Hypoalbuminemia and Central Venous Catheter as Risk Factors for Multidrug-resistant Healthcare-associated Pneumonia in an Intensive Care Setting

The rapid emergence of antibiotic-resistant bacteria is a threat to global health particularly in the area of healthcare-associate pneumonia (HCAP) where there is high rate of mortality. In general, guidelines should serve as a framework that needs to be complemented by local antibiogram data due to multiple factors influencing the development of multidrug-resistant (MDR) HCAP. Failure to administer prompt and appropriate empirical therapy would often result in a high mortality rate. Based on these concerns, the aim of the study was to evaluate the appropriate empirical use of antibiotic and risk factors of MDR HCAP based on local pathogen resistant pattern. This was a retrospective analysis on HCAP in critical care of a tertiary-care hospital with data from January 2016 to December 2018. Patients diagnosed with HCAP: hospital-associated pneumonia (HAP) and ventilator-associated pneumonia (VAP), with positive bacterial cultures were included into the study. Of the 269 patients and isolates included, 160 (59.5%) had MDR strains. The top causative pathogens isolated were Acinetobacter baumannii (n=104, 38.7%), Pseudomonas aeruginosa (n=66, 24.5%), Klebsiella spp (n==55, 20.4%), and Staphylococcus aureus (n=16, 5.9%). The incidence of inappropriate empirical antibiotic was significantly higher in patients with MDR HCAP (n=135, 84.4%) compared to those with non-MDR HCAP (n=34, 31.2%) (p < 0.001). Mortality was significantly higher in patients receiving inappropriate empirical therapy (n = 118, 72.4%) compared to those receiving appropriate empirical antibiotic (n = 36, 54.5%) (P = 0.009). The independent risk factors for MDR HCAP identified in this study were hypoalbuminemia (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.08 – 10.87, p = 0.036) and indwelling central venous catheter (OR 5.65, 95% CI 1.13 – 28.18, p = 0.035). This work serves as a basis for a center-specific guideline to improve antibiotic use among HCAP patients in intensive care setting.