TY - JOUR T1 - Pseudomonas, enterobacteriaceae ESBL positive and staphylococcus MRSA: When to suspect them in CAP? JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P2475 AU - Elena Prina AU - Otavio T. Ranzani AU - Eva Polverino AU - Catia Cillóniz AU - Miguel Ferrer AU - Laia Fernandez AU - Jorge Puig de la Bellacasa AU - Rosario Menéndez AU - Josep Mensa AU - Antoni Torres Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P2475.abstract N2 - Background: Nosocomial pathogens have been emerging as a cause of community-acquired infections and they need different antibiotic treatment. HCAP definition presented many limitations in the identification of patients at risk. In order to identify different to treat pathogens in community-acquired pneumonia (CAP), we propose the acronym PES: Pseudomonas aeruginosa, Enterobacteriaceae extended-spectrum beta-lactamase (ESBL+) and methycilline-resistant Staphylococcus aureus (MRSA). Aims: to compare outcomes of patients with CAP due to PES pathogens with those of patients with pneumonia due to common CAP pathogens and to identify risk factors for PES. Methods: By an observational prospective study, we evaluated immunocompetent patients with CAP and an established etiologic diagnosis. We computed a score based on risk factors. Results: Of 4,549 patients, we analyzed 1,597 who presented an etiologic diagnosis. Pneumonia due to PES was identified in 94 (6%) patients with a total of 108 PES pathogens isolated (n=72 P. aeruginosa, n=15 ESBL+ and n=21 MRSA). These patients were older, had more frequently received prior antibiotic and presented acute renal failure (all p<0.001). PES pathogens were an independent variable associated to 30-day mortality (OR 2.51 95% CI, 1.20-5.25, p=0.015). The score we computed presented an AUC: 0.751 [0.703-0.800], p<0.001 and a negative predictive value of 98%. Conclusion: PES pathogens are responsible for CAP with high mortality. These pathogens need a different antibiotic treatment and the score based on risk factors can help clinicians to suspect these etiologies or to identify patients with low risk who need antibiotic recommended by CAP guideline. ER -