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Risk Factors for Drug-Resistant Cap in Immunocompetent Patients

  • Respiratory Infections (F Arnold, Section Editor)
  • Published:
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Abstract

Purpose of Review

The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens.

Recent Findings

In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbi-mortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine.

Summary

This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. File Jr TM, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010;122:130–41.

    Article  PubMed  Google Scholar 

  2. Lim WS, Baudouin SV, George RC, Pneumonia Guidelines Committee of the BTS Standards of Care Committee, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64 Suppl 3:iii1–55.

    Article  PubMed  Google Scholar 

  3. Mandell LA, Wunderink RG, Anzueto A, Infectious Diseases Society of America; American Thoracic Society, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.

    Article  CAS  PubMed  Google Scholar 

  4. File Jr TM. Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia. Clin Microbiol Infect. 2006;12 Suppl 3:31–41.

    Article  CAS  PubMed  Google Scholar 

  5. Jones RN, Sader HS, Mendes RE, Flamm RK. Update on antimicrobial susceptibility trends among Streptococcus pneumoniae in the United States: report of ceftaroline activity from the SENTRY Antimicrobial Surveillance Program (1998–2011). Diagn Microbiol Infect Dis. 2013;75(1):107–9.

    Article  CAS  PubMed  Google Scholar 

  6. Antimicrobial resistance: global report on surveillance. 2014. are available on http://www.who.int/drugresistance/documents/surveillancereport/en/.

  7. •• Chen LF, Chopra T, Kaye KS. Pathogens resistant to antibacterial agents. Med Clin N Am. 2011;95:647–76. Excellent review that clearly addresses the mechanisms of antimicrobial resistance and its mechanisms of transmission between the pathogens.

    Article  CAS  PubMed  Google Scholar 

  8. Recchia GD, Hall RM. Origins of the mobile gene cassettes found in integrons. Trends Microbiol. 1997;5:389–94.

    Article  CAS  PubMed  Google Scholar 

  9. Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanism and drivers of antimicrobial resistance. Lancet. 2016;387:176–87.

    Article  CAS  PubMed  Google Scholar 

  10. Nikaido H. Preventing drug access to targets: cell surface permeability barriers and active efflux in bacteria. Semin Cell Dev Biol. 2001;12(3):215–23.

    Article  CAS  PubMed  Google Scholar 

  11. Hernando-Amada S, Blanco P, Alcalde-Rico M, Corona F, Reales-Calderon JA, Sanchez MB, et al. Multidrug efflux pump as main players in intrinsic and acquired resistance to antimicrobials. Drug Resist Updat. 2016;28:13–27.

    Article  Google Scholar 

  12. Bush K. Bench-to-bedside review: the role of beta-lactamases in antibiotic resistant gram-negative infections. Crit Care. 2010;14(3):224.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sivaneson M, Mikkelsen H, Ventre I, Bordi C, Filloux A. Two-component regulatory systems in pseudomonas aeruginosa: an intricate network mediating fimbrial and efflux pump gene expression. Mol Microbiol. 2011;79(5):1353–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Spratt BG. Resistance to antibiotics mediated by target alterations. Science. 1994;264(5157):388–93.

    Article  CAS  PubMed  Google Scholar 

  15. Courvalin P. Vancomycin resistance in gram-positive cocci. Clin Infect Dis. 2006;42 Suppl 1:S25–34.

    Article  CAS  PubMed  Google Scholar 

  16. Doern GV, Richter SS, Miller A, et al. Antimicrobial resistance among Streptococcus pneumonaie in the United States: have we begun to turn the corner on resistance to certain antimicrobial classes? Clin Infect Dis. 2005;41:139–48.

    Article  CAS  PubMed  Google Scholar 

  17. European Antimicrobial Resistance Surveillance Network (EARS-Net). http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/database/Pages/database.aspx. Accessed Oct 2012.

  18. Pfaller MA, Farrell DJ, Sader HS, Jones RN. AWARE Ceftaroline Surveillance Program (2008–2010): trends in resistance patterns among Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States. Clin Infect Dis. 2012;55 Suppl 3:S187–93.

    Article  CAS  PubMed  Google Scholar 

  19. Jones RN, Sader HS, Moet GJ, Farrell DJ. Declining antimicrobial susceptibility of Streptococcus pneumoniae in the United States: report from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis. 2010;68:334–6.

    Article  PubMed  Google Scholar 

  20. Rodríguez-Avial I, Ramos B, Ríos E, Cercenado E, Ordobás M, Sanz JC, et al. Clonal spread of levofloxacin-resistant Streptococcus pneumoniae invasive isolates in Madrid Spain 2007 to 2009. Antimicrob Agents Chemother. 2011;55:2469–71.

    Article  PubMed  PubMed Central  Google Scholar 

  21. • Pallares R, Linares J, Vadillo M, Cabellos C, Manresa F, Viladrich PF, et al. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain [see comments] [published erratum appears in N Engl J Med 1995;333(24):1655]. N Engl J Med. 1995;333:474–80. First study showing that the resistance of Streptococcus pneumoniae to beta-lactamics does not imply higher mortality.

    Article  CAS  PubMed  Google Scholar 

  22. Yu VL, Chiou CC, Feldman C, Ortqvist A, Rello J, Morris AJ, et al. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis. 2003;37:230–7.

    Article  CAS  PubMed  Google Scholar 

  23. Song JH, Jung SI, Ki HK, Shin MH, Ko KS, Son JS, et al. Clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains in Asian countries: a study by the Asian Network for Surveillance of Resistant Pathogens. Clin Infect Dis. 2004;38:1570–8.

    Article  PubMed  Google Scholar 

  24. Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM. The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2006;42:788–97.

    Article  PubMed  Google Scholar 

  25. Cilloniz C, Albert RK, Liapikou A, Gabarrus A, Rangel E, Bello S, et al. The effect of macrolide resistance on the presentation and outcome of patients hospitalized for streptococcus pneumoniae pneumonia. Am J Respir Crit Care Med. 2015;191(11):1265–72.

    Article  CAS  PubMed  Google Scholar 

  26. Metlay JP, Hofmann J, Cetron MS, Fine MJ, Farley MM, Whitney C, et al. Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2000;30(3):520–8.

    Article  CAS  PubMed  Google Scholar 

  27. Cillóniz C, Ardanuy C, Vila J, Torres A. What is the clinical relevance of drug-resistant pneumococcus? Curr Opin Pulm Med. 2016;22(3):227–34.

    Article  PubMed  Google Scholar 

  28. Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. 2006;354:1455–63.

    Article  CAS  PubMed  Google Scholar 

  29. Hampton LM, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison LH, et al. Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines. J Infect Dis. 2012;205(3):401–11.

    Article  CAS  PubMed  Google Scholar 

  30. Imöhl M, Reinert RR, van der Linden M. Antibiotic susceptibility rates of invasive pneumococci before and after the introduction of pneumococcal conjugate vaccination in Germany. Int J Med Microbiol. 2015;305(7):776–83.

    Article  PubMed  Google Scholar 

  31. Givon-Lavi N, Fraser D, Dagan R. Vaccination of day-care center attendees reduces carriage of Streptococcus pneumoniae among their younger siblings. Pediatr Infect Dis J. 2003;22:524–32.

    PubMed  Google Scholar 

  32. Bonten MJ, Huijts SM, Bolkenbaas M. Vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;373(1):93.

    Article  PubMed  Google Scholar 

  33. Hoban D, Felmingham D. The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections. J Antimicrob Chemother. 2002;50(Suppl S1):49–59.

    Article  CAS  PubMed  Google Scholar 

  34. •• Feldman C, Anderson R. Antibiotic resistant pathogens causing community-acquired pneumonia. Semin Respir Crit Care Med. 2012;33:232–43. Excellent review, very complete and concise. It is complemented with notions on prevention.

    Article  PubMed  Google Scholar 

  35. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67:71–9.

    Article  CAS  PubMed  Google Scholar 

  36. Eldere JV, Slack MPE, Ladhani S, Cripps AW. Non-typeable Haemophilus influenzae, an under-recognised pathogen. Lancet. 2014;14:1281–92.

    Article  PubMed  Google Scholar 

  37. Alpuche C, Garau J, Lim V. Global and local variations in antimicrobial susceptibilities and resistance development in the major respiratory pathogens. Int J Antimicrob Agents. 2007;30 suppl 2:S135–8.

    Article  CAS  PubMed  Google Scholar 

  38. Beekmann SE, Heilmann KP, Richter SS, García-de-Lomas J, Doern GV, the GRASP Study Group. Antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and group A beta-haemolytic streptococci in 2002–2003. Results of the multinational GRASP Surveillance Program. Int J Antimicrob Agents. 2005;25:148–56.

    Article  CAS  PubMed  Google Scholar 

  39. Heilmann KP, Rice CL, Miller AL, Miller NJ, Beekmann SE, Pfaller MA, et al. Decreasing prevalence of beta-lactamase production among respiratory tract isolates of Haemophilus influenzae in the United States. Antimicrob Agents Chemother. 2005;49:2561–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Jansen WT, Verel A, Beitsma M, Verhoef J, Milatovic D. Surveillance study of the susceptibility of Haemophilus infl uenzae to various antibacterial agents in Europe and Canada. Curr Med Res Opin. 2008;24:2853–61.

    Article  CAS  PubMed  Google Scholar 

  41. Liebowitz LD, Slabbert M, Huisamen A. National surveillance programme on susceptibility patterns of respiratory pathogens in South Africa: moxifl oxacin compared with eight other antimicrobial agents. J Clin Pathol. 2003;56:344–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Sener B, Tunçkanat F, Ulusoy S, Tunger A, Soyletir G, Mulazimoglu L, et al. A survey of antibiotic resistance in Streptococcus pneumoniae and Haemophilus influenzae in Turkey, 2004–2005. J Antimicrob Chemother. 2007;60:587–93.

    Article  CAS  PubMed  Google Scholar 

  43. Ulanova M, Tsang RSW. Haemophilus influenzae serotype as a cause of serious invasive infections. Lancet. 2014;14:70–82.

    Article  PubMed  Google Scholar 

  44. Cardines R, Giufrè M, Pompilio A, Fiscarelli E, Ricciotti G, Di Bonaventura G, et al. Haemophilus influenzae in children with cystic fibrosis: antimicrobial susceptibility, molecular epidemiology, distribution of adhesins and biofilm formation. Int J Med Microbiol. 2012;302:45–52.

    Article  CAS  PubMed  Google Scholar 

  45. Bogdanovich T, Bozdogan B, Appelbaum PC. Effect of efflux on telithromycin and macrolide susceptibility in Haemophilus influenzae. Antimicrob Agents Chemother. 2006;50:893–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Peric M, Bozdogan B, Jacobs MR, Appelbaum PC. Effects of an efflux mechanism and ribosomal mutations on macrolide susceptibility of Haemophilus influenzae clinical isolates. Antimicrob Agents Chemother. 2003;47:1017–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Sánchez L, Leranoz S, Puig M, Lorén JG, Nikaido H, Viñas M. Molecular basis of antimicrobial resistance in non-typable Haemophilus influenzae. Microbiologia. 1997;13:309–14.

    PubMed  Google Scholar 

  48. Rennie RP, Ibrahim K. Antimicrobial resistance in Haemophilus influenzae: how can we prevent the inevitable? Commentary on antimicrobial resistance in H. Influenzae based on data from the TARGETed surveillance program. CID. 2005;41(4):S234–8.

    Article  CAS  Google Scholar 

  49. Boucher HW, Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008;46 suppl 5:S344–9.

    Article  PubMed  Google Scholar 

  50. DeLeo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated meticillin-resistant Staphylococcus aureus. Lancet. 2010;375:1557–68.

    Article  PubMed  PubMed Central  Google Scholar 

  51. • Moran GJ, Krishnadasan A, Gorwitz RJ, Emergency ID NET Study Group, et al. Prevalence of methicillin-resistant Staphylococcus aureus as an etiology of community-acquired pneumonia. Clin Infect Dis. 2012;54:1126–33. Prospective, multicentric study showing a low prevalence of CA-MRSA.

    Article  PubMed  Google Scholar 

  52. Cilloniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrús A, et al. Microbial aetiology of communityacquired pneumonia and its relation to severity. Thorax. 2011;66:340–6.

    Article  PubMed  Google Scholar 

  53. Obed M, García-Vidal C, Pessacq P, Mykietiuk A, Viasus D, Cazzola L, et al. Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Enferm Infecc Microbiol Clin. 2014;32(1):23–7.

    Article  PubMed  Google Scholar 

  54. Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, et al. Association between Staphylococcus aureus strains carrying gene for PVL and highly lethal necrotizing pneumonia in young immunocompetent patients. Lancet. 2002;359:753–9.

    Article  CAS  PubMed  Google Scholar 

  55. Lobo LJ, Reed KD, Wunderink RG. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest. 2010;138:130–6.

    Article  CAS  PubMed  Google Scholar 

  56. Sicot N, Khanafer N, Meyssonnier V, Dumitrescu O, Tristan A, Bes M, et al. Methicillin resistance is not a predictor of severity in community-acquired Staphylococcus aureus necrotizing pneumonia—results of a prospective observational study. Clin Microbiol Infect. 2013;19:E142–8.

    Article  CAS  PubMed  Google Scholar 

  57. Karampela I, Poulakou G, Dimopoulos G. Community acquired methicillin resistant Staphylococcus aureus pneumonia: an update for the emergency and intensive care physician. Minerva Anestesiol. 2012;78(8):930–40.

    CAS  PubMed  Google Scholar 

  58. Torres A, Niederman M, van der Eerden M, Chalmers J, Welte T, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med. 2016;42(9):1374–86.

    Article  PubMed  Google Scholar 

  59. Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, et al. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;175(10):1086–93.

    Article  PubMed  Google Scholar 

  60. Kümpers P, Tiede A, Kirschner P, Girke J, Ganser A, Peest D. Legionnaires’ disease in immunocompromised patients: a case report of Legionella longbeachae pneumonia and review of the literature. J Med Microbiol. 2008;57(3):384–7.

    Article  PubMed  Google Scholar 

  61. Koufakis T, Gabranis I, Chatzopoulou M, Margaritis A, Tsiakalou M. Severe Legionnaires’ disease complicated by Rhabdomyolysis and clinically resistant to moxifloxacin in a splenectomised patient: too much of a coincidence? Case Rep Infect Dis. 2015;2015:793786.

    PubMed  PubMed Central  Google Scholar 

  62. Luchsinger V, Ruiz M, Zunino E, Martinez MA, Machado C, Piedra PA, et al. Community-acquired pneumonia in Chile: the clinical relevance in the detection of viruses and atypical bacteria. Thorax. 2013;68(11):1000–6.

    Article  PubMed  Google Scholar 

  63. Bébéar C, Pereyre S, Peuchant O. Mycoplasma pneumoniae: susceptibility and resistant to antibiotics. Future Microbiol. 2011;6(4):423–31.

    Article  PubMed  Google Scholar 

  64. Bébéar C. Mycoplasma, ureaplasma. In: Courvalin P, Leclercq R, Rice LB, editors. Antibiogram. Portland: ESKA Publishing, ASM Press; 2010. p. 519–29.

    Google Scholar 

  65. Bébéar CM, Kempf I. Antimicrobial therapy and antimicrobial resistance. In: Blanchard A, Browning GF, editors. Mycoplasmas: pathogenesis, molecular biology, and emerging strategies for control. Wymondham: Horizon Bioscience; 2005. p. 535–68.

    Google Scholar 

  66. Morozumi M, Takahashi T, Ubukata K. Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia. J Infect Chemother. 2010;16:78–86.

    Article  PubMed  Google Scholar 

  67. Gruson D, Pereyre S, Renaudin H, Charron A, Bebéar C, Bébéar CM. In vitro development of resistance to six and four fluoroquinolones in Mycoplasma pneumoniae and Mycoplasma hominis, respectively. Antimicrob Agents Chemother. 2005;49:1190–3.

  68. Okazaki N, Narita M, Yamada S, Izumikawa K, Umetsu M, Kenri T, et al. Characteristics of macrolide-resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro. Microbiol Immunol. 2001;45:617–20.

    Article  CAS  PubMed  Google Scholar 

  69. Isozumi R, Yoshimine H, Morozumi M, Ubukata K, Ariyoshi K. Adult case of community-acquired pneumonia caused by macrolide-resistant Mycoplasma pneumoniae. Respirology. 2009;14(8):1206–8.

    Article  PubMed  Google Scholar 

  70. Morozumi M, Iwata S, Hasegawa K, Chiba N, Takayanagi R, Matsubara K, et al. Increased macrolide resistance of Mycoplasma pneumoniae in pediatric patients with community-acquired pneumonia. Antimicrob Agents Chemother. 2008;52:348–50.

    Article  CAS  PubMed  Google Scholar 

  71. Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. 2006;50:709–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Matsubara K, Morozumi M, Okada T, Matsushima T, Komiyama O, Shoji M, et al. A comparative clinical study of macrolide sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients. J Infect Chemother. 2009;15(6):380–3.

    Article  PubMed  Google Scholar 

  73. Xin D, Mi Z, Han X, Qin L, Li J, Wei T, et al. Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China. Antimicrob Agents Chemother. 2009;53:2158–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Van Duin D, Paterson DL. Multidrug-resistant bacteria in the community trends and lessons learned. Infect Dis Clin N Am. 2016;30:377–90.

    Article  Google Scholar 

  75. Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999;160:397–405.

    Article  CAS  PubMed  Google Scholar 

  76. Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman MS, et al. Community-acquired pneumonia due to Gram-negative bacteria and Pseudomonas aeruginosa. Incidence, risk and prognosis. Arch Intern Med. 2001;162:1849–58.

    Article  Google Scholar 

  77. Labelle A, Kollef MH. Healthcare-associated pneumonia: approach to management. Clin Chest Med. 2011;32:507–15.

    Article  PubMed  Google Scholar 

  78. Wu Ch KS, Yang K, Fang W, Tu C, Chen C, et al. Antimicrobial drug-resistant microbes associated with hospitalized community-acquired pneumonia and healthcare-associated pneumonia: a multi-center study in Taiwan. J Formos Med Assoc. 2013;112:31–40.

    Article  Google Scholar 

  79. Polverino E, Torres A, Menéndez R, Cillóniz C, Valles JM, Capelastegui A, et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013;68:1007–14.

    Article  PubMed  Google Scholar 

  80. •• Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potencially resistant pathogens: a systematic review and meta-analysis. CID. 2014;58:330. Meta-analysis demonstrating the lack of precision of the criteria for healthcare-associated pneumonia in determining the risk of infection with multidrug-resistant pathogens.

    Article  CAS  Google Scholar 

  81. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for healthcare-associated pneumonia. Arch Intern Med. 2008;168:2205–10.

    Article  PubMed  Google Scholar 

  82. Shorr AF, Zirberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, et al. Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the Emergency Department. CID. 2012;54(2):193–8.

    Article  Google Scholar 

  83. Aliberti E, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. CID. 2012;54(4):470–8.

    Article  Google Scholar 

  84. Aliberti S, Cilloniz C, Chalmers JD, Zanaboni AM, Cosentini R, Tarsia P, et al. Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European Perspective. Thorax. 2013;68:997–9.

    Article  PubMed  Google Scholar 

  85. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;14:2016. doi:10.1093/cid/ciw353.

    Google Scholar 

  86. Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia due to Pseudomonas aeruginosa: part I: epidemiology, clinical diagnosis, and source. Chest. 2011;139:909–19.

    Article  PubMed  Google Scholar 

  87. von Baum H, Welte T, Marre R, Suttorp N, Ewig S, CAPNETZ Study Group. Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: diagnosis, incidence and predictors. Eur Respir J. 2010;35:598–605.

    Article  Google Scholar 

  88. Kang CI, Song JH, Oh WS, Ko KS, Chung DR, Peck KR. Clinical outcomes and risk factors of community-acquired pneumonia caused by gram-negative bacilli. Eur J Clin Microbiol Infect Dis. 2008;27(8):657–61.

    Article  PubMed  Google Scholar 

  89. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines for the management of community acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.

    Article  CAS  PubMed  Google Scholar 

  90. Sibila O, Laserna E, Maselli DJ, Fernandez JF, Mortensen EM, Anzueto A, et al. Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia. Respirology. 2015;20(4):660–6.

    Article  PubMed  Google Scholar 

  91. Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc. 2015;12(2):153–60.

    Article  PubMed  Google Scholar 

  92. Gross AE, Van Schooneveld TC, Olsen KM, Rupp ME, Bui TH, Forsung E, et al. Epidemiology and predictors of multidrug-resistant community-acquired and health care-associated pneumonia. Antimicrob Agents Chemother. 2014;58(9):5262–8.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Servicio de Medicina Respiratoria, Instituto Nacional Del Tórax and Unidad de Enfermedades Respiratorias, Facultad de Medicina Oriente, Universidad de Chile, J.M.Infante 717, Providencia, Santiago of Chile, Chile

    Francisco Arancibia

  2. Departamento de Medicina, Hospital Clínico U. de Chile, Universidad de Chile, Av. Independencia 1027, Independencia, Providencia, Santiago of Chile, Chile

    Mauricio Ruiz

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  1. Francisco Arancibia
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Arancibia, F., Ruiz, M. Risk Factors for Drug-Resistant Cap in Immunocompetent Patients. Curr Infect Dis Rep 19, 11 (2017). https://doi.org/10.1007/s11908-017-0565-x

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