Background: Several patient-related factors for acquisition of penicillin/erythromycin-resistant pneumococcal community-acquired pneumonia (CAP) have been reported. However, risk factors associated with CAP caused by multidrug-resistant Streptococcus pneumoniae (MDRSP) have not been extensively studied.
Methods: From January 1999 to April 2000, a prospective-multicenter study was conducted in 35 Spanish hospitals to determine the risk factors associated with CAP caused by MDRSP. Pneumococci resistant to multiple antimicrobial agents were defined by the presence of intermediate or high-level resistance to penicillin plus intermediate resistance/resistance to ≥2 non-β-lactam agents (erythromycin, tetracycline, vanco mycin, chloramphenicol, or respiratory quinolones).
Results: One hundred forty-two of 638 isolates were found to be MDRSP. The 30-day survival probability was 79.5 and 86.6 for MDRSP-CAP and non-MDRSP-CAP, respectively (P = 0.059). Using multivariate survival analysis, only shock (hazard ratio: 16.4) showed an association with 30-day mortality in MDRSP-CAP. Multivariate analysis showed that asthma (odds ratio [OR], 2.17), HIV infection (OR, 1.97), previous hospital admission (OR, 1.75), nursing home residence (OR, 2.94), and Pneumonia Severity Index (PSI) classes ≥ III (PSI-III, P = 0.008; PSI-IV, P = 0.022; PSI-V, P = 0.005) were significantly associated with MDRSP-CAP.
Conclusions: Pneumonia Severity Index score, asthma, HIV infection, previous hospital admission, and nursing home residence are risk factors for MDRSP in CAP patient.