Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumonia

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• dc.contributor.author Marin Corral, Judith
• dc.contributor.author Pascual Guàrdia, Sergi, 1979-
• dc.contributor.author Amati, Francesco
• dc.contributor.author Aliberti, Stefano
• dc.contributor.author Masclans Enviz, Joan Ramon
• dc.contributor.author Soni, Nilam J.
• dc.contributor.author Rodríguez, Alejandro
• dc.contributor.author Sibila, Oriol
• dc.contributor.author Sanz, Francisco
• dc.contributor.author Sotgiu, Giovanni
• dc.contributor.author Anzueto, Antonio
• dc.contributor.author Dimakou, Katerina
• dc.contributor.author Petrino, Roberta
• dc.contributor.author van de Garde, Ewoudt
• dc.contributor.author Restrepo, Marcos I.
• dc.contributor.author GLIMP investigators
• dc.date.accessioned 2022-02-11T07:52:18Z
• dc.date.available 2022-02-11T07:52:18Z
• dc.date.issued 2021
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Marin-Corral J, Pascual-Guardia S, Amati F, Aliberti S, Masclans JR, Soni N, et al. Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumònia. Chest. 2021 Jan; 159(1): 58-72. DOI: 10.1016/j.chest.2020.06.079
• dc.identifier.doi http://dx.doi.org/10.1016/j.chest.2020.06.079
• dc.identifier.issn 0012-3692
• dc.identifier.uri http://hdl.handle.net/10230/52472
• dc.language.iso eng
• dc.publisher Elsevier
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.chest.2020.06.079
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword Anaerobic
• dc.subject.keyword Aspiration
• dc.subject.keyword Bacteria
• dc.subject.keyword Pneumonia
• dc.subject.keyword Risk factors
• dc.title Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumonia
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion