TY - JOUR
T1 - Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia
AU - GLIMP Investigators
AU - Marin-Corral, Judith
AU - Pascual-Guardia, Sergi
AU - Amati, Francesco
AU - Aliberti, Stefano
AU - Masclans, Joan R.
AU - Soni, Nilam
AU - Rodriguez, Alejandro
AU - Sibila, Oriol
AU - Sanz, Francisco
AU - Sotgiu, Giovanni
AU - Anzueto, Antonio
AU - Dimakou, Katerina
AU - Petrino, Roberta
AU - van de Garde, Ewoudt
AU - Restrepo, Marcos I.
AU - Aruj, Patricia Karina
AU - Attorri, Silvia
AU - Barimboim, Enrique
AU - Caeiro, Juan Pablo
AU - Garzón, María I.
AU - Cambursano, Victor Hugo
AU - Adrian Ceccato, V. H.Dr Cazaux A.
AU - Chertcoff, Julio
AU - Lascar, Florencia
AU - Di Tulio, Fernando
AU - Díaz, Ariel Cordon
AU - de Vedia, Lautaro
AU - Ganaha, Maria Cristina
AU - Lambert, Sandra
AU - Lopardo, Gustavo
AU - Luna, Carlos M.
AU - Malberti, Alessio Gerardo
AU - Morcillo, Nora
AU - Tartara, Silvina
AU - Pensotti, Claudia
AU - Pereyra, Betiana
AU - Scapellato, Pablo Gustavo
AU - Stagnaro, Juan Pablo
AU - Shah, Sonali
AU - Lötsch, Felix
AU - Thalhammer, Florian
AU - Anseeuw, Kurt
AU - Francois, Camille A.
AU - Van Braeckel, Eva
AU - Vincent, Jean Louis
AU - Djimon, Marcel Zannou
AU - Bashi, Jules
AU - Dodo, Roger
AU - Nouér, Simone Aranha
AU - Rupp, Jan
N1 - Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85098083139&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.06.079
DO - 10.1016/j.chest.2020.06.079
M3 - Journal articles
C2 - 32687909
AN - SCOPUS:85098083139
SN - 0012-3692
VL - 159
SP - 58
EP - 72
JO - Chest
JF - Chest
IS - 1
ER -