Pneumonia in hospitalized neurologic patients: trends in pathogen distribution and antibiotic susceptibility

Abstract

BACKGROUND: Bed-ridden state, dysphagia, altered mental state, or respiratory muscle weakness are common in neurologic patients and increase the risk of pneumonia. The major causes of pneumonia in neurologic patients may differ from those in the general population, resulting in a different pathogen distribution. We investigated the trends of pathogen distribution in culture-positive pneumonia in hospitalized neurologic patients and the related antibiotic resistance in those with hospital-acquired pneumonia (HAP). METHODS: A retrospective study was performed at Seoul National University Hospital, South Korea. Patients admitted to the Department of Neurology with a positive respiratory specimen culture between 2007 and 2016 were included. Pneumonia events in patients were screened by chronologically associating the date of respiratory specimen acquisition for culture studies and the date of antibiotics administration. Subgroup analyses regarding multidrug resistance in HAP were performed in different pneumonia categories, by presence of >/=1 risk factor and by time period (first half vs. second half of study period). Microbial resistance profiles of isolates from patients with pneumonia were analyzed. RESULTS: We identified 351 pneumonia cases in 227 patients involving 36 different pathogens. 232 cases were HAP, of which 70 cases were intensive care unit (ICU)-HAP. The leading pathogens were Stapylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Enterobacter aerogenes, which were isolated in 133 (37.9%), 72 (20.5%), 55 (15.7%), 44 (12.5%), 33 (9.4%), and 27 (7.7%) cases, respectively. Cases with HAP showed a higher proportion of P. aeruginosa and a lower proportion of S. pneumoniae (both, p < 0.05) than those with non-HAP. ICU-HAP isolates showed a higher multidrug resistance (MDR) rate than non-ICU-HAP isolates (p < 0.005) in those with >/=1 MDR risk factor. Non-susceptibility to imipenem (p < 0.0005), piperacillin-tazobactam (p < 0.001), cefepime (p < 0.005), and trimethoprim-sulfamethoxazole (p < 0.05) in Gram-negative pathogens increased over time in both ICU and non-ICU settings. CONCLUSIONS: S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, S. pneumoniae, and E. aerogenes were the leading isolates in culture-positive pneumonia in hospitalized neurologic patients. Antimicrobial resistance of Gram-negative pathogens in neurologic patients with culture-positive HAP has recently increased.