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Background The prediction of multi-drug resistant (MDR) pathogens is a key issue in the management of health-care associated pneumonia (HCAP). Multiple risk factors have been proposed, some of which overlap with items of the pneumonia severity index (PSI). The aim of this study was to investigate the relationship between PSI and presence of MDR pathogens.
Methods Patients who were admitted to a tertiary-care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia. Patients were enrolled if they fulfilled the definition of HCAP by 2005 ATS/IDSA guideline.
MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA).
The criteria for HCAP is defined as follows: patients who had been hospitalized in an acute care hospital for two or more days within the past 90 days; residents of a nursing home or long-term care facility; recipients of recent intravenous antibiotic therapy, chemotherapy or wound care within the past 30 days; or patients who attended a hospital or hemodialysis clinic.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PSI II | PSI less than 70 or equal to 70 | ||
| PSI III | PSI 70-90 | ||
| PSI IV | PSI 90-130 | ||
| PSI V | PSI more than 130 |
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| Measure | Description | Time Frame |
|---|---|---|
| Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | sputum culture and sterile specimen such as blood or pleural effusion culture for healthcare associated pneumonia within seven days of admission | 7 days |
| Number of Participants With MDR Pathogens | MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA). | seven days after admission |
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Inclusion Criteria:
Exclusion Criteria:
-
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Patients who were admitted to the Far Eastern Memorial Hospital, an 800-bed tertiary care hospital in northern Taiwan, from January 2005 to December 2010 were screened by discharge diagnoses.The patients whose primary discharge diagnosis was pneumonia (International Classification of Diseases codes 482, 485, and 486) were selected.
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| Name | Affiliation | Role |
|---|---|---|
| Ping-huai Wang, M.D. | Far Eastern Memorial Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Far Eastern Memorial Hospital | New Taipei City | 220 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 10987697 | Background | Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000 Aug;31(2):347-82. doi: 10.1086/313954. Epub 2000 Sep 7. No abstract available. | |
| 8630626 | Background |
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Patients who were admitted to our hospital,Jan 2005 to Dec 2010 The patients with the diagnosis was pneumonia were selected. They were enrolled if they fulfilled the criteria for HCAP defined in 2005 ATS/IDSA
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| ID | Title | Description |
|---|---|---|
| FG000 | PSI II | Pneumonia severity index less than 70 or equal to 70, (Pneumonia is more severe if the index is higher) |
| FG001 | PSI III | Pneumonia severity index 70-90 |
| FG002 | PSI IV | Pneumonia severity index 91-130 |
| FG003 | PSI V | Pneumonia severity index more than 130 |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | PSI II | PSI less than 70 or equal to 70 |
| BG001 | PSI III | PSI 70-90 |
| BG002 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | sputum culture and sterile specimen such as blood or pleural effusion culture for healthcare associated pneumonia within seven days of admission | Posted | Count of Participants | Participants | 7 days |
|
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It was a retrospective observational study. No intervention was done during this study. Thereafter, no serious adverse event was assessed.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | PSI II | PSI less than 70 or equal to 70 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Serious adverse event | Investigations | Non-systematic Assessment | It was a retrospective observational study. No intervention was done during this study. Thereafter, no serious adverse event was assessed. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| non-serious adverse event | Investigations | Non-systematic Assessment | It was a retrospective observational study. No intervention was done during this study. Thereafter, no adverse event was assessed. |
The limitations to this study is that the microbiology data mainly came from sputum cultures, retrospective studies and single center experience
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Ping-huai Wang | Far Eastern Memorial hospital | 886-2-89667000 | 2816 | pinghuaiwang@gmail.com |
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| ID | Term |
|---|---|
| D000077299 | Healthcare-Associated Pneumonia |
| ID | Term |
|---|---|
| D003428 | Cross Infection |
| D007239 | Infections |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
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| Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. 1996 May;153(5):1711-25. doi: 10.1164/ajrccm.153.5.8630626. No abstract available. |
| 15699079 | Background | American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416. doi: 10.1164/rccm.200405-644ST. No abstract available. |
| 22033455 | Background | Micek ST, Reichley RM, Kollef MH. Health care-associated pneumonia (HCAP): empiric antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa predict optimal outcome. Medicine (Baltimore). 2011 Nov;90(6):390-395. doi: 10.1097/MD.0b013e318239cf0a. |
| 18162378 | Background | Song JH, Oh WS, Kang CI, Chung DR, Peck KR, Ko KS, Yeom JS, Kim CK, Kim SW, Chang HH, Kim YS, Jung SI, Tong Z, Wang Q, Huang SG, Liu JW, Lalitha MK, Tan BH, Van PH, Carlos CC, So T; Asian Network for Surveillance of Resistant Pathogens Study Group. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents. 2008 Feb;31(2):107-14. doi: 10.1016/j.ijantimicag.2007.09.014. Epub 2007 Dec 26. |
| PSI IV |
PSI 90-130 |
| BG003 | PSI V | PSI more than 130 |
| BG004 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Pneumonia severity index 91-130
| OG003 | PSI V | Pneumonia severity index more than 130 |
|
|
| Primary | Number of Participants With MDR Pathogens | MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA). | Posted | Number | participants | seven days after admission |
|
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | PSI III | PSI 70-90 | 0 | 0 | 0 | 0 |
| EG002 | PSI IV | PSI 90-130 | 0 | 0 | 0 | 0 |
| EG003 | PSI V | PSI more than 130 | 0 | 0 | 0 | 0 |
|
|
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| D008171 |
| Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D007049 | Iatrogenic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| mortality |
|