Author, as appears in the article.: Marin-Corral J; Pascual-Guardia S; Francesco A; Aliberti S; Masclans JR; Soni N; Rodriguez A; Sibila O; Sanz F; Sotgiu G; Anzueto A; Dimakou K; Petrino R; van de Garde E; Restrepo MI; GLIMP investigators

Department: Medicina i Cirurgia

URV's Author/s: Rodríguez Oviedo, Alejandro Hugo

Keywords: Ventilator-associated pneumonia Risk factors Practice guidelines Pneumonia Metronidazole Management Impact Flora Features Bacteriology Bacteria Aspiration Anaerobic Adults

Abstract: © 2020 American College of Chest Physicians Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

Thematic Areas: Saúde coletiva Respiratory system Química Pulmonary and respiratory medicine Odontología Medicina iii Medicina ii Medicina i Interdisciplinar General medicine Farmacia Engenharias iv Enfermagem Educação física Economia Critical care medicine Critical care and intensive care medicine Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciências ambientais Cardiology and cardiovascular medicine Cardiac & cardiovascular systems Astronomia / física

licence for use: https://creativecommons.org/licenses/by/3.0/es/

Author's mail: alejandrohugo.rodriguez@urv.cat

Author identifier: 0000-0001-8828-5984

Record's date: 2023-09-02

Papper version: info:eu-repo/semantics/acceptedVersion

Link to the original source: https://journal.chestnet.org/article/S0012-3692(20)31905-X/fulltext

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Chest. 159 (1): 58-72

APA: Marin-Corral J; Pascual-Guardia S; Francesco A; Aliberti S; Masclans JR; Soni N; Rodriguez A; Sibila O; Sanz F; Sotgiu G; Anzueto A; Dimakou K; Petrin (2021). Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia. Chest, 159(1), 58-72. DOI: 10.1016/j.chest.2020.06.079

Article's DOI: 10.1016/j.chest.2020.06.079

Entity: Universitat Rovira i Virgili

Journal publication year: 2021

Publication Type: Journal Publications