Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia.
BACKGROUND AND OBJECTIVE
Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP.


METHODS
We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection.


RESULTS
Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP.


CONCLUSION
This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.
['Villafuerte|David|D|', 'Aliberti|Stefano|S|0000-0002-0090-4531', 'Soni|Nilam J|NJ|', 'Faverio|Paola|P|0000-0002-0360-1237', 'Marcos|Pedro J|PJ|0000-0001-9600-3537', 'Wunderink|Richard G|RG|0000-0002-8527-4195', 'Rodriguez|Alejandro|A|', 'Sibila|Oriol|O|0000-0002-4833-6713', 'Sanz|Francisco|F|0000-0003-4076-0816', 'Martin-Loeches|Ignacio|I|0000-0002-5834-4063', 'Menzella|Francesco|F|0000-0003-3950-5789', 'Reyes|Luis F|LF|0000-0003-1172-6539', 'Jankovic|Mateja|M|0000-0002-0171-764X', 'Spielmanns|Marc|M|0000-0002-1565-2162', 'Restrepo|Marcos I|MI|0000-0001-9107-3405', '|||']
D000368:Aged D015331:Cohort Studies D017714:Community-Acquired Infections D018432:Drug Resistance, Multiple D004755:Enterobacteriaceae D004756:Enterobacteriaceae Infections D005260:Female D006760:Hospitalization D006801:Humans D007391:International Cooperation D008297:Male D008826:Microbial Sensitivity Tests D015995:Prevalence D012307:Risk Factors
prevalence risk factors Enterobacteriaceae community-acquired pneumonia multidrug-resistance