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Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case–case–control study

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Abstract

Purpose

This case-case-control study aims to identify clinical predictors for pneumonia due to Pseudomonas aeruginosa (PA) which is (1) susceptible to all routinely tested antipseudomonal beta-lactams (APBL-S) and (2) resistant to at least one antipseudomonal beta-lactam (APBL-R).

Methods

Hospitalized adults with acute bacterial pneumonia at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2012 to April 15, 2014 were identified. Multivariate logistic regression was used to determine risk factors for pneumonia due to APBL-S PA and APBL-R PA.

Results

Among 326 unique patients, 119 had pneumonia due to APBL-S PA (cases), 44 due to APBL-R PA (cases) and 163 due to ceftriaxone-susceptible bacteria (controls). Bronchiectasis [odds ratio (OR) 5.7, 95% confidence intervals (CI) 1.3–39.2], interstitial lung disease (OR 6.2, 95% CI 1.5–42.6), prior airway colonization with APBL-S PA (OR 7.2, 95% CI 1.1–139.4) and recent exposure to both antipseudomonal beta-lactam (APBL; OR 2.2, 95% CI 1.1–4.5) and nonpseudomonal beta-lactams (OR 2.6, 95% CI 1.0–6.8) were independently associated with increased risk of APBL-S PA pneumonia. Bronchiectasis (OR 8.3, 95% CI 1.7–46.6), prior airway colonization with APBL-R PA (OR 14.9, 95% CI 2.0–312.9) and recent use of only APBL (OR 7.7, 95% CI 3.4–17.9) were predictors for APBL-R PA pneumonia.

Conclusions

Stratification of hospitalized patients with pneumonia based on structural lung disease, prior airway colonization and recent antimicrobial exposure may improve empirical antimicrobial selection. Expansion of antimicrobial regimen from ceftriaxone to APBL or combination therapy is suggested in patients with risk factors for APBL-S or APBL-R PA, respectively.

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Acknowledgements

The authors thank the Palmetto Health Antimicrobial Stewardship and Support Team and Microbiology Laboratory for their help in facilitating the conduct of this study. MJA and MNA have full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the analysis. The preliminary results of this study were presented in part at ASM Microbe 2017; New Orleans, LA, USA, June 1–5, 2017 (Abstract #Saturday-120).

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Authors and Affiliations

  1. Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Mohammed J. Al-Jaghbeer

  2. Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA

    Julie Ann Justo & P. Brandon Bookstaver

  3. Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA

    Julie Ann Justo, Joseph Kohn & P. Brandon Bookstaver

  4. University of South Carolina School of Medicine, Columbia, SC, USA

    William Owens, Jennifer Hucks & Majdi N. Al-Hasan

  5. Department of Medicine, Palmetto Health University of South Carolina Medical Group, Columbia, SC, USA

    William Owens, Jennifer Hucks & Majdi N. Al-Hasan

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  1. Mohammed J. Al-Jaghbeer
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  7. Majdi N. Al-Hasan
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Correspondence to Majdi N. Al-Hasan.

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Conflict of interest

MJA, JAJ, WO, JK, JH: no conflicts. MNA and PBB: Continuing medical education steering committee for Rockpointe Corporation, Columbia, MD, USA.

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Al-Jaghbeer, M.J., Justo, J.A., Owens, W. et al. Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case–case–control study. Infection 46, 487–494 (2018). https://doi.org/10.1007/s15010-018-1147-z

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  • DOI: https://doi.org/10.1007/s15010-018-1147-z

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