All ETDs from UAB

Advisory Committee Chair

Sadeep Shrestha

Advisory Committee Members

Gary R Cutter

Russell Griffin

Rachael Lee

James Wells

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

In this dissertation research, I examined the challenges of treating patients with bacterial community-acquired pneumonia (CAP) with the purpose of identifying risk factors linked with multidrug-resistant (MDR) Pseudomonas, treatment toxicity, and poor disease prognosis. I used a retrospective cohort study design to explore a clinical cohort of patients admitted to the University of Alabama at Birmingham hospital network who had bacterial pneumonia diagnosis assessed to be from community transmission between January 2013-December 2019. Electronic medical records were accessed for socio-demographic and clinical information. First, I examined the local prevalence/incidence of Pseudomonas CAP and MDR Pseudomonas CAP, and the relationship between chronic obstructive pulmonary disease (COPD) comorbidity and the risk of Pseudomonas and MDR Pseudomonas CAP. Then I assessed the risk of acute kidney injury (AKI) associated with broad-spectrum antibiotics that have coverage against challenging bacteria like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Lastly, I assessed how socio-demographic characteristics and comorbidity affect the risk of poor disease prognosis in CAP. In the first aim, I found that in CAP patients with respiratory culture, the estimated prevalence of Pseudomonas CAP was 18%. Also, among those with Pseudomonas CAP, the estimated prevalence of MDR Pseudomonas CAP was 22%. iv There was no significant trend in the yearly rates of MDR Pseudomonas CAP. Though COPD was associated with the risk of Pseudomonas CAP, it was not associated with the risk of MDR Pseudomonas CAP. Stroke and dependence on supplemental oxygen increased the risk of MDR Pseudomonas CAP. The second aim results showed that vancomycin+piperacillin-tazobactam (V-PT) combination treatment in CAP patients was associated with a higher risk of AKI when compared with ceftriaxone or vancomycin+cefepime (V-C) combination. Lastly, the third aim showed that COPD patients had a shorter length of hospital stay when compared to non-COPD patients. Also, the risk of death among COPD patients was similar to non-COPD patients. Though the local incidence of MDR Pseudomonas CAP is stable, the bacteria is still a threat in CAP patients. COPD comorbidity is a risk factor for Pseudomonas CAP. Also, broad-spectrum antibiotics toxicity, socio-demographic characteristics, and comorbidities are important considerations in the clinical management of CAP.

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