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Thorax. Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective
[Source: Thorax, full text: (LINK). Abstract, edited.]
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<CITE><ABBR>Thorax</ABBR> doi:10.1136/thoraxjnl-2013-203384 </CITE>
<CITE></CITE>
<CITE></CITE>Respiratory infection / Original article
Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective
Stefano Aliberti 1, Catia Cilloniz 2, James D Chalmers 3, Anna Maria Zanaboni 4, Roberto Cosentini 5, Paolo Tarsia 6, Alberto Pesci 1, Francesco Blasi 6, Antoni Torres 2
Author Affiliations: <SUP>1</SUP>Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy <SUP>2</SUP>Hospital Cl?nic, IDIBAPS, Ciberes, Barcelona, Spain <SUP>3</SUP>Tayside Respiratory Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK <SUP>4</SUP>Computer Science Department, University of Milan, Milan, Italy <SUP>5</SUP>Emergency Medicine Department, IRCCS Fondazione Ca? Granda, Ospedale Maggiore Policlinico, Milan, Italy <SUP>6</SUP>Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca? Granda Ospedale Maggiore Policlinico, Milan, Italy
Correspondence to Professor Francesco Blasi, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca? Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan I-20122, Italy; francesco.blasi@unimi.it
Received 6 February 2013 - Revised 9 April 2013 - Accepted 16 May 2013 - Published Online First 17 June 2013
Abstract
Background
Probabilistic scores have been recently suggested to identify pneumonia caused by multidrug-resistant (MDR) bacteria. The aim of the study was to validate both Aliberti and Shorr scores in predicting MDR pneumonia, comparing them with healthcare associated pneumonia (HCAP) classification.
Methods
Two independent European cohorts of consecutive patients hospitalised with pneumonia were prospectively evaluated in Barcelona, Spain (BC) and Edinburgh, UK (EC). Data on admission and during hospitalisation were collected. The predictive value of the three scores was explored for correctly indicating the presence of MDR pneumonia via a receiver-operating characteristic (ROC) curve.
Results
A total of 1591 patients in the BC and 1883 patients in the EC were enrolled. The prevalence of patients with MDR pathogen among those with isolated bacteria was 7.6% in the BC and 3.3% in the EC. The most common MDR pathogen found in both cohorts was MRSA, followed by MDR P aeruginosa. A significantly higher prevalence of MDR bacteria was found among patients in the intensive care unit (ICU). The two probabilistic scores, and particularly the Aliberti one, showed an area under the ROC curve higher than the HCAP classification in predicting MDR pneumonia, especially in the ICU.
Conclusions
Risk scores able to identify MDR pneumonia could help in developing strategies for antimicrobial stewardship.
-<CITE></CITE>
<CITE></CITE>Respiratory infection / Original article
Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective
Stefano Aliberti 1, Catia Cilloniz 2, James D Chalmers 3, Anna Maria Zanaboni 4, Roberto Cosentini 5, Paolo Tarsia 6, Alberto Pesci 1, Francesco Blasi 6, Antoni Torres 2
Author Affiliations: <SUP>1</SUP>Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy <SUP>2</SUP>Hospital Cl?nic, IDIBAPS, Ciberes, Barcelona, Spain <SUP>3</SUP>Tayside Respiratory Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK <SUP>4</SUP>Computer Science Department, University of Milan, Milan, Italy <SUP>5</SUP>Emergency Medicine Department, IRCCS Fondazione Ca? Granda, Ospedale Maggiore Policlinico, Milan, Italy <SUP>6</SUP>Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca? Granda Ospedale Maggiore Policlinico, Milan, Italy
Correspondence to Professor Francesco Blasi, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca? Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan I-20122, Italy; francesco.blasi@unimi.it
Received 6 February 2013 - Revised 9 April 2013 - Accepted 16 May 2013 - Published Online First 17 June 2013
Abstract
Background
Probabilistic scores have been recently suggested to identify pneumonia caused by multidrug-resistant (MDR) bacteria. The aim of the study was to validate both Aliberti and Shorr scores in predicting MDR pneumonia, comparing them with healthcare associated pneumonia (HCAP) classification.
Methods
Two independent European cohorts of consecutive patients hospitalised with pneumonia were prospectively evaluated in Barcelona, Spain (BC) and Edinburgh, UK (EC). Data on admission and during hospitalisation were collected. The predictive value of the three scores was explored for correctly indicating the presence of MDR pneumonia via a receiver-operating characteristic (ROC) curve.
Results
A total of 1591 patients in the BC and 1883 patients in the EC were enrolled. The prevalence of patients with MDR pathogen among those with isolated bacteria was 7.6% in the BC and 3.3% in the EC. The most common MDR pathogen found in both cohorts was MRSA, followed by MDR P aeruginosa. A significantly higher prevalence of MDR bacteria was found among patients in the intensive care unit (ICU). The two probabilistic scores, and particularly the Aliberti one, showed an area under the ROC curve higher than the HCAP classification in predicting MDR pneumonia, especially in the ICU.
Conclusions
Risk scores able to identify MDR pneumonia could help in developing strategies for antimicrobial stewardship.
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