Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Villafuerte, D.; Aliberti, S.; Soni, N. J.; Faverio, P.; Marcos, P. J.; Wunderink, R. G.; Rodriguez, A.; Sibila, O.; Sanz, F.; Martin-Loeches, I.; Menzella, F.; Reyes, L. F.; Jankovic, M.; Spielmanns, M.; Restrepo, M. I.; Aruj, P. K.; Attorri, S.; Barimboim, E.; Caeiro, J. P.; Garzon, M. I.; Cambursano, V. H.; Ceccato, A.; Chertcoff, J.; Cordon Diaz, A.; De Vedia, L.; Ganaha, M. C.; Lambert, S.; Lopardo, G.; Luna, C. M.; Malberti, A. G.; Morcillo, N.; Tartara, S.; Pensotti, C.; Pereyra, B.; Scapellato, P. G.; Stagnaro, J. P.; Shah, S.; Lotsch, F.; Thalhammer, F.; Anseeuw, K.; Francois, C. A.; Van Braeckel, E.; Vincent, J. L.; Djimon, M. Z.; Nouer, S. A.; Chipev, P.; Encheva, M.; Miteva, D.; Petkova, D.; Balkissou, A. D.; Yone, E. W. P.; Ngahane, B. H. M.; Shen, N.; J. -F., Xu; Rico, C. A. B.; Buitrago, R.; Paternina, F. J. P.; Ntumba, J. -M. K.; Carevic, V. V.; Jakopovic, M.; Jankovic, M.; Matkovic, Z.; Mitrecic, I.; Jacobsson, M. -L. B.; Christensen, A. B.; Heitmann Bodtger, U. C.; Meyer, C. N.; Jensen, A. V.; El-Said Abd El-Wahhab, I.; Morsy, N. E.; Shafiek, H.; Sobh, E.; Abdulsemed, K. A.; Bertrand, F.; Brun-Buisson, C.; Montmollin, E. D.; Fartoukh, M.; Messika, J.; Tattevin, P.; Khoury, A.; Ebruke, B.; Dreher, M.; Kolditz, M.; Meisinger, M.; Pletz, M. W.; Hagel, S.; Rupp, J.; Schaberg, T.; Spielmanns, M.; Creutz, P.; Suttorp, N.; Siaw-Lartey, B.; Dimakou, K.; Papapetrou, D.; Tsigou, E.; Ampazis, D.; Kaimakamis, E.; Bhatia, M.; Dhar, R.; D'Souza, G.; Garg, R.; Koul, P. A.; Mahesh, P. A.; Jayaraj, B. S.; Narayan, K. V.; Udnur, H. B.; Krishnamurthy, S. B.; Kant, S.; Swarnakar, R.; Limaye, S.; Salvi, S.; Golshani, K.; Keatings, V. M.; Martin-Loeches, I.; Maor, Y.; Strahilevitz, J.; Battaglia, S.; Carrabba, M.; Ceriana, P.; Confalonieri, M.; Monforte, A. D.; Prato, B. D.; Rosa, M. D.; Fantini, R.; Fiorentino, G.; Gammino, M. A.; Menzella, F.; Milani, G.; Nava, S.; Palmiero, G.; Petrino, R.; Gabrielli, B.; Rossi, P.; Sorino, C.; Steinhilber, G.; Zanforlin, A.; Franzetti, F.; Carone, M.; Patella, V.; Scarlata, S.; Comel, A.; Kurahashi, K.; Bacha, Z. A.; Ugalde, D. B.; Zuniga, O. C.; Villegas, J. F.; Medenica, M.; Van De Garde, E. M. W.; Mihsra, D. R.; Shrestha, P.; Ridgeon, E.; Awokola, B. I.; Nwankwo, O. N. O.; Olufunlola, A. B.; Olumide, S.; Ukwaja, K. N.; Irfan, M.; Minarowski, L.; Szymon, S.; Froes, F.; Leuschner, P.; Meireles, M.; Ravara, S. B.; Brocovschii, V.; Ion, C.; Rusu, D.; Toma, C.; Chirita, D.; Dorobat, C. M.; Birkun, A.; Kaluzhenina, A.; Almotairi, A.; Bukhary, Z. A. A.; Edathodu, J.; Fathy, A.; Enani, A. M. A.; Mohamed, N. E.; Memon, J. U.; Bella, A.; Bogdanovic, N.; Milenkovic, B.; Pesut, D.; Borderias, L.; Garcia, N. M. B.; Cabello Alarcon, H.; Cilloniz, C.; Torres, A.; Diaz-Brito, V.; Casas, X.; Gonzalez, A. E.; Fernandez-Almira, M. L.; Gallego, M.; Gaspar-Garcia, I.; Castillo, J. G. D.; Victoria, P. J.; Laserna Martinez, E.; Molina, R. M. D.; Marcos, P. J.; Menendez, R.; Pando-Sandoval, A.; Aymerich, C. P.; Rello, J.; Moyano, S.; Sanz, F.; Sibila, O.; Rodrigo-Troyano, A.; Sole-Violan, J.; Uranga, A.; Van Boven, J. F. M.; Torra, E. V.; Pujol, J. A.; Feldman, C.; Yum, H. K.; Fiogbe, A. A.; Yangui, F.; Bilaceroglu, S.; Dalar, L.; Yilmaz, U.; Bogomolov, A.; Elahi, N.; Dhasmana, D. J.; Feneley, A.; Hancock, C.; Hill, A. T.; Rudran, B.; Ruiz-Buitrago, S.; Campbell, M.; Whitaker, P.; Youzguin, A.; Singanayagam, A.; Allen, K. S.; Brito, V.; Dietz, J.; Dysart, C. E.; Kellie, S. M.; Franco-Sadud, R. A.; Meier, G.; Gaga, M.; Holland, T. L.; Bergin, S. P.; Kheir, F.; Landmeier, M.; Lois, M.; Nair, G. B.; Patel, H.; Reyes, K.; Rodriguez-Cintron, W.; Saito, S.; Soni, N. J.; Noda, J.; Hinojosa, C. I.; Levine, S. M.; Angel, L. F.; Anzueto, A.; Whitlow, K. S.; Hipskind, J.; Sukhija, K.; Totten, V.; Wunderink, R. G.; Shah, R. D.; Mateyo, K. J.; Noriega, L.; Alvarado, E.; Aman, M.; Labra, L.

doi:10.1111/resp.13663

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.