A therapeutic strategy for all pneumonia patients: a 3-year prospective multicenter cohort study using risk factors for multiresistant pathogens to select initial empiric therapy
Pneumonia empiric therapy is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multiresistant (MDR) pathogens. The authors applied an algorithm to 1,089 patients using MDR risks (antibiotic use on the last 180 days before pneumonia diagnosis, poor functional state, hospitalized patient for more than 2 days within the last 90 days before pneumonia diagnosis, pneumonia occurring for 5 or more days after admission to acute care hospital, hemodialysis and immune suppression). Of these, 656 patients had community acquired pneumonia; 238 healthcare associated pneumonia; 140 hospital associated pneumonia and 55 ventilator associated pneumonia. Mortality at 30 days was 50.1 % for ventilator associated pneumonia, 27.9 % for hospital associated pneumonia, 13.6 % for healthcare associated pneumonia, and 4.7 % for community acquired pneumonia. The algorithm adopted was 0 to 1 risk factors treated with one beta lactam plus one quinolone, or one macrolide, and 2 or more risk factors treated with an anti-pseudomonal beta lactam plus quinolone, or aminoglycoside, and if chosen by physician, vancomycin or linezolide. Of patients, 83 % were treated using the algorithm. Mortality was statistically correlated with risk factors, hypotension, and inappropriate therapy, but it was not associated to the site where the pneumonia was acquired.
Maruyama T, Fujisawa T, Ishida T, Ito A, Oyamada Y, Fujimoto K, et al. A therapeutic strategy for all pneumonia patients: a 3 year prospective multicenter cohort study using risk factors for multidrug resistant pathogens to select initial empiric therapy. Clin Infect Dis. 2019;86:1083-88. https://doi.org/10.1093/cid/ciy631.