6533b837fe1ef96bd12a3453

RESEARCH PRODUCT

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

Judith Marin-corralS. Pascual-guardiaFrancesco AmatiStefano AlibertiJoan R MasclansNilam SoniAlejandro RodriguezOriol SibilaFrancisco SanzGiovanni SotgiuAntonio AnzuetoKaterina DimakouRoberta PetrinoEwoudt Van De GardeMarcos I RestrepoGlimp InvestigatorsPatricia Karina ArujSilvia AttorriEnrique BarimboimJuan Pablo CaeiroMaría I GarzónVictor Hugo CambursanoV H Dr Cazaux A Adrian CeccatoJulio ChertcoffFlorencia LascarFernando Di TulioAriel Cordon DíazLautaro De VediaMaria Cristina GanahaSandra LambertGustavo LopardoCarlos M LunaAlessio Gerardo MalbertiNora MorcilloSilvina TartaraClaudia PensottiBetiana PereyraPablo Gustavo ScapellatoJuan Pablo StagnaroSonali ShahFelix LötschFlorian ThalhammerKurt AnseeuwCamille A FrancoisEva Van BraeckelJean Louis VincentMarcel Zannou DjimonJules BashiRoger DodoSimone Aranha NouérPeter ChipevMilena EnchevaDarina MitevaDiana PetkovaAdamou Dodo BalkissouEric Walter Pefura YoneBertrand Hugo Mbatchou NgahaneNing ShenJin-fu XuCarlos Andres Bustamante RicoRicardo BuitragoFernando Jose Pereira PaterninaJean-marie Kayembe NtumbaVesna Vladic CarevicMarko JakopovicMateja JankovicZinka MatkovicIvan MitrecicMarie-laure Bouchy JacobssonAnette Bro ChristensenUffe Christian Heitmann BødtgerChristian Niels MeyerAndreas Vestergaard JensenGertrud Baunbæk-knudsenPelle Trier PetersenStine AndersenIbrahim El-said Abd El-wahhabNesreen Elsayed MorsyHanaa ShafiekEman SobhKedir Abdella AbdulsemedFabrice BertrandChristian Brun-buissonEtienne De MontmollinMuriel FartoukhJonathan MessikaPierre TattevinAbdo KhouryBernard EbrukeMichael DreherMartin KolditzMatthias MeisingerMathias W PletzStefan HagelJan RuppTom SchabergMarc SpielmannsPetra CreutzNorton SuttorpBeatrice Siaw-larteyDimosthenis PapapetrouEvdoxia TsigouDimitrios AmpazisEvaggelos KaimakamisMohit BhatiaRaja DharGeorge D'souzaRajiv GargParvaiz A KoulP A MaheshB S JayarajKiran Vishnu NarayanHirennappa B UdnurShashi Bhaskara KrishnamurthySurya KantRajesh SwarnakarSneha LimayeSundeep SalviKeihan GolshaniVera M KeatingsIgnacio Martin-loechesYasmin MaorJacob StrahilevitzPaola FaverioSalvatore BattagliaMaria CarrabbaPiero CerianaMarco ConfalonieriAntonella D'arminio MonforteBruno Del PratoMarino De RosaRiccardo FantiniGiuseppe FiorentinoMaria Antonia GamminoFrancesco MenzellaGiuseppe MilaniStefano NavaGerardo PalmieroBarbra GabrielliPaolo RossiClaudio SorinoGundi SteinhilberAlessandro ZanforlinOspedale San LucaFabio FranzettiManuela CarugatiManuela MorosiElisa MongeMauro CaroneVincenzo PatellaSimone ScarlataAndrea ComelKiyoyasu KurahashiZeina Aoun BachaDaniel Barajas UgaldeOmar Ceballos ZuñigaJosé F VillegasMilic MedenicaDeebya Raj MihsraPoojan ShresthaElliott RidgeonBabatunde Ishola AwokolaOgonna N O Adefuye Bolanle OlufunlolaSegaolu OlumideKingsley N UkwajaMuhammad IrfanŁUkasz MinarowskiSkoczyński SzymonFelipe FroesPedro LeuschnerMariana MeirelesCláudia FerrãoPedro LeuschnerJoão NevesAbel SalazarSofia B RavaraVictoria BrocovschiiDoina RusuCristina TomaDaniela ChiritaCarmen Mihaela DorobatAlexei BirkunAnna KaluzheninaAbdullah AlmotairiZakeya Abdulbaqi Ali BukharyJameela EdathoduAmal FathyAbdullah Mushira Abdulaziz EnaniNazik Eltayeb MohamedJawed Ulhadi MemonAbdelhaleem BellaSerbia Nada BogdanovićBranislava MilenkovicDragica PesutLuis BorderìasNoel Manuel Bordon GarciaHugo Cabello AlarcónCatia CillonizAntoni TorresVicens Diaz-britoXavier CasasAlicia Encabo GonzálezMaria Luisa Fernández-almiraMedicina InternaMiguel GallegoInmaculada Gaspar-garcíaJuan González Del CastilloPatricia Javaloyes VictoriaElena Laserna MartínezRosa Malo De MolinaPedro J MarcosRosario MenéndezAna Pando-sandovalCristina Prat AymerichAlicia Lacoma De La TorreIgnasi García-olivéJordi RelloSilvia MoyanoAna Rodrigo-troyanoJordi Solé-violánAne UrangaJob Fm Van BovenEster Vendrell TorraJordi Almirall PujolCharles FeldmanHo Kee YumInje Univ Arnauld Attannon FiogbeFerdaous YanguiSemra BilacerogluIzmir Dr Levent DalarUfuk YilmazArtemii BogomolovNaheed ElahiDevesh J DhasmanaAndrew FeneleyAdam T HillBanu RudranSilvia Ruiz-buitragoMarion CampbellPaul WhitakerAlexander YouzguinAnika SinganayagamC HancockDavid VillafuerteKaren S AllenVeronica BritoJessica DietzClaire E DysartSusan M KellieClement J Ricardo A Franco-sadudGarnet MeierMina GagaThomas L HollandStephen P BerginFayez KheirMark LandmeierManuel LoisGirish B NairHemali PatelKatherine ReyesWilliam Rodriguez-cintronShigeki SaitoJulio NodaCecilia I HinojosaStephanie M LevineLuis F ReyesLuis F AngelAntonio AnzuetoK Scott WhitlowJohn HipskindKunal SukhijaVicken TottenRichard G WunderinkRay D ShahKondwelani John MateyoLorena NoriegaEzequiel AlvaradoMohamed AmanLucía Labra

subject

MalePulmonary and Respiratory Medicinemedicine.drug_classAspiration riskAntibioticsNursing home residentSettore MED/10 - Malattie Dell'Apparato RespiratorioCritical Care and Intensive Care MedicineMicrobiologyanaerobic; aspiration; bacteria; pneumonia; risk factors.Cohort Studies03 medical and health sciences0302 clinical medicineCommunity-acquired pneumoniaTaverneAnti-Bacterial AgentmedicineHumanspneumoniarisk factors.Community-Acquired Infection030212 general & internal medicinebacteriaStrokeAgedAged 80 and overaspirationbusiness.industryRespiratory AspirationMiddle Agedmedicine.diseaseAntibiotic coverageAnti-Bacterial AgentsCommunity-Acquired InfectionsHospitalizationPneumonia030228 respiratory systemRisk factorsrisk factoranaerobicFemaleUnderweightmedicine.symptombusinessCardiology and Cardiovascular Medicine

description

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.

yearjournalcountryeditionlanguage
2021-01-01
10.1016/j.chest.2020.06.079http://hdl.handle.net/10447/534645