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Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

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Author(s)

GLIMP investigators, David Villafuerte, Stefano Aliberti, Nilam J Soni, Paola Faverio, Pedro J Marcos, Richard G Wunderink, Alejandro Rodriguez, Oriol Sibila, Francisco Sanz, Ignacio Martin-Loeches, Francesco Menzella, Luis F Reyes, Mateja Jankovic, Marc Spielmanns, Marcos I Restrepo

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Abstract

Background and objective: Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP.

Methods: We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection.

Results: Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP.

Conclusion: This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.

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Original languageEnglish
Pages (from-to)543-551
Number of pages9
JournalRespirology
Volume25
Issue number5
Early online date5 Aug 2019
DOIs
Publication statusPublished - May 2020

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