Abstract
Pneumonia caused by MDR pathogens is becoming a worldwide problem difficult to manage.The aim was to investigate whether in pneumonia MDR infection is associated with acute respiratory failure (ARF) development or with a higher mortality.
We retrospectively investigated patients with CAP or HCAP who had been admitted to Fondazione IRCCS Ca' Granda Policlinico of Milan from January 2008 to April 2010. We considered as MDR the following ones: MRSA,ESBL bacteria,multiresistant Pseudomonas,Vancomycin-resistant-Enterococcus and Acynetobacter baumanii.
935 patients with pneumonia (504 males) with a mean age of 76±14, were included in the study. One or more pathogens were isolated in 183 cases (20%)and MDR was found in 28 (3%). Factors that most likely were associated to a MDR infection were a previous hospitalization (odds ratio 5; CI95% 2.1-11.8) and antibiotic treatment (OR 2.48; CI95% 1.008-6.1)within 90 days. MDR infection was associated with a higher mortality (p 0.0001, OR 5; CI95% 2.11-11.8) but not with ARF development (p 0.093).Clinical features on admission are listed in table 1.
A multivariable regression logistic analysis adjusted for immune system status and empiric antibiotic coverage of aetiologic pathogen,showed that MDR infection was an independent risk factor for mortality (OR 7.5; CI95%1.75-32).
These results suggest that,despite a correct initial antibiotic treatment,a MDR infection seem related to a poor outcome so this subgroup of patients should be closely monitored and treated with aggresive support measures.
- © 2011 ERS