Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-23T03:10:02.407Z Has data issue: false hasContentIssue false
  • English
  • Français

Imipenem Resistance in Pseudomonas aeruginosa Emergence, Epidemiology, and Impact on Clinical and Economic Outcomes

Published online by Cambridge University Press:  02 January 2015

Ebbing Lautenbach ,
Marie Synnestvedt ,
Mark G. Weiner ,
Warren B. Bilker ,
Lien Vo ,
Jeff Schein  and
Myoung Kim
Ebbing Lautenbach*
Affiliation:
Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania of the Department of Medicine, the Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Marie Synnestvedt
Affiliation:
Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mark G. Weiner
Affiliation:
General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
of the Department of Medicine, the Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Lien Vo
Affiliation:
Ortho-McNeil Janssen Scientific Affairs, Raritan, New Jersey
Jeff Schein
Affiliation:
Ortho-McNeil Janssen Scientific Affairs, Raritan, New Jersey
Myoung Kim
Affiliation:
Ortho-McNeil Janssen Scientific Affairs, Raritan, New Jersey
*
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 191046021 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Background.

Pseudomonas aeruginosa is one of the most common gram-negative hospital-acquired pathogens. Resistance of this organism to imipenem complicates treatment.

Objective.

To elucidate the risk factors for imipenem-resistant P. aeruginosa (IRPA) infection or colonization and to identify the effect of resistance on clinical and economic outcomes.

Methods.

Longitudinal trends in prevalence of IRPA from 2 centers were characterized during the period from 1989 through 2006. For P. aeruginosa isolates obtained during the period from 2001 through 2006, a case-control study was conducted to investigate the association between prior carbapenem use and IRPA infection or colonization, and a cohort study was performed to identify the effect of IRPA infection or colonization on mortality, length of stay after culture, and hospital cost after culture.

Results.

From 1989 through 2006, the proportion of P. aeruginosa isolates demonstrating resistance to imipenem increased from 13% to 20% (P< .001, trend). During the period from 2001 through 2006, there were 2,542 unique patients with P. aeruginosa isolates, and 253 (10.0%) had IRPA isolates. Prior carbapenem use was independently associated with IRPA infection or colonization (adjusted odds ratio [OR], 7.92 [95% confidence interval {CI}, 4.78-13.11]). Patients with an IRPA isolate recovered had higher in-hospital mortality than did patients with an imipenem-susceptible P. aeruginosa isolate (17.4% vs 13.4%; P = .01). IRPA infection or colonization was an independent risk factor for mortality among patients with isolates recovered from blood (adjusted OR, 5.43 [95% CI, 1.72-17.10]; P = .004) but not among patients with isolates recovered from other anatomic sites (adjusted OR, 0.78 [95% CI, 0.51-1.21]; P = .27). Isolation of IRPA was associated with longer hospital stay after culture (P<.001) and greater hospital cost after culture (P<.001) than was isolation of an imipenem-susceptible strain. In multivariable analysis, IRPA infection or colonization remained an independent risk factor for both longer hospital stay after culture (coefficient, 0.20 [95% CI, 0.04-0.36]; P = .02) and greater hospital cost after culture (coefficient, 0.30 [95% CI, 0.06-0.54]; P = .02).

Conclusions.

The prevalence of IRPA infection or colonization has increased significantly, with important implications for both clinical and economic outcomes. Interventions to curb this continued increase and strategies to optimize therapy are urgently needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 47 - 53
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fluit, AC, Jones, ME, Schmitz, FJ, Acar, J, Gupta, R, Verhoef, J. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY antimicrobial surveillance program, 1997 and 1998. Clin Infect Dis 2000;30:454–460.CrossRefGoogle ScholarPubMed
2.Gaynes, R, Edwards, JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41:848–854.Google Scholar
3.Hilf, M, Yu, VL, Sharp, JA, Zuravleff, JJ, Korvick, JA, Muder, RR. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlation in a prospective study of 200 patients. Am J Med 1989;87:540–546.CrossRefGoogle Scholar
4.Micek, ST, Lloyd, AE, Ritchie, DJ, Reichley, RM, Fraser, VJ, Kollef, MH. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother 2005;49:1306–1311.CrossRefGoogle ScholarPubMed
5.Vidal, F, Mensa, J, Alrnela, M, et al. Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis of the influence of antibiotic treatment. Arch Intern Med 1996;156:2121–2126.CrossRefGoogle ScholarPubMed
6.Paterson, DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43(Suppl 2):43–48.Google Scholar
7.McGowan, JE. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. Am J Med 2006;119(Suppl 1):S29–S36.CrossRefGoogle ScholarPubMed
8.Harris, AD, Karchmer, TB, Carmeli, Y, Samore, MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001;32:1055–1061.Google Scholar
9.Gasink, LB, Fishman, NO, Weiner, MG, Nachamkin, I, Bilker, WB, Lautenbach, E. Fluoroquinolone-resistant Pseudomonas aeruginosa: assessment of risk factors and clinical impact. Am J Med 2006;199:e19–e26. Available at: http://www.amjmed.com/article/PIIS0002934305011502. Accessed November 20, 2009.Google Scholar
10.Lautenbach, E, Weiner, MG, Nachamkin, I, Bilker, WB, Sheridan, A, Fishman, NO. Imipenem resistance among Pseudomonas aeruginosa isolates: risk factors for infection and impact of resistance on clinical and economic outcomes. Infect Control Hosp Epidemiol 2006;27:893–900.CrossRefGoogle ScholarPubMed
11.NCCLS. Performance standards for antimicrobial susceptibility testing: 11th informational supplement. NCCLS document. Wayne, PA: NCCLS, 2001:M100–S11.Google Scholar
12.Defez, C, Fabbro-Peray, P, Bouziges, N, et al. Risk factors for multidrug-resistant Pseudomonas aeruginosa nosocomial infection. J Hosp Infect 2004;57:209–216.Google Scholar
13.Falagas, ME, Koletsi, PK, Bliziotis, IA. The diversity of definitions of mul-tidrug-resistant (MDR) and pandrug-resistant (PDR) Atinetobacter bau-mannii and Pseudomonas aeruginosa. J Med Microbiol 2006;55:1619–1629.Google Scholar
14.MacAdam, H, Zaoutis, TE, Gasink, LB, Bilker, WB, Lautenbach, E. Investigating the association between antibiotic use and antibiotic resistance: impact of different methods of categorizing prior antibiotic use. Int J Antimicrob Agents 2006;28:325–332.CrossRefGoogle ScholarPubMed
15.Gasink, LB, Zaoutis, TE, Bilker, WB, Lautenbach, E. The categorization of prior antibiotic use: impact of the identification of risk factors for drug resistance in case control studies. Am J Infect Control 2007;35:638–642.CrossRefGoogle ScholarPubMed
16.Armitage, P. Test for linear trend in proportions and frequencies. Biometrics 1955;11:375–386.Google Scholar
17.Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologic Research: Principles and Quantitative Methods. New York, NY: Van Nostrand Rein-hold; 1982.Google Scholar
18.Mantel, N, Haenszel, W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748.Google ScholarPubMed
19.Hosmer, DO, Lemeshow, SL. Applied Logistic Regression. New York, NY: Wiley and Sons; 1989.Google Scholar
20.Sun, GW, Shook, TL, Kay, GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996;49:907–916.CrossRefGoogle ScholarPubMed
21.Mickey, RM, Greenland, S. The impact of confounder selection criteria of effect estimation. Am J Epidemiol 1989;129:125–137.Google Scholar
22.Garner, JS, Jarvis, WR, Emori, TG, Horau, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
23.Ozkurt, Z, Ertek, M, Eroi, S, Altoparlak, U, Akcay, MN. The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit. Burns 2005;31:870–873.Google Scholar
24.Fortaleza, CM, Freira, MP, Filho, D, de Carvalho Ramos, M. Risk factors for recovery of imipenem- or ceftazidime-resistant Pseudomonas aeruginosa among patients admitted to a teaching hospital in Brazil. Infect Control Hosp Epidemiol 2006;27:901–906.CrossRefGoogle ScholarPubMed
25.Cao, B, Wang, H, Sun, H, Zhu, Y, Chen, M. Risk factors and clinical outcomes of nosocomial multi-drug resistant Pseudomonas aeruginosa infections. J Hosp Infect 2004;57:112–118.CrossRefGoogle ScholarPubMed
26.Harris, AD, Smith, D, Johnson, JA, Bradham, DD, Roghmann, MC. Risk factors for imipenem-resistant Pseudomonas aeruginosa among hospitalized patients. Clin Infect Dis 2002;34:340–345.Google Scholar
27.Troillet, N, Samore, MH, Carmeli, Y. Imipenem-resistant Pseudomonas aeruginosa: risk factors and antibiotic susceptibility patterns. Clin Infect Dis 1997;25:1094–1098.Google Scholar
28.Carmeli, Y, Troillet, N, Eliopoulos, GM, Samore, MH. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999;43:1379–1382.CrossRefGoogle ScholarPubMed
29.Peña, C, Guzmán, A, Suarez, C, et al. Effects of carbapenem exposure of the risk for digestive tract carriage of intensive care unit-endemic car-bapenem-resistant Pseudomonas aeruginosa strains in critically ill patients. Antimicrob Agents Chemother 2007;51:1967–1971.CrossRefGoogle ScholarPubMed
30.Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.Google Scholar
31.Lautenbach, E, Fishman, NO, Bilker, WB, et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 2002;162:2469–2477.CrossRefGoogle ScholarPubMed
32.Lautenbach, E, Strom, BL, Bilker, WB, Patel, JB, Edelstem, PH, Fishman, NO. Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Clin Infect Dis 2001;33:1288–1294.CrossRefGoogle ScholarPubMed
33.Krcmery, V, Trup, J, Kunova, A, et al. Imipenem-resistant P. aeruginosa bacteremia in cancer patients: risk factors, clinical features, and outcome. Int J Clin Pharmacol Res 1996;16:43–49.Google ScholarPubMed
34.Carmeli, Y, Troillet, N, Karchmer, AW, Samore, M. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159:1127–1132.Google Scholar