Risk factors for health care-associated pneumonia: Transmission of multidrug-resistant Pseudomonas aeruginosa isolates from general hospitals to nursing homes

2011 ◽  
Vol 39 (2) ◽  
pp. 173-175 ◽  
Author(s):  
Shigeru Fujimura ◽  
Yoshihisa Nakano ◽  
Hidenari Takane ◽  
Toshiaki Kikuchi ◽  
Akira Watanabe
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Pseudomonas Aeruginosa ◽  
Nursing Homes ◽  
Multidrug Resistant ◽  
General Hospitals ◽  
Health Care Associated Pneumonia

scholarly journals Epidemiology and Predictors of Multidrug-Resistant Community-Acquired and Health Care-Associated Pneumonia

2014 ◽  
Vol 58 (9) ◽  
pp. 5262-5268 ◽  
Author(s):  
Alan E. Gross ◽  
Trevor C. Van Schooneveld ◽  
Keith M. Olsen ◽  
Mark E. Rupp ◽  
Thu Hong Bui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Wound Care ◽  
Medical Center ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Content Type ◽  
Therapeutic Decisions ◽  
Health Care Associated Pneumonia ◽  
Community Onset

ABSTRACTThere are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP). However, concern for the presence of these pathogens drives the prescribing of empiric broad-spectrum antibiotics for CAP and HCAP. A retrospective study of all adults hospitalized with community-onset pneumonia (CAP and HCAP) at a large U.S. medical center from January 2010 to December 2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate whether HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score-adjusted multivariate analyses were performed. A total of 521 patients (50.5% CAP and 49.5% HCAP) were included. The most common etiologies of pneumonia were primary viral andStreptococcus pneumoniae. MDROs were isolated in 20 (3.8%) patients overall, and MDROs occurred in 5.9% and 1.9% of HCAP and CAP patients, respectively. The presence of an MDRO was not associated with HCAP classification (odds ratio [OR] = 1.95; 95% confidence interval [95% CI], 0.66 to 5.80;P= 0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and ≥48-h hospitalization in the last 90 days). Independent predictors of MDRO included the following:Pseudomonas aeruginosacolonization/infection in the previous year (OR = 7.43; 95% CI, 2.24 to 24.61;P< 0.001), antimicrobial use in the previous 90 days (OR = 2.90; 95% CI, 1.13 to 7.45;P= 0.027), admission from a nursing home (OR = 4.19; 95% CI, 1.55 to 11.31;P= 0.005), and duration of hospitalization in the previous 90 or 180 days (P= 0.013 andP= 0.002, respectively). MDROs were uncommon in HCAP and CAP. HCAP did not predict MDRO isolation. Local etiology of community onset pneumonia and specific MDRO risk factors should be integrated into therapeutic decisions to prevent empirical overprescribing of antibiotics for methicillin-resistantStaphylococcus aureus(MRSA) andP. aeruginosa.

scholarly journals Management of Health-Care Associated Pneumonia (HCAP)

2013 ◽  
pp. 87-90
Author(s):  
Alessia Rosato ◽  
Claudio Santini
Keyword(s):  
Health Care ◽  
Treatment Approach ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Community Acquired Pneumonia ◽  
Traditional Classification ◽  
Hospital Acquired Pneumonia ◽  
Health Care Associated Pneumonia ◽  
Hospital Acquired

Introduction The traditional classification of Pneumonia as either community acquired (CAP) or hospital acquired (HAP) reflects deep differences in the etiology, pathogenesis, approach and prognosis between the two entities. Health-Care Associated Pneumonia (HCAP) develops in a heterogeneous group of patients receiving invasive medical care or surgical procedures in an outpatient setting. For epidemiology and outcomes, HCAP closely resembles HAP and possibly requires an analogous therapeutic regimen effective against multidrug-resistant pathogens. Materials and methods We reviewed the pertinent literature and the guidelines for the diagnosis and management of HCAP to analyze the evidence for the recommended approach. Results Growing evidence seems to confirm the differences in epidemiology and outcome between HCAP and CAP but fails to confirm any real advantage in pursuing an aggressive treatment for all HCAP and CAP patients. Discussion Further investigations are needed to establish the optimal treatment approach according to the different categories of patients and the different illness severities. Keywords Health Care Associated Pneumonia (HCAP); Community Acquired Pneumonia (CAP); Hospital Acquired Pneumonia (HAP); Multidrug-resistant (MDR) Pathogens

scholarly journals Vaccine Protection against Multidrug-Resistant Klebsiella pneumoniae in a Nonhuman Primate Model of Severe Lower Respiratory Tract Infection

mBio ◽  
2019 ◽  
Vol 10 (6) ◽  
Author(s):  
Natalia Malachowa ◽  
Scott D. Kobayashi ◽  
Adeline R. Porter ◽  
Brett Freedman ◽  
Patrick W. Hanley ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Health Care ◽  
Lower Respiratory Tract ◽  
The United States ◽  
Multidrug Resistant ◽  
Sequence Type ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Cynomolgus Macaques

ABSTRACT Klebsiella pneumoniae is a human gut communal organism and notorious opportunistic pathogen. The relative high burden of asymptomatic colonization by K. pneumoniae is often compounded by multidrug resistance—a potential problem for individuals with significant comorbidities or other risk factors for infection. A carbapenem-resistant K. pneumoniae strain classified as multilocus sequence type 258 (ST258) is widespread in the United States and is usually multidrug resistant. Thus, treatment of ST258 infections is often difficult. Inasmuch as new preventive and/or therapeutic measures are needed for treatment of such infections, we developed an ST258 pneumonia model in cynomolgus macaques and tested the ability of an ST258 capsule polysaccharide type 2 (CPS2) vaccine to moderate disease severity. Compared with sham-vaccinated animals, those vaccinated with ST258 CPS2 had significantly less disease as assessed by radiography 24 h after intrabronchial installation of 108 CFU of ST258. All macaques vaccinated with CPS2 ultimately developed ST258-specific antibodies that significantly enhanced serum bactericidal activity and killing of ST258 by macaque neutrophils ex vivo. Consistent with a protective immune response to CPS2, transcripts encoding inflammatory mediators were increased in infected lung tissues obtained from CPS-vaccinated animals compared with control, sham-vaccinated macaques. Taken together, our data provide support for the idea that vaccination with ST258 CPS can be used to prevent or moderate infections caused by ST258. As with studies performed decades earlier, we propose that this prime-boost vaccination approach can be extended to include multiple capsule types. IMPORTANCE Multidrug-resistant bacteria continue to be a major problem worldwide, especially among individuals with significant comorbidities and other risk factors for infection. K. pneumoniae is among the leading causes of health care-associated infections, and the organism is often resistant to multiple classes of antibiotics. A carbapenem-resistant K. pneumoniae strain known as multilocus sequence type 258 (ST258) is the predominant carbapenem-resistant Enterobacteriaceae in the health care setting in the United States. Infections caused by ST258 are often difficult to treat and new prophylactic measures and therapeutic approaches are needed. To that end, we developed a lower respiratory tract infection model in cynomolgus macaques in which to test the ability of ST258 CPS to protect against severe ST258 infection.

scholarly journals Erratum for Gross et al., Epidemiology and Predictors of Multidrug-Resistant Community-Acquired and Health Care-Associated Pneumonia

2014 ◽  
Vol 58 (10) ◽  
pp. 6342-6342 ◽  
Author(s):  
Alan E. Gross ◽  
Trevor C. Van Schooneveld ◽  
Keith M. Olsen ◽  
Mark E. Rupp ◽  
Thu Hong Bui ◽  
...  
Keyword(s):  
Health Care ◽  
Multidrug Resistant ◽  
Health Care Associated Pneumonia

scholarly journals Role of multidrug-resistant pathogens in health-care-associated pneumonia

2011 ◽  
Vol 11 (1) ◽  
pp. 11-12 ◽  
Author(s):  
Marco Falcone ◽  
Mario Venditti ◽  
Salvatore Corrao ◽  
Pietro Serra
Keyword(s):  
Health Care ◽  
Multidrug Resistant ◽  
Multidrug Resistant Pathogens ◽  
Health Care Associated Pneumonia

scholarly journals Pseudomonas aeruginosa Nosocomial Pneumonia: Impact of Pneumonia Classification

2015 ◽  
Vol 36 (10) ◽  
pp. 1190-1197 ◽  
Author(s):  
Scott T. Micek ◽  
Marin H. Kollef ◽  
Antoni Torres ◽  
Catherine Chen ◽  
Jordi Rello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Multidrug Resistance ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Multidrug Resistant ◽  
Resistant Isolate ◽  
Antibiotic Administration ◽  
Specific Risk ◽  
Charlson Comorbidity Score

OBJECTIVETo describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).DESIGNWe conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).SETTINGTwelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).PATIENTS/PARTICIPANTSA total of 742 patients with Pa-NP.RESULTSHospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.CONCLUSIONSAmong patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.Infect Control Hosp Epidemiol 2015;36(10):1190–1197

scholarly journals Occupational Risk Factors for Upper-limb and Neck Musculoskeletal Disorder among Health-care Staff in Nursing Homes for the Elderly in France

2014 ◽  
Vol 52 (4) ◽  
pp. 334-346 ◽  
Author(s):  
Carole PELISSIER ◽  
Luc FONTANA ◽  
Emmanuel FORT ◽  
Jean Pierre AGARD ◽  
Francoise COUPRIE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Nursing Homes ◽  
Upper Limb ◽  
Musculoskeletal Disorder ◽  
The Elderly ◽  
Care Staff ◽  
Health Care Staff ◽  
Occupational Risk Factors ◽  
Homes For The Elderly

scholarly journals Genotypic Characterization of Multidrug-Resistant Pseudomonas aeruginosa Using Whole-Genome Sequencing

2021 ◽  
Vol 10 (32) ◽  
Author(s):  
Baha Abdalhamid ◽  
Itidal Reslane ◽  
Emily Mccutchen ◽  
Peter C. Iwen
Keyword(s):  
Health Care ◽  
Pseudomonas Aeruginosa ◽  
Draft Genome ◽  
Multidrug Resistant ◽  
Whole Genome ◽  
Significant Morbidity ◽  
Genome Sequences ◽  
Content Type ◽  
Human Infections

Multidrug-resistant Pseudomonas aeruginosa is a serious threat worldwide causing health care-acquired infections and is associated with significant morbidity and mortality. This report describes the draft genome sequences of five multidrug-resistant Pseudomonas aeruginosa strains isolated from human infections.

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