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Original article
Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective
  1. Stefano Aliberti1,
  2. Catia Cilloniz2,
  3. James D Chalmers3,
  4. Anna Maria Zanaboni4,
  5. Roberto Cosentini5,
  6. Paolo Tarsia6,
  7. Alberto Pesci1,
  8. Francesco Blasi6,
  9. Antoni Torres2
  1. 1Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy
  2. 2Hospital Clínic, IDIBAPS, Ciberes, Barcelona, Spain
  3. 3Tayside Respiratory Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  4. 4Computer Science Department, University of Milan, Milan, Italy
  5. 5Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
  6. 6Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  1. 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{at}unimi.it

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.

  • Pneumonia
  • Respiratory Infection
  • Bacterial Infection

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