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

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.

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

mBio ◽

10.1128/mbio.02994-19 ◽

2019 ◽

Vol 10 (6) ◽

Cited By ~ 3

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.

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

American Journal of Infection Control ◽

10.1016/j.ajic.2010.06.020 ◽

2011 ◽

Vol 39 (2) ◽

pp. 173-175 ◽

Cited By ~ 1

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

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Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02441-14 ◽

2014 ◽

Vol 58 (8) ◽

pp. 4630-4635 ◽

Cited By ~ 20

Author(s):

Teena Chopra ◽

Dror Marchaim ◽

Paul C. Johnson ◽

Reda A. Awali ◽

Hardik Doshi ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Acinetobacter Baumannii ◽

Bloodstream Infection ◽

Medical Center ◽

Care Facility ◽

Health Care Facility ◽

Positive Culture ◽

Acinetobacter Calcoaceticus ◽

Content Type

ABSTRACTIdentifying patients at risk for bloodstream infection (BSI) due toAcinetobacter baumannii-Acinetobacter calcoaceticuscomplex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥3 (odds ratio [OR], 2.34;P= 0.001), a direct admission from another health care facility (OR, 4.63;P< 0.0001), a prior hospitalization (OR, 3.11;P< 0.0001), the presence of an indwelling central venous line (OR, 2.75;P= 0.011), the receipt of total parenteral nutrition (OR, 21.2;P< 0.0001), the prior receipt of β-lactams (OR, 3.58;P< 0.0001), the prior receipt of carbapenems (OR, 3.18;P= 0.006), and the prior receipt of chemotherapy (OR, 15.42;P< 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40;P< 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

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Complete Genome Sequence of Pandoraea pnomenusa TF-18, a Multidrug-Resistant Organism Isolated from the Rhizosphere of Rice (Oryza sativa L. subsp. japonica)

Microbiology Resource Announcements ◽

10.1128/mra.01008-19 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Mihnea R. Mangalea ◽

Emily K. Luna ◽

Janet Ziegle ◽

Christine Chang ◽

Angela M. Bosco-Lauth ◽

...

Keyword(s):

Single Molecule ◽

Complete Genome ◽

Oryza Sativa L ◽

Gc Content ◽

Multidrug Resistant ◽

Selective Medium ◽

Resistant Organism ◽

Smrt Sequencing ◽

Sequencing Technology ◽

Content Type

Pandoraea pnomenusa strain TF-18 was isolated from the roots of rice seedlings on selective medium containing four classes of antibiotics for isolation of Burkholderia pseudomallei. Using Pacific Biosciences (PacBio) single-molecule real-time (SMRT) sequencing technology, we report here a complete genome of 5,499,432 bases, a GC content of 64.8%, and 4,849 coding sequences.

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Research on risk management of medical and health care integration projects based on fuzzy WINGS-G1

Kybernetes ◽

10.1108/k-07-2021-0578 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Yu Zhang ◽

Lan Xu

Keyword(s):

Risk Factors ◽

Health Care ◽

Risk Management ◽

Fuzzy Theory ◽

Dynamic Nature ◽

Content Type ◽

Care Integration ◽

Rational Allocation ◽

Control And Prevention ◽

Risk Potential

PurposeThis study establishes a risk management system for medical and health care integration projects to address the problem of high-risk potential and a strong correlation between risk factors.Design/methodology/approachA new fuzzy WINGS-G1 model for identifying key risk factors in medical and health care integration projects is proposed by introducing the fuzzy theory and the concept of risk incidence into the Weighted Influence Non-linear Gauge System (WINGS) method.FindingsThe authors analyze the fluidity of project risk factors through complex networks to control direct risks and cut off risk transmission paths to provide a reference for risk control and prevention of medical and health care integration projects.Originality/value(1) The integration of fuzzy theory into the WINGS method solves the problem of strong subjectivity of expert scoring in the traditional WINGS method; (2) By the different probabilities of risk factors, the concept of risk incidence is introduced in the WINGS model, which is more conducive to the identification of the critical risk factors and the rational allocation and utilization of organizational resources; (3) The use of the complex network for risk interactivity analysis fully reflects the dynamic nature of risk factors in medical and health care integration projects.

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Impact of Extended-Spectrum β-Lactamase Production on Treatment Outcomes of Acute Pyelonephritis Caused by Escherichia coli in Patients without Health Care-Associated Risk Factors

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04821-14 ◽

2015 ◽

Vol 59 (4) ◽

pp. 1962-1968 ◽

Cited By ~ 13

Author(s):

Sun Hee Park ◽

Su-Mi Choi ◽

Dong-Gun Lee ◽

Sung-Yeon Cho ◽

Hyo-Jin Lee ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Health Care ◽

Treatment Outcomes ◽

Acute Pyelonephritis ◽

Esbl Production ◽

Content Type ◽

E Coli ◽

Extended Spectrum ◽

The Impact

ABSTRACTExtended-spectrum β-lactamase-producingEscherichia coli(ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused byE. coliat a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3;P= 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38;P= 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65;P= 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused byE. colishowed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30;P= 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12;P= 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associatedE. coliAPN.

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Management of Health-Care Associated Pneumonia (HCAP)

Italian Journal of Medicine ◽

10.4081/itjm.2012.87 ◽

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

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Clinical and Genomic Epidemiology of Carbapenem-Nonsusceptible Citrobacter spp. at a Tertiary Health Care Center over 2 Decades

Journal of Clinical Microbiology ◽

10.1128/jcm.00275-20 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Ahmed Babiker ◽

Daniel R. Evans ◽

Marissa P. Griffith ◽

Christi L. McElheny ◽

Mohamed Hassan ◽

...

Keyword(s):

Health Care ◽

Clinical Epidemiology ◽

Medical Center ◽

Care Center ◽

Carbapenem Resistance ◽

Time Frame ◽

Content Type ◽

Health Care Center ◽

Genomic Epidemiology ◽

Genes Encoding

ABSTRACT Carbapenem-nonsusceptible Citrobacter spp. (CNSC) are increasingly recognized as health care-associated pathogens. Information regarding their clinical epidemiology, genetic diversity, and mechanisms of carbapenem resistance is lacking. We examined microbiology records of adult patients at the University of Pittsburgh Medical Center (UMPC) Presbyterian Hospital (PUH) from 2000 to 2018 for CNSC, as defined by ertapenem nonsusceptibility. Over this time frame, the proportion of CNSC increased from 4% to 10% (P = 0.03), as did daily defined carbapenem doses/1,000 patient days (6.52 to 34.5; R2 = 0.831; P < 0.001), which correlated with the observed increase in CNSC (lag = 0 years; R2 = 0.660). Twenty CNSC isolates from 19 patients at PUH and other UPMC hospitals were available for further analysis, including whole-genome short-read sequencing and additional antimicrobial susceptibility testing. Of the 19 patients, nearly all acquired CNSC in the health care setting and over half had polymicrobial cultures containing at least one other organism. Among the 20 CNSC isolates, Citrobacter freundii was the predominant species identified (60%). CNSC genomes were compared with genomes of carbapenem-susceptible Citrobacter spp. from UPMC and with other publicly available CNSC genomes. Isolates carrying genes encoding carbapenemases (blaKPC-2, blaKPC-3, and blaNDM-1) were also long-read sequenced, and their carbapenemase-encoding plasmid sequences were compared with one another and with publicly available sequences. Phylogenetic analysis of 102 UPMC Citrobacter genomes showed that CNSC from our setting did not cluster together. Similarly, a global phylogeny of 64 CNSC genomes showed a diverse population structure. Our findings suggest that both local and global CNSC populations are genetically diverse and that CNSC harbor carbapenemase-encoding plasmids found in other Enterobacterales.

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Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae, Melbourne, Australia, 2007 to 2018

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01221-19 ◽

2019 ◽

Vol 63 (10) ◽

Cited By ~ 6

Author(s):

Deborah A. Williamson ◽

Christopher K. Fairley ◽

Benjamin P. Howden ◽

Marcus Y. Chen ◽

Kerrie Stevens ◽

...

Keyword(s):

Risk Factors ◽

Neisseria Gonorrhoeae ◽

Laboratory Data ◽

Northeast Asia ◽

Public Health Problem ◽

Multidrug Resistant ◽

International Travel ◽

Major Public Health Problem ◽

Comprehensive Overview ◽

Content Type

ABSTRACT Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae. Here, over a 12-year period, we assessed the trends and risk factors for resistant N. gonorrhoeae in individuals attending a large publicly funded sexual health center in Melbourne, Australia. A total of 7,588 N. gonorrhoeae isolates were cultured from 5,593 individuals between 1 January 2007 and 31 December 2018. The proportion of isolates with penicillin resistance decreased from 49.5% in 2007 to 18.3% in 2018 (ptrend < 0.001) and from 63.5% in 2007 to 21.1% in 2018 for ciprofloxacin resistance (ptrend < 0.001). In contrast, the proportion of isolates displaying decreased susceptibility to ceftriaxone increased from 0.5% in 2007 to 2.9% in 2018 (ptrend < 0.001), with a significant increase in low-level azithromycin resistance, from 2.5% in 2012 to 8.2% in 2018 (ptrend < 0.001). Multivariate analysis identified risk factors for multidrug-resistant (MDR) N. gonorrhoeae, namely, female sex and country of birth, with MDR isolates more common in individuals born in northeast Asia, further highlighting the importance of this region and international travel as factors in the cross-border transmission of MDR N. gonorrhoeae. Future surveillance work should incorporate additional epidemiological and genomic data to provide a comprehensive overview of the emergence and spread of resistant N. gonorrhoeae.

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