359. Distribution of Pathogens in Patients Hospitalized for Community-Acquired Pneumonia: Analysis of Data from US Hospitals, 2006-2009
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Background:  To examine the distribution of pathogens in patients hospitalized for community-acquired pneumonia (CAP) in the US between 2006 and 2009.

Methods:  Using a large US multi-hospital database, we identified all patients hospitalized for CAP between 1/1/2006 and 6/30/2009 who received antibiotic therapy for at least 48 hours (except in event of death), beginning within 24 hours of hospital admission. We excluded patients with probable healthcare-associated pneumonia (HCAP), and further limited our analyses to patients with one or more positive isolates from respiratory and/or blood cultures drawn within 24 hours of initial clinical presentation (“initial cultures”).  We characterized the distribution of pathogens based on findings from all initial cultures, and we stratified patients in all analyses according to whether or not they were admitted to intensive care within 24 hours of initial clinical presentation (“ICU patients” and “non-ICU patients”, respectively).

Results: We identified 5542 patients hospitalized for CAP who met all study entry criteria, of whom 1386 (25%) were ICU patients.  The most commonly identified pathogens were Staphylococcus aureus (17.6% of all study subjects [methicillin-resistant [MRSA]: 10.1%; methicillin-susceptible [MSSA]: 7.5%), Streptococcus pneumoniae (13.4%), Pseudomonas aeruginosa (7.4%), Escherichia coli (6.2%), and Klebsiella pneumoniae (3.1%).  Prevalence of these pathogens in ICU patients was 25.0% (MRSA: 15.9%; MSSA: 9.1%), 16.4%, 7.9%, 8.1%, and 4.6%, respectively; corresponding prevalence in non-ICU patients was 15.2% (MRSA: 8.2%; MSSA: 7.0%), 12.4%, 7.3%, 5.5%, and 2.6%.  Almost one-quarter of all patients (23.4%) had ESKAPE pathogens (i.e., Enterococcus faecium, MRSA, K. pneumoniae, Acinetobacter baumannii, P. aeruginosa, Enterobacter spp); ESKAPE pathogens were present in 32.0% and 20.5% of ICU and non-ICU patients, respectively.

Conclusion:  S. aureus was the most frequently identified pathogen among patients hospitalized for CAP in the US between 2006 and 2009.


Subject Category: A. Antimicrobial agents and Resistance

David Weber, MD, MPH, FIDSA1, Ariel Berger, MPH2, John Edelsberg, MD, MPH2, Xing-Yue Huang, B. Pharm, Ph.D.3 and Gerry Oster, Ph.D.2, (1)University of North Carolina, School of Medicine, Chapel Hill, NC, (2)Policy Analysis Inc., Brookline, MA, (3)Forest Research Institute, Jersey City, NJ

Disclosures:

D. Weber, Cubist: Collaborator, Consultant, Research Contractor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Merck: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
GSK: Scientific Advisor, Consulting fee and Speaker honorarium
Pfizer: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
Ortho: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
Sanofi: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium

A. Berger, Forest Research Institute: Research Contractor, Research grant
Pfizer: Research Contractor, Research support
Cubist: Research Contractor, Research grant

J. Edelsberg, Forest Research Institute: Research Contractor, Research grant and Research support
cubist: Research Contractor, Research grant
pfizer: Research Contractor, Research grant

X. Y. Huang, Forest Research Institute: Employee and Shareholder, Salary

G. Oster, Forest Research Institute: Research Contractor, Research grant
Pfizer: Research Contractor, Research grant
Cubist: Research Contractor, Research grant

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