Short reportMeropenem as predictive risk factor for isolation of multidrug-resistant Pseudomonas aeruginosa
Introduction
Infections caused by resistant strains of Pseudomonas aeruginosa are associated with a higher rate of mortality, an increase in the length of hospital stay, and a considerable increase in healthcare costs.1 The interplay of various resistance mechanisms results in antimicrobial resistance being simultaneously identified, thereby conferring multidrug-resistant (MDR) phenotypes.2 Among the risk factors for nosocomial MDR P. aeruginosa, previous antimicrobial chemotherapy may be a key element in promoting the emergence and spread of MDR P. aeruginosa. In this study, we aimed to determine independent risk factors for the isolation of MDR P. aeruginosa in hospitalized patients over a 14-year study period.
Section snippets
Methods
This study was retrospectively conducted between January 1997 and December 2010 at Juntendo University Hospital, Tokyo, Japan, a 1020-bed tertiary-care teaching hospital. We reviewed annual microbiological data of all clinical isolates obtained from inpatients, except for faeces and nasal swabs. Antimicrobial consumption of products for intravenous injection was calculated in terms of the number of defined daily doses per 100 bed-days. When P. aeruginosa isolates with different susceptibility
Results
A total of 36,732 bacterial isolates were detected from hospitalized patients over the 14-year period; of these, 6287 (17%) were P. aeruginosa. Susceptibility testing showed that 32 different phenotypes of P. aeruginosa were identified. Of these, the phenotype resistant to all five antimicrobials (MDR phenotype) was identified in 192 isolates (3%). A total of 183 patients with MDR P. aeruginosa were identified between 1997 and 2010. Longitudinal observation showed that the number of patients
Discussion
The increasing rate of antimicrobial resistance among P. aeruginosa is a worldwide problem, including Japan.2, 5 In this study, 159 patients with MDR P. aeruginosa were identified over the 14-year period. This rate was consistent with that of nationwide surveillance in Japan.5 Multiple stepwise regression analysis showed a positive correlation between the incidence of patients with MDR P. aeruginosa and antimicrobial consumption of total carbapenems and MEPM. Multivariate logistic regression
Conflict of interest statement
None declared.
Funding source
None.
References (10)
Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum
Am J Med
(2006)- et al.
Association between antimicrobial consumption and clinical isolates of methicillin-resistant Staphylococcus aureus: a 14-year study
J Infect Chemother
(2012) - et al.
Antimicrobial stewardship
Mayo Clin Proc
(2011) - et al.
Risk factors and clinical outcomes of nosocomial multi-drug resistant Pseudomonas aeruginosa infections
J Hosp Infect
(2004) Prescribing guidelines for severe Pseudomonas infections
J Antimicrob Chemother
(2002)
Cited by (31)
Multi-drug resistant Pseudomonas aeruginosa: a 2019–2020 single center retrospective case control study
2023, Infection Prevention in PracticeChanges of resistance rates in Pseudomonas aeruginosa strains are unrelated to antimicrobial consumption in ICU populations with invasive device-related infection
2020, Medicina IntensivaCitation Excerpt :This study failed to demonstrate a statistically significant relationship between the overall consumption of antipseudomonal antimicrobials in ICU populations, expressed as DOT and resistance of P. aeruginosa to individual antimicrobial agent in patients with IDRI related to invasive devices admitted to a large number of Spanish ICUs during a 10-year period. Such negative finding is clinically relevant and in contrast to different studies published in the literature.1,25–34 In individual patients, it has been shown that previous exposure to imipenem or fluoroquinolones influences upon the selection of resistant P. aeruginosa strains to these agents or the development of multiresistant isolates.25–31
Efficacy of PCR-based open reading frame typing assay for outbreak investigation of metallo-β-lactamase-producing Pseudomonas aeruginosa in hematology unit
2018, Journal of Infection and ChemotherapyRisk factors for Pseudomonas aeruginosa infections in Asia-Pacific and consequences of inappropriate initial antimicrobial therapy: A systematic literature review and meta-analysis
2018, Journal of Global Antimicrobial ResistanceCitation Excerpt :In studies of drug-resistant versus drug-susceptible P. aeruginosa infections (seven studies), six studies reported that previous exposure to antibiotics was a significant risk factor for serious infection. Of these, four studies specifically identified previous exposure to the carbapenem antibiotics (imipenem and meropenem) [37,39,40,42], whilst two studies identified previous exposure to fluoroquinolone antibiotics (ciprofloxacin and levofloxacin) [38,40]. In one study, previous exposure to carbapenems was associated with a 45-fold increase in the odds of a drug-resistant P. aeruginosa infection (OR = 44.8, 95% CI 9.2–219; P < 0.001) [37], whilst previous exposure to fluoroquinolones was associated with a 6-fold increase (OR = 6.0, 95% CI 1.6–21.8; P = 0.007) [40].
Impact of hospital length of stay on the distribution of Gram negative bacteria and likelihood of isolating a resistant organism in a Canadian burn center
2016, BurnsCitation Excerpt :In this study, up to 95% of patients received one or more of the selected study antibiotics at some point from 3 days before to 7 days after collecting a culture sample in each time period evaluated. This is reflective of clinical practice as exposure to empiric broad spectrum antibiotics in this population is inevitable and is a risk factor for isolating a multidrug resistant pathogen [16,17]. The low meropenem susceptibility rates against P. aeruginosa observed in our study coincide with CANWARD 2012 susceptibility data of 77.6% in the province of Ontario [13].
Epidemiology and Management of Emerging Drug-Resistant Gram-Negative Bacteria: Extended-Spectrum β-Lactamases and Beyond
2015, Urologic Clinics of North AmericaCitation Excerpt :Consistent with the low colonization rate seen in healthy individuals, a majority of infections caused by P aeruginosa are HAIs, and the most frequently encountered HAIs due to this organism are CAUTIs.29 Risk factors associated with MDR Pseudomonas infections in the hospitalized patients include61,62 Trauma (especially burn injuries)