Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia : a multinational point prevalence study of hospitalised patients

Restrepo, M. I.; Babu, B. L.; Reyes, L. F.; Chalmers, J. D.; Soni, N. J.; Sibila, O.; Faverio, P.; Cilloniz, C.; Rodriguez-Cintron, W.; Aliberti, S.; Aruj, P. K.; Attorri, S.; Barimboim, E.; Caeiro, J. P.; Garzon, M. I.; Cambursano, V. H.; Ceccato, 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.; Dodo Balkissou, A.; Pefura Yone, E. W.; Mbatchou Ngahane, B. H.; Shen, N.; J. F., Xu; 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.; Bro Christensen, A.; Heitmann Bodtger, U. C.; Niels Meyer, C.; Vestergaard Jensen, A.; Baunbaek-Knudsen, G.; Petersen, P. T.; Andersen, S.; Abd El-Wahhab, I. E.; Elsayed Morsy, N.; Shafiek, H.; Sobh, E.; Abdella Abdulsemed, K.; 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.; Dimakou, K.; 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.; 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.; Petrino, R.; Gabrielli, B.; Rossi, P.; Sorino, C.; Steinhilber, G.; Zanforlin, A.; 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.; van de Garde, E. M. W.; Raj Mihsra, D.; Shrestha, P.; Ridgeon, E.; Awokola, B. I.; Nwankwo, O. N. O.; Olufunlola, A. B.; Olumide, S.; Ukwaja, K. N.; Irfan, M.; Minarowski, L.; Szymon, S.; Froes, F.; Leuschner, P.; Meireles, M.; Ferrao, C.; Neves, J.; Ravara, S. B.; Brocovschii, V.; Ion, C.; 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, N.; Milenkovic, B.; Pesut, D.; Feldman, C.; Yum, H. K.; Borderias, L.; Bordon Garcia, N. M.; Cabello Alarcon, H.; Torres, A.; Diaz-Brito, V.; Casas, X.; Gonzalez, A. E.; Fernandez-Almira, M. L.; Gallego, M.; Gaspar-Garcia, I.; Del Castillo, J. G.; Victoria, P. J.; Martinez, E. L.; de Molina, R. M.; Marcos, P. J.; Menendez, R.; Pando-Sandoval, A.; Aymerich, C. P.; de la Torre, A. L.; Garcia-Olive, I.; Rello, J.; Moyano, S.; Sanz, F.; Rodrigo-Troyano, A.; Sole-Violan, J.; Uranga, A.; van Boven, J. F. M.; Torra, E. V.; Pujol, J. A.; Fiogbe, A. A.; Yangui, F.; Bilaceroglu, S.; Dalar, L.; Yilmaz, U.; Bogomolov, A.; Elahi, N.; Dhasmana, D. J.; Feneley, A.; Ions, R.; Skeemer, J.; Woltmann, G.; Hancock, C.; Hill, A. T.; Rudran, B.; Ruiz-Buitrago, S.; Campbell, M.; Whitaker, P.; Youzguin, A.; Singanayagam, A.; Allen, K. S.; Brito, V.; Dietz, J.; Dysart, C. E.; Kellie, S. M.; Zablocki, C. J.; Murphymurphy, R. G.; Franco-Sadud, R. A.; Meier, G.; Gaga, M.; Holland, T. L.; Bergin, S. P.; Kheir, F.; Landmeier, M.; Lois, M.; Nair, G. B.; Patel, H.; Saito, S.; Noda, J.; Hinojosa, C. I.; Levine, S. M.; Angel, L. F.; Anzueto, A.; 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.

doi:10.1183/13993003.01190-2017

Pseudomonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients.