Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia
- Autori: Marin-Corral J.; Pascual-Guardia S.; Amati F.; Aliberti S.; Masclans J.R.; Soni N.; Rodriguez A.; Sibila O.; Sanz F.; Sotgiu G.; Anzueto A.; Dimakou K.; Petrino R.; van de Garde E.; Restrepo M.I.; Aruj P.K.; Attorri S.; Barimboim E.; Caeiro J.P.; Garzon M.I.; Cambursano V.H.; Adrian Ceccato V.H.D.C.A.; Chertcoff J.; Lascar F.; Di Tulio F.; Diaz A.C.; de Vedia L.; Ganaha M.C.; Lambert S.; Lopardo G.; Luna C.M.; Malberti A.G.; Morcillo N.; Tartara S.; Pensotti C.; Pereyra B.; Scapellato P.G.; Stagnaro J.P.; Shah S.; Lotsch F.; Thalhammer F.; Anseeuw K.; Francois C.A.; Van Braeckel E.; Vincent J.L.; Djimon M.Z.; Bashi J.; Dodo R.; Nouer S.A.; Chipev P.; Encheva M.; Miteva D.; Petkova D.; Balkissou A.D.; Pefura Yone E.W.; Mbatchou Ngahane B.H.; Shen N.; Xu J.-F.; Bustamante Rico C.A.; Buitrago R.; Pereira Paternina F.J.; Kayembe Ntumba J.-M.; Carevic V.V.; Jakopovic M.; Jankovic M.; Matkovic Z.; Mitrecic I.; Bouchy Jacobsson M.-L.; Christensen A.B.; Heitmann Bodtger U.C.; Meyer C.N.; Jensen A.V.; Baunbaek-knudsen G.; Petersen P.T.; Andersen S.; El-Said Abd El-Wahhab I.; Morsy N.E.; Shafiek H.; Sobh E.; Abdulsemed K.A.; Bertrand F.; Brun-Buisson C.; de Montmollin E.; Fartoukh M.; Messika J.; Tattevin P.; Khoury A.; Ebruke B.; Dreher M.; Kolditz M.; Meisinger M.; Pletz M.W.; Hagel S.; Rupp J.; Schaberg T.; Spielmanns M.; Creutz P.; Suttorp N.; Siaw-Lartey B.; Papapetrou D.; Tsigou E.; Ampazis D.; Kaimakamis E.; Bhatia M.; Dhar R.; D'Souza G.; Garg R.; Koul P.A.; Mahesh P.A.; Jayaraj B.S.; Narayan K.V.; Udnur H.B.; Krishnamurthy S.B.; Kant S.; Swarnakar R.; Limaye S.; Salvi S.; Golshani K.; Keatings V.M.; Martin-Loeches I.; Maor Y.; Strahilevitz J.; Faverio P.; Battaglia S.; Carrabba M.; Ceriana P.; Confalonieri M.; Monforte A.D.; Del Prato B.; De Rosa M.; Fantini R.; Fiorentino G.; Gammino M.A.; Menzella F.; Milani G.; Nava S.; Palmiero G.; Gabrielli B.; Rossi P.; Sorino C.; Steinhilber G.; Zanforlin A.; San Luca O.; Franzetti F.; Carugati M.; Morosi M.; Monge E.; Carone M.; Patella V.; Scarlata S.; Comel A.; Kurahashi K.; Bacha Z.A.; Ugalde D.B.; Zuniga O.C.; Villegas J.F.; Medenica M.; Mihsra D.R.; Shrestha P.; Ridgeon E.; Awokola B.I.; Adefuye Bolanle Olufunlola O.N.O.; Olumide S.; Ukwaja K.N.; Irfan M.; Minarowski L.; Szymon S.; Froes F.; Leuschner P.; Meireles M.; Ferrao C.; Neves J.; Abel Salazar; Ravara S.B.; Brocovschii V.; Rusu D.; Toma C.; Chirita D.; Dorobat C.M.; Birkun A.; Kaluzhenina A.; Almotairi A.; Ali Bukhary Z.A.; Edathodu J.; Fathy A.; Abdulaziz Enani A.M.; Mohamed N.E.; Memon J.U.; Bella A.; Bogdanovic S.N.; Milenkovic B.; Pesut D.; Borderias L.; Bordon Garcia N.M.; Alarcon H.C.; Cilloniz C.; Torres A.; Diaz-Brito V.; Casas X.; Gonzalez A.E.; Fernandez-Almira M.L.; Interna M.; Gallego M.; Gaspar-GarcIa I.; Gonzalez del Castillo J.; Victoria P.J.; Martinez E.L.; Malo de Molina R.; Marcos P.J.; Menendez R.; Pando-Sandoval A.; Aymerich C.P.; Lacoma de la Torre A.; Garcia-Olive I.; Rello J.; Moyano S.; Rodrigo-Troyano A.; Sole-Violan J.; Uranga A.; van Boven J.F.; Torra E.V.; Pujol J.A.; Feldman C.; Yum H.K.; Arnauld Attannon Fiogbe I.U.; Yangui F.; Bilaceroglu S.; Levent Dalar I.D.; Yilmaz U.; Bogomolov A.; Elahi N.; Dhasmana D.J.; Feneley A.; Hill A.T.; Rudran B.; Ruiz-Buitrago S.; Campbell M.; Whitaker P.; Youzguin A.; Singanayagam A.; Hancock C.; Villafuerte D.; Allen K.S.; Brito V.; Dietz J.; Dysart C.E.; Kellie S.M.; Ricardo A. Franco-Sadud C.J.; Meier G.; Gaga M.; Holland T.L.; Bergin S.P.; Kheir F.; Landmeier M.; Lois M.; Nair G.B.; Patel H.; Reyes K.; Rodriguez-Cintron W.; Saito S.; Noda J.; Hinojosa C.I.; Levine S.M.; Reyes L.F.; Angel L.F.; Whitlow K.S.; Hipskind J.; Sukhija K.; Totten V.; Wunderink R.G.; Shah R.D.; Mateyo K.J.; Noriega L.; Alvarado E.; Aman M.; Labra L.
- Anno di pubblicazione: 2021
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/534645
Abstract
Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.