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Endemic Multidrug-Resistant Pseudomonas aeruginosa in Critically Ill Patients

Published online by Cambridge University Press:  02 January 2015

Bryan Ortega ,
A. B. Johan Groeneveld  and
Constance Schultsz
Bryan Ortega
Affiliation:
Intensive Care Unit, the Institute for Cardiovascular Research at the, Vrije Universiteit, Amsterdam, the Netherlands
A. B. Johan Groeneveld*
Affiliation:
Intensive Care Unit, the Institute for Cardiovascular Research at the, Vrije Universiteit, Amsterdam, the Netherlands
Constance Schultsz
Affiliation:
Department of Medical Microbiology, the Institute for Cardiovascular Research at theVrije Universiteit, Amsterdam, the Netherlands
*
Department of Intensive Care, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
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Abstract

Objective:

To describe the epidemiology of endemic multidrug-resistant Pseudomonas aeruginosa colonizations and infections in critically ill patients.

Design:

Prospective study on bacterial strain typing and retrospective cohort study of charts of patients in the intensive care unit (ICU).

Patients:

Fifty-three patients with P. aeruginosa isolated from clinical cultures in 2001 were selected, divided into those with P. aeruginosa in vitro resistant to at least two classes of antibiotics (multidrug-resistant, n = 18) and those susceptible to all or resistant to only one antibiotic (susceptible, n = 35).

Results:

Risk factors for multidrug-resistant P. aeruginosa included maxillary sinusitis, long-dwelling central venous catheters, prolonged use of certain antibiotics, a high lung injury score, and prolonged mechanical ventilation and duration of stay. The frequency of colonization (approximately 50%) versus infection (ie, ventilator-associated pneumonia) did not differ between the groups. On amplified fragment-length polymorphism analysis, 64% of the multidrug-resistant strains had been potentially transmitted via cross-colonization and 36% had probably originated endogenously. ICU mortality was 22% in the multidrug-resistant group and 23% in the susceptible group, although the duration of mechanical ventilation was longer in the former.

Conclusions:

Patients with sinusitis who stayed in the ICU longer, were ventilated longer because of acute lung injury, received antibiotics for longer durations, and had long-dwelling central venous catheters ran an elevated risk of acquiring multidrug-resistant P. aeruginosa. These patients did not have a higher mortality than patients with susceptible P. aeruginosa. Prevention of the emergence of multidrug-resistant strains requires changes in infection control measures and antibiotic policies in our ICU.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 825 - 831
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

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