Predictive factors for multidrug-resistant pathogens in hemodialysis patients with pneumonia: a multicenter study

Abstract

Background: In patients with hemodialysis-associated pneumonia (HDAP), information on both microbiologic features and antimicrobial strategies is limited. The aim of this study is to investigate predictive factors of infection with multidrug-resistant (MDR) pathogens in HDAP patients. Methods: This was a multicenter, retrospective, and observational study. We analyzed the associations between risk factors of HDAP and infection with MDR pathogens and created a decision support tool to predict infection with MDR pathogens. Results: The median age of the enrolled patients was 71. MDR pathogens were identified in 24 (22.8%) out of a total of 105 HDAP patients and in 7 (11.4%) of 61 pure HDAP patients without other components of healthcare-associated pneumonia. The most common MDR pathogens was methicillin-resistant Staphylococcus aureus (10 patients, 9.5%). Logistic regression showed two variables were independently associated with the isolation of MDR pathogens: prior hospitalization (odds ratio [OR]: 3.109, 95% confidence interval [CI]: 1.043 – 9.272) and PSI score (OR: 1.021, 95% CI: 1.001– 1.042). The optimal cut-off value for PSI score using ROC curve analysis was 147. As the risk determined by the two-factor prediction tool increased, the prevalence of infection with MDR pathogens in each group also increased (P Conclusions: We demonstrated that prior hospitalization and PSI > 147 are risk factors of infection with MDR pathogens in HDAP patients. This simple proposed tool would facilitate more accurate identification of MDR pathogens in these patients.