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

Respirology. 2020 May;25(5):543-551. doi: 10.1111/resp.13663. Epub 2019 Aug 5.

Abstract

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.

Keywords: Enterobacteriaceae; community-acquired pneumonia; multidrug-resistance; prevalence; risk factors.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Cohort Studies
  • Community-Acquired Infections* / epidemiology
  • Community-Acquired Infections* / microbiology
  • Community-Acquired Infections* / therapy
  • Drug Resistance, Multiple
  • Enterobacteriaceae Infections* / diagnosis
  • Enterobacteriaceae Infections* / epidemiology
  • Enterobacteriaceae Infections* / therapy
  • Enterobacteriaceae* / classification
  • Enterobacteriaceae* / isolation & purification
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • International Cooperation
  • Male
  • Microbial Sensitivity Tests
  • Prevalence
  • Risk Factors