370. Pneumonia in Intensive Care Unit Patients: Incidence, Risk Factors and Outcomes Related to Multidrug-Resistant Organisms
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-095 MDROs - IDSA11.pdf (331.2 kB)
  • Background: Hospital-acquired (HAP), ventilator-associated (VAP) and healthcare-associated pneumonia (HCAP) are caused by a wide spectrum of bacterial pathogens. Rates of infection due to multidrug-resistant pathogens (MDRs) have increased dramatically in hospitalized patients, especially in intensive care (ICU). While multiple risk factors exist for MDRs infection, we wished to assess which risk factors were most likely associated with pneumonia due to MDRs in ICU patients.

    Methods: Retrospective, multicenter observational evaluation of ICU patients with pneumonia enrolled in the IMPACT-HAP study (02/06 - 07/07). We used CDC criteria for the diagnosis of pneumonia and ATS/IDSA definitions for HAP, VAP, and HCAP. All patients had a confirmed microbiologic diagnosis. MDRs included: methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter species. Pneumonia patients with MDRs were compared with those with no MDRs.

    Results: 278 ICU patients (HAP=43, VAP=189, HCAP=46) had pneumonia and ≥1 pathogen identified. MDRs were found in 64% (n=178) of subjects. Variables independently associated with recovery of MDRs in logistic regression: history of COPD (OR, 2.52; 95% CI, 1.17-5.43; p=0.018), antimicrobial therapy in preceding 30 days (OR, 1.9; 95% CI, 1.02-3.54; p=0.042). Residence in a nursing home or extended care facility approached statistical significance (OR, 2.3; 95% CI, 0.90-5.84; p=0.080). We used these 3 variables to create a point score to determine risk of pneumonia due to MDRs [Figure 1].

    Initial empiric therapy included ≥1 antibiotic active against the first (91.6%) and second (81.5%) pathogen(s) recovered from the 278 patients. Clinical success at day 14 (72% vs 62%, p=0.1), day 28 (65% vs 58%, p=0.25), and mortality day 28 (15% vs 14%, p=0.89) were comparable between MDRs/non-MDRs groups.

    Conclusion: Patients with HAP/VAP/HCAP in the ICU have at least 50% chance of pneumonia with MDRs. Presence of additional risk factors can elevate likelihood of MDRs to 80%. The comparable outcomes may suggest that MDR pathogens are not inherently more virulent that non-resistant bacteria when treated correctly.

    Figure 1. Point score to determine risk of pneumonia due to MDR pathogens (p<0.001 for trend).


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Daniel H. Kett, MD1, Verna L. Welch, PhD, MPH2, Paula Peyrani, MD3, Ernesto G. Scerpella, MD4, Kimbal D. Ford, PharmD4 and Julio Ramirez, MD3, (1)Section of Critical Care Medicine, Miller School of Medicine at the University of Miami, Miami, FL, (2)US Medical Affairs, Pfizer, Inc, New York, NY, (3)Division of Infectious Diseases, University of Louisville, Louisville, KY, (4)Infectious Diseases, Specialty Care Medicines Development Group, Pfizer Inc., Collegeville, PA

    Disclosures:

    D. H. Kett, Pfizer: Consultant, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
    Astellas: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
    Cubist: Scientific Advisor, Consulting fee

    V. L. Welch, Pfizer, Inc.: Employee and Shareholder, Salary and Stock

    P. Peyrani, None

    E. G. Scerpella, Pfizer Inc.: Employee and Shareholder, Salary

    K. D. Ford, Pfizer, Inc.: Employee and Shareholder, Salary

    J. Ramirez, Pfizer: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Cubist: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Ortho McNeil: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.