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Community-Acquired Pneumonia Due to Gram-Negative Bacteria and Pseudomonas aeruginosa
Incidence, Risk, and Prognosis
Francisco Arancibia, MD;
Torsten T. Bauer, MD;
Santiago Ewig, MD;
Josep Mensa, MD;
Julia Gonzalez, MD;
Michael S. Niederman, MD;
Antoni Torres, MD
Arch Intern Med. 2002;162:1849-1858.
Background Initial empirical antimicrobial treatment of patients with community-acquired
pneumonia (CAP) is based on expected microbial patterns. We determined the
incidence of, prognosis of, and risk factors for CAP due to gram-negative
bacteria (GNB), including Pseudomonas aeruginosa.
Methods Consecutive patients with CAP hospitalized in our 1000-bed tertiary
care university teaching hospital were studied prospectively. Independent
risk factors for CAP due to GNB and for death were identified by means of
stepwise logistic regression analysis.
Results From January 1, 1997, until December 31, 1998, 559 hospitalized patients
with CAP were included. Sixty patients (11%) had CAP due to GNB, including P aeruginosa in 39 (65%). Probable aspiration (odds ratio
[OR], 2.3; 95% confidence interval [CI], 1.02-5.2; P
= .04), previous hospital admission (OR, 3.5; 95% CI, 1.7-7.1; P<.001), previous antimicrobial treatment (OR, 1.9; 95% CI, 1.01-3.7; P = .049), and the presence of pulmonary comorbidity (OR,
2.8; 95% CI, 1.5-5.5; P = .02) were independent predictors
of GNB. In a subgroup analysis of P aeruginosa pneumonia,
pulmonary comorbidity (OR, 5.8; 95% CI, 2.2-15.3; P<.001)
and previous hospital admission (OR, 3.8; 95% CI, 1.8-8.3; P = .02) were predictive. Infection with GNB was independently associated
with death (relative risk, 3.4; 95% CI, 1.6-7.4; P
= .002).
Conclusions In our setting, in every tenth patient with CAP, an etiology due to
GNB has to be considered. Patients with probable aspiration, previous hospitalization
or antimicrobial treatment, and pulmonary comorbidity are especially prone
to GNB. These pathogens are also an independent risk factor for death in patients
with CAP.
From the Insituto Nacional del Tórax, Santiago de Chile, Chile
(Dr Arancibia); Medizinische Klinik, Abteilung für Pneumologie, Allergologie
und Schlafmedizin, Bergmannsheil-Universitätsklinik, Bochum, Germany
(Dr Bauer); Medizinische Universitätsklinik und Poliklinik II, Bonn,
Germany (Dr Ewig); Serveis de Malalties Infeccioses (Dr Mensa), Microbiologia
(Dr Gonzalez), and Pneumologia i Allèrgia Respiratòria (Dr Torres),
Departament de Medicina, Biomèdiques August Pi i Sunyer, Hospital Clinic,
Universitat de Barcelona, Barcelona, Spain; and the Department of Pulmonary
and Critical Care Medicine, Winthrop University Hospital, Mineola, NY (Dr
Niederman).
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