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Background: COPD is associated with the development of Community-Acquired Pneumonia (CAP). Limited data are available regarding the association of P. aeruginosa (PA) risk factors as predictors of appropriate selection of anti-PA antibiotics. Our aim was to developed a novel PA scoring system based on risk factors to guide appropriate selection of empiric anti-PA antibiotics in hospitalized COPD patients with CAP. Methods: This pre-planned analysis of an international, multicenter, point-prevalence study included immunocompetent COPD patients hospitalized with CAP. We developed a scoring system of independently associated risk factors for PA-CAP. The primary outcomes were prevalence of PA-CAP and the appropriate selection of empiric anti-PA antibiotics. Results: We enrolled 689 hospitalized COPD patients with CAP, with a prevalence of PA-CAP of 7% (n=45). The variables independently associated with PA-CAP were a previous PA infection or colonization (OR 14.2 [95%CI 5.7-35.2] – 3 points), hospitalization in the past 12 months (OR 3.7 [1.5-9.2] – 1 point), and the presence of bronchiectasis (OR 3.2 [1.4-7.2] - 1 point). The PA score-COPD (PAS-COPD) was stratified in 0, 1, 2, or ≥3 points with a PA-CAP prevalence of 2%, 5%, 20% and 50%, respectively. Current anti-PA empiric antibiotics overuse occurs in 54% of the patients, but after the application of the PAS-COPD the overuse of anti-PA empiric antibiotics may ideally drop to 6%. Conclusions: We developed a novel PAS-COPD that accurately identified the risk of PA-CAP and is able to assist providers in the appropriate use of anti-PA antibiotics in COPD patients hospitalized with CAP.

Community-acquired pneumonia (CAP) is the leading infectious cause of death worldwide and its empiric treatment is a critical decision. Several guidelines recommend the appropriate use of antibiotics for patients with CAP, but evidence regarding guideline concordance (GC) is limited to local or regional studies. Our aim was to evaluate the national and international GC of empiric antibiotic selection for hospitalized patients with CAP. Methods: We used the platform of an international, multicenter, point-prevalence study of hospitalized immunocompetent patients with CAP. We analyzed the continental GC according to the recommendations by ERS-2011, ATS/IDSA-2007, and ALAT-2004, and by national guidelines from Portugal, United Kingdom, Pakistan, Spain, India, Germany and Croatia. We stratified the patients according to the site of care in ward or intensive care unit (ICU) admission. Results: We enrolled 3,019 patients with 83% admitted from the ward and 17% from the ICU. At a global level GC was 42%, highest in European countries according to the ERS-2011 (53%), followed by North America (35%) according to ATS/IDSA 2007 guidelines and 33% of South American countries according to ALAT-2004, respectively (p value Conclusions: Adherence to CAP guidelines is suboptimal among the majority of participating countries or at the continental level. Antimicrobial stewardship programs should focus on improving adherence of empiric antibiotic selection in clinical practice.