Care. 2008; 12: R56https://doi.org/10.1186/cc6877
        • Masterton R.G.
        • Galloway A.
        • French G.
        • Street M.
        • Armstrong J.
        • Brown E.
        • et al.
        Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy.
        J Antimicrob Chemother. 2008; 62: 5-34https://doi.org/10.1093/jac/dkn162
        • Benenson R.S.
        • Kepner A.M.
        • Pyle 2nd, D.N.
        • Cavanaugh S.
        Selective use of blood cultures in emergency department pneumonia patients.
        J Emerg Med. 2007; 33: 1-8https://doi.org/10.1016/j.jemermed.2006.12.034
        • Mensa J.
        • Barberán J.
        • Soriano A.
        • Llinares P.
        • Marco F.
        • Cantón R.
        • et al.
        Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: guidelines by the Spanish Society of Chemotherapy.
        Rev Española Quimioter. 2018; 31: 78-100
        • Castanheira M.
        • Mills J.C.
        • Farrell D.J.
        • Jones R.N.
        Mutation-driven β-lactam resistance mechanisms among contemporary ceftazidime-nonsusceptible Pseudomonas aeruginosa isolates from U.S. hospitals.
        Antimicrob Agents Chemother. 2014; 58: 6844-6850https://doi.org/10.1128/aac.03681-14