PMID- 32687909 OWN - NLM STAT- MEDLINE DCOM- 20210611 LR - 20210611 IS - 1931-3543 (Electronic) IS - 0012-3692 (Linking) VI - 159 IP - 1 DP - 2021 Jan TI - Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia. PG - 58-72 LID - S0012-3692(20)31905-X [pii] LID - 10.1016/j.chest.2020.06.079 [doi] 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. CI - Copyright (c) 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. FAU - Marin-Corral, Judith AU - Marin-Corral J AD - Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX. FAU - Pascual-Guardia, Sergi AU - Pascual-Guardia S AD - Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain; Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Spain. FAU - Amati, Francesco AU - Amati F AD - Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy. FAU - Aliberti, Stefano AU - Aliberti S AD - Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy. FAU - Masclans, Joan R AU - Masclans JR AD - Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain. FAU - Soni, Nilam AU - Soni N AD - Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX. FAU - Rodriguez, Alejandro AU - Rodriguez A AD - Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Spain; Critical Care Medicine, Hospital Universitari Joan XXIII and Rovira & Virgili University, Tarragona, Spain. FAU - Sibila, Oriol AU - Sibila O AD - Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain. FAU - Sanz, Francisco AU - Sanz F AD - Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain. FAU - Sotgiu, Giovanni AU - Sotgiu G AD - Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. FAU - Anzueto, Antonio AU - Anzueto A AD - Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX. FAU - Dimakou, Katerina AU - Dimakou K AD - 5th Department of Pulmonary Medicine, Sotiria Chest Diseases Hospital, Athens, Greece. FAU - Petrino, Roberta AU - Petrino R AD - Emergency Department, S. Andrea Hospital, Vercelli, Italy. FAU - van de Garde, Ewoudt AU - van de Garde E AD - Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands. FAU - Restrepo, Marcos I AU - Restrepo MI AD - Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX. Electronic address: restrepom@uthscsa.edu. CN - GLIMP investigators LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20200717 PL - United States TA - Chest JT - Chest JID - 0231335 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Aged MH - Aged, 80 and over MH - Anti-Bacterial Agents/*therapeutic use MH - Cohort Studies MH - Community-Acquired Infections/diagnosis/*drug therapy/*etiology MH - Female MH - *Hospitalization MH - Humans MH - Male MH - Middle Aged MH - Respiratory Aspiration/*complications/diagnosis/therapy MH - Risk Factors OTO - NOTNLM OT - anaerobic OT - aspiration OT - bacteria OT - pneumonia OT - risk factors FIR - Aruj, Patricia Karina IR - Aruj PK FIR - Attorri, Silvia IR - Attorri S FIR - Barimboim, Enrique IR - Barimboim E FIR - Caeiro, Juan Pablo IR - Caeiro JP FIR - Garzon, Maria I IR - Garzon MI FIR - Cambursano, Victor Hugo IR - Cambursano VH FIR - Adrian Ceccato, V H Dr Cazaux A IR - Adrian Ceccato VHDCA FIR - Chertcoff, Julio IR - Chertcoff J FIR - Lascar, Florencia IR - Lascar F FIR - Di Tulio, Fernando IR - Di Tulio F FIR - Diaz, Ariel Cordon IR - Diaz AC FIR - de Vedia, Lautaro IR - de Vedia L FIR - Ganaha, Maria Cristina IR - Ganaha MC FIR - Lambert, Sandra IR - Lambert S FIR - Lopardo, Gustavo IR - Lopardo G FIR - Luna, Carlos M IR - Luna CM FIR - Malberti, Alessio Gerardo IR - Malberti AG FIR - Morcillo, Nora IR - Morcillo N FIR - Tartara, Silvina IR - Tartara S FIR - Pensotti, Claudia IR - Pensotti C FIR - Pereyra, Betiana IR - Pereyra B FIR - Scapellato, Pablo Gustavo IR - Scapellato PG FIR - Stagnaro, Juan Pablo IR - Stagnaro JP FIR - Shah, Sonali IR - Shah S FIR - Lotsch, Felix IR - Lotsch F FIR - Thalhammer, Florian IR - Thalhammer F FIR - Anseeuw, Kurt IR - Anseeuw K FIR - Francois, Camille A IR - Francois CA FIR - Van Braeckel, Eva IR - Van Braeckel E FIR - Vincent, Jean Louis IR - Vincent JL FIR - Djimon, Marcel Zannou IR - Djimon MZ FIR - Bashi, Jules IR - Bashi J FIR - Dodo, Roger IR - Dodo R FIR - Nouer, Simone Aranha IR - Nouer SA FIR - Chipev, Peter IR - Chipev P FIR - Encheva, Milena IR - Encheva M FIR - Miteva, Darina IR - Miteva D FIR - Petkova, Diana IR - 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Kellie, Susan M IR - Kellie SM FIR - Ricardo A Franco-Sadud, Clement J IR - Ricardo A Franco-Sadud CJ FIR - Meier, Garnet IR - Meier G FIR - Gaga, Mina IR - Gaga M FIR - Holland, Thomas L IR - Holland TL FIR - Bergin, Stephen P IR - Bergin SP FIR - Kheir, Fayez IR - Kheir F FIR - Landmeier, Mark IR - Landmeier M FIR - Lois, Manuel IR - Lois M FIR - Nair, Girish B IR - Nair GB FIR - Patel, Hemali IR - Patel H FIR - Reyes, Katherine IR - Reyes K FIR - Rodriguez-Cintron, William IR - Rodriguez-Cintron W FIR - Saito, Shigeki IR - Saito S FIR - Noda, Julio IR - Noda J FIR - Hinojosa, Cecilia I IR - Hinojosa CI FIR - Levine, Stephanie M IR - Levine SM FIR - Reyes, Luis F IR - Reyes LF FIR - Angel, Luis F IR - Angel LF FIR - Anzueto, Antonio IR - Anzueto A FIR - Whitlow, K Scott IR - Whitlow KS FIR - Hipskind, John IR - Hipskind J FIR - Sukhija, Kunal IR - Sukhija K FIR - Totten, Vicken IR - Totten V FIR - Wunderink, Richard G IR - Wunderink RG FIR - Shah, Ray D IR - Shah RD FIR - Mateyo, Kondwelani John IR - Mateyo KJ FIR - Noriega, Lorena IR - Noriega L FIR - Alvarado, Ezequiel IR - Alvarado E FIR - Aman, Mohamed IR - Aman M FIR - Labra, Lucia IR - Labra L EDAT- 2020/07/21 06:00 MHDA- 2021/06/12 06:00 CRDT- 2020/07/21 06:00 PHST- 2020/01/06 00:00 [received] PHST- 2020/06/18 00:00 [revised] PHST- 2020/06/22 00:00 [accepted] PHST- 2020/07/21 06:00 [pubmed] PHST- 2021/06/12 06:00 [medline] PHST- 2020/07/21 06:00 [entrez] AID - S0012-3692(20)31905-X [pii] AID - 10.1016/j.chest.2020.06.079 [doi] PST - ppublish SO - Chest. 2021 Jan;159(1):58-72. doi: 10.1016/j.chest.2020.06.079. Epub 2020 Jul 17.