Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia

Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed as a new pneumonia category in 2005, and treatment recommendations include broad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens. However, this concept continues to be controversial, and microbiological data are lacking for HCAP patients in the intensive care unit (ICU). This study was conducted to determine the rate and type of antibiotic-resistant organisms and the clinical outcomes in patients with HCAP in the ICU, compared to patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Methods: We conducted a retrospective cohort analysis of patients with pneumonia (n = 195) who admitted to medical ICU in tertiary teaching hospital from March 2011 to February 2013. Clinical characteristics, microbiological distributions, treatment outcomes, and prognosis of HCAP (n = 74) were compared to those of CAP (n = 75) and HAP (n = 46). Results: MDR pathogens were significantly higher in HCAP patients (39.1%) than in CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriate antibiotic treatment occurred more frequently in the HCAP (32.6%) and HAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differences in clinical outcomes. The significant prognostic factors were pneumonia severity and treatment response. Conclusions: MDR pathogens were isolated in HCAP patients requiring ICU admission at intermediate rates between those of CAP and HAP.