By Ethan Covey
Patients with recent Pseudomonas aeruginosa infection or colonization are at higher risk for community-acquired pneumonia (CAP), and may benefit from empiric antipseudomonal therapy for CAP, according to a study presented during the IDWeek 2021 virtual conference.
“The 2019 American Thoracic Society/IDSA [Infectious Diseases Society of America] CAP guidelines recommend empiric PSA coverage if locally validated risk factors are present,” said Emily A. Gibbons, PharmD, a PGY-2 infectious diseases pharmacy resident at South Texas Veterans Health Care System, in San Antonio. “And they further recommend obtaining data on CAP pathogens to quantify risk factors and help guide clinical decision making.”
Dr. Gibbons and her colleagues conducted a study to comply with these guidelines and determine which patients might benefit from empiric antipseudomonal therapy by assessing risk factors for CAP caused by P. aeruginosa.
The single-center matched cohort study reviewed data from patients admitted to the South Texas Veterans Health Care System with a diagnosis of CAP within the past 20 years.
A total of 213 patients were included in the study, 99% of whom were men. The median age was 70 years. Logistic regression was performed to assess whether a relationship existed between PSA and risk factors including chronic obstructive pulmonary disease (COPD), bronchiectasis, tracheostomy, pseudomonal infection or colonization within the past year, hospital admission with receipt of IV antibiotics in the past 90 days, residence in a long-term care facility, and the need for mechanical ventilation or vasopressor support in the first 24 hours of hospitalization.
Of these, only prior P. aeruginosa infection or colonization within the last year was independently associated as a risk factor for Pseudomonas (odds ratio [OR], 3.66; 95% CI, 1.26-10.56; P=0.018).
Both severe or very severe COPD and tracheostomy may be clinically significant, but did not reach statistically significant levels (OR, 2.52; 95% CI, 2.52-6.38; P=0.055 and OR, 5.28; 95% CI, 0.74-38.85; P=0.098, respectively).
“The results of this study provide valuable data to help guide empiric CAP treatment,” Dr. Gibbons said. “Further evaluation of severe or very severe COPD and tracheostomy would be beneficial to better characterize their role in CAP caused by P. aeruginosa.”
—Dr. Gibbons reported no relevant financial disclosures.
