What's hot that the other lot got

Community acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. The contribution of Pseudomonas aeruginosa to both disease burden and antibiotic resistance is unclear; Restrepo et al (European Respiratory Journal 2018;52: 1701190) present a point-prevalence study to address this gap in the data. This multinational study of hospitalised patients investigated the prevalence, risk factors and antibiotic resistance profiles of P. aeruginosa-CAP in 54 countries. A total of 3193 patients were included, all had microbiological testing on admission and had a confirmed diagnosis of CAP. Prevalence of P. aeruginosa-CAP was 4.2 % (133/3193) which represented 11.3 % (133/1173) of all patients with a positive bacterial culture result. Almost half of these patients had an antibiotic-resistant strain (64/133, 48 %; 2.0 % of total cohort) and a quarter had a multi-drug resistant strain of P. aeruginosa (33/133, 25 %; 1.0 % of total cohort). Prior Pseudomonas infection/colonisation (OR 16.10, 95% CI 9.48 to 27.35), prior tracheostomy (OR 6.50, 95% CI 2.61 to 16.19), bronchiectasis (OR 2.88, 95% CI 1.65 to 5.05), patients requiring invasive respiratory and/or vasopressor support (OR 2.33, 95% CI 1.44 to 3.78) and very severe chronic obstructive pulmonary disease (COPD) (OR 2.67, 95% CI 1.25 to 6.06) were all independent risk factors associated with the development of P. aeruginosa-CAP. The study suggests that the risk of P. aeruginosa-CAP is low in hospitalised patients with a diagnosis of CAP but identifiable risk factors may be used to help direct anti-pseudomonal antibiotic therapy.