Korean J Intern Med.  2016 May;31(3):525-534. 10.3904/kjim.2015.103.

Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia

• Lee H
• Park JY
• Lee T
• Lee YJ
• Lim HJ
• Park JS
• Yoon HI
• Lee JH
• Lee CT
• Cho YJ

• KMID: 2163509
• DOI: http://doi.org/10.3904/kjim.2015.103

Abstract

BACKGROUND/AIMS
Healthcare-associated pneumonia (HCAP) was proposed asa new pneumonia category in 2005, and treatment recommendations includebroad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens.However, this concept continues to be controversial, and microbiological data arelacking for HCAP patients in the intensive care unit (ICU). This study was conductedto determine the rate and type of antibiotic-resistant organisms and theclinical outcomes in patients with HCAP in the ICU, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).
METHODS
We conducted a retrospective cohort analysis of patients with pneumonia(n = 195) who admitted to medical ICU in tertiary teaching hospital fromMarch 2011 to February 2013. Clinical characteristics, microbiological distributions,treatment outcomes, and prognosis of HCAP (n = 74) were compared tothose of CAP (n = 75) and HAP (n = 46).
RESULTS
MDR pathogens were significantly higher in HCAP patients (39.1%) thanin CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriateantibiotic treatment occurred more frequently in the HCAP (32.6%) andHAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differencesin clinical outcomes. The significant prognostic factors were pneumoniaseverity and treatment response.
CONCLUSIONS
MDR pathogens were isolated in HCAP patients requiring ICU admissionat intermediate rates between those of CAP and HAP.

Keyword

Community-acquired pneumonia; Healthcare-associated pneumonia; Hospital-acquired pneumonia; Intensive care units; Multidrug-resistant pathogens

MeSH Terms

Anti-Bacterial Agents
Cohort Studies
Hospitals, Teaching
Humans
Intensive Care Units*
Intensive Care*
Pneumonia*
Prognosis
Retrospective Studies
Anti-Bacterial Agents