Articles producció científica> Medicina i Cirurgia

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

  • Datos identificativos

    Identificador: imarina:8997668
    Autores:
    Marin-Corral JPascual-Guardia SFrancesco AAliberti SMasclans JRSoni NRodriguez ASibila OSanz FSotgiu GAnzueto ADimakou KPetrino Rvan de Garde ERestrepo MIGLIMP investigators
    Resumen:
    © 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. Int
  • Otros:

    Autor según el artículo: 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
    Departamento: Medicina i Cirurgia
    Autor/es de la URV: Rodríguez Oviedo, Alejandro Hugo
    Palabras clave: Ventilator-associated pneumonia Risk factors Practice guidelines Pneumonia Metronidazole Management Impact Flora Features Bacteriology Bacteria Aspiration Anaerobic Adults
    Resumen: © 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.
    Áreas temáticas: 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
    Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
    Direcció de correo del autor: alejandrohugo.rodriguez@urv.cat
    Identificador del autor: 0000-0001-8828-5984
    Fecha de alta del registro: 2024-07-27
    Versión del articulo depositado: info:eu-repo/semantics/acceptedVersion
    Enlace a la fuente original: https://journal.chestnet.org/article/S0012-3692(20)31905-X/fulltext
    URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
    Referencia al articulo segun fuente origial: Chest. 159 (1): 58-72
    Referencia de l'ítem segons les normes 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
    DOI del artículo: 10.1016/j.chest.2020.06.079
    Entidad: Universitat Rovira i Virgili
    Año de publicación de la revista: 2021
    Tipo de publicación: Journal Publications
  • Palabras clave:

    Cardiac & Cardiovascular Systems,Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,Critical Care Medicine,Pulmonary and Respiratory Medicine,Respiratory System
    Ventilator-associated pneumonia
    Risk factors
    Practice guidelines
    Pneumonia
    Metronidazole
    Management
    Impact
    Flora
    Features
    Bacteriology
    Bacteria
    Aspiration
    Anaerobic
    Adults
    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
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