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Vol. 44. Issue 7.
Pages 399-408 (October 2020)
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Vol. 44. Issue 7.
Pages 399-408 (October 2020)
Original
DOI: 10.1016/j.medin.2019.09.020
Changes of resistance rates in Pseudomonas aeruginosa strains are unrelated to antimicrobial consumption in ICU populations with invasive device-related infection
Los cambios en la resistencia de cepas de Pseudomonas aeruginosa identificadas en infecciones relacionadas con dispositivos invasores no se relacionan con el consumo de antibióticos en la UCI
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F. Álvarez-Lermaa,b,c,
Corresponding author
Falvarez@parcdesalutmar.cat

Corresponding author.
, P. Olaechea-Astigarragad, R. Gimenoe, M. Catalanf, X. Nuvialsg, M.P. Gracia-Arnillaa,c, M. Palomar-Martínezh, I. Seijas-Betolazai, M. Martínez-Alonsoj, ENVIN-HELICS Study Group
a Service of Intensive Care Medicine, Hospital del Mar, Spain
b Universitat Autònoma de Barcelona, Barcelona, Spain
c Research Group in Critical Disorders (GREPAC), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
d Service of Intensive Care Medicine, Hospital Galdakao-Usansolo, Bizkaia, Spain
e Service of Intensive Care Medicine, Hospital Universitario la Fe, Valencia, Spain
f Service of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
g Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
h Intensive Care Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain
i Service of Intensive Care Medicine, Hospital de Cruces, Barakaldo, Bizkaia, Spain
j Unit of Biostatistics, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA) and Department of Basic Medical Sciencies, Universitat de Lleida, Lleida, Spain
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Tables (3)
Table 1. Evolution of Pseudomonas aeruginosa strains identified each year in HCAIs related to invasive devices controlled in the ENVIN-HELICS registry.
Table 2. Evolution of each antipseudomonal antimicrobial family consumption during the study period (2007–2016) expressed as DOT (days of treatment/days of ICU stay×1000).
Table 3. Relationship between evolution of annual resistance rates of P. aeruginosa isolates in ICU-acquired IDRI and consumption of antipseudomonal antimicrobials family in the current and previous years, expressed as DOT (days of treatment/days of ICU stay×1000).
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Abstract
Objective

To evaluate the relationship between antipseudomonal antibiotic consumption and each individual drug resistance rate in Pseudomonas aeruginosa strains causing ICU acquired invasive device-related infections (IDRI).

Design

A post hoc analysis was made of the data collected prospectively from the ENVIN-HELICS registry.

Setting

Intensive Care Units participating in the ENVIN-UCI registry between the years 2007 and 2016 (3-month registry each year).

Patients

Patients admitted for over 24h.

Main variables

Annual linear and nonlinear trends of resistance rates of P. aeruginosa strains identified in IDRI and days of treatment of each antipseudomonal antibiotic family per 1000 occupied ICU bed days (DOT) were calculated.

Results

A total of 15,095 episodes of IDRI were diagnosed in 11,652 patients (6.2% out of a total of 187,100). Pseudomonas aeruginosa was identified in 2095 (13.6%) of 15,432 pathogens causing IDRI. Resistance increased significantly over the study period for piperacillin-tazobactam (P<0.001), imipenem (P=0.016), meropenem (P=0.004), ceftazidime (P=0.005) and cefepime (P=0.015), while variations in resistance rates for amikacin, ciprofloxacin, levofloxacin and colistin proved nonsignificant. A significant DOT decrease was observed for aminoglycosides (P<0.001), cephalosporins (P<0.001), quinolones (P<0.001) and carbapenems (P<0.001).

Conclusions

No significant association was observed between consumption of each antipseudomonal antibiotic family and the respective resistance rates for P. aeruginosa strains identified in IDRI.

Keywords:
Pseudomonas aeruginosa
Invasive device-related infections (IDRI)
Antibiotic resistance
Critically ill
ICU
Antipseudomonal antimicrobials
Abbreviations:
CI
CAUTI
CRBSI
DOT
ENVIN
EUCAST
GTEIS
HELICS
IDRI
ICU
MRB
SEMICYUC
VAP
Resumen
Objetivo

Evaluar la relación entre el consumo de antibióticos antipseudomonales y la tasa de resistencia de cada fármaco individual en cepas de Pseudomonas aeruginosa aisladas en infecciones relacionadas con dispositivos invasivos (IDRI, por sus siglas en inglés) adquiridas en la unidad de cuidados intensivos (UCI).

Diseño

Análisis post-hoc de los datos recopilados prospectivamente del registro ENVIN-HELICS.

Ámbito

Las UCI que participaron en el registro ENVIN-UCI entre los años 2007-2016 (registro de 3 meses cada año).

Pacientes

Pacientes ingresados >24h.

Variables principales

Se calcularon las tendencias anuales lineales y no lineales de las tasas de resistencia de las cepas de P. aeruginosa identificadas en IDRI y los días de tratamiento de cada familia de antibióticos antipseudomonales por 1.000 días de cama ocupada en la UCI (DOT).

Resultados

Se diagnosticaron 15.095 episodios de IDRI en 11.652 pacientes (6,2% de 187.100). Se identificó P. aeruginosa en 2.095 (13,6%) de 15.432 patógenos que causaron IDRI. La resistencia aumentó significativamente durante el período de estudio para piperacilina-tazobactam (p<0,001), imipenem (p=0,016), meropenem (p=0,004), ceftazidima (p=0,005) y cefepima (p=0,015), mientras que las variaciones en las tasas de resistencia de amikacina, ciprofloxacina, levofloxacina y colistina no fueron significativas. Se observó una disminución significativa de la DOT para aminoglucósidos (p<0,001), cefalosporinas (p<0,001), quinolonas (p<0,001) y carbapenems (p<0,001).

Conclusiones

No se encontró asociación significativa del consumo de cada familia de antibióticos antipseudomonales con sus respectivas tasas de resistencia para las cepas de P. aeruginosa identificadas en IDRI.

Palabras clave:
Pseudomonas aeruginosa
Infecciones relacionadas con dispositivos invasivos
Resistencia a antibióticos
Paciente crítico
Unidad de Cuidados Intensivos
Antibióticos antipseudomonales

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