Healthcare-Associated Pneumonia Does Not Accurately Identify Potentially Resistant Pathogens: A Systematic Review and Meta-Analysis

作者：James Duncan Chalmers, Catriona Rother, Waleed Salih, Santiago Ewig · 发表于：Clinical Infectious Diseases · 年份：2013 · DOI：10.1093/cid/cit734 · 被引用次数：254 · 研究领域：Nosocomial Infections in ICU、Pneumonia and Respiratory Infections、Antibiotic Resistance in Bacteria

BACKGROUND: The 2005 American Thoracic Society/Infectious Diseases Society of America guidelines introduced a concept of healthcare-associated pneumonia (HCAP) to define patients at higher risk of antibiotic-resistant pathogens, thus requiring broad spectrum therapy. There has been no systematic evaluation of the ability of this definition to identify antibiotic-resistant pathogens. METHODS: We conducted a systematic review and meta-analysis of studies comparing the frequency of resistant pathogens (defined as methicillin-resistant Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas aeruginosa) in populations with HCAP compared with populations with community-acquired pneumonia (CAP). Predictive accuracy was evaluated using the area under the receiver operator characteristic curve (AUC). The frequencies of pathogens in each group were pooled using a random effects model. RESULTS: Twenty-four studies were included (n = 22 456). Overall study quality was poor. HCAP was associated with an increased risk of methicillin-resistant S. aureus (odds ratio [OR], 4.72; 95% confidence interval [CI], 3.69-6.04) enterobactericeae (OR, 2.11; 95% CI, 1.69-2.63), and P. aeruginosa (OR, 2.75; 95% CI, 2.04-3.72; all P < .0001), but these analyses were confounded by publication bias. The discriminatory ability of HCAP for resistant pathogens was low (AUC, 0.70; 95% CI, 0.69-0.71) and was lower in high-quality (AUC, 0.66; 95% CI, 0.62-0.70) and prospective studies (AUC, 0.64; 95% CI 0.62-0...