Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-16T21:16:07.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

Published online by Cambridge University Press:  21 June 2016

Ebbing Lautenbach ,
Mark G. Weiner ,
Irving Nachamkin ,
Warren B. Bilker ,
Angela Sheridan  and
Neil O. Fishman
Ebbing Lautenbach*
Affiliation:
Divisions of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistic, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mark G. Weiner
Affiliation:
General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistic, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Angela Sheridan
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Divisions of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104–6021, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives.

To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.

Designs.

An ecologic study, a case-control study, and a retrospective cohort study.

Setting.

A 625-bed tertiary care medical center.

Patients.

All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.

Results.

From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.

Conclusions.

The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 893 - 900
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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, RN, 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.Pfaller, MA, Jones, RN, Doern, GV, Kugler, K. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother 1998; 42:1762–1970.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.Vidal, F, Mensa, J, Almela, M, et al. Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Arch Intern Med 1996; 156:2121–2126.Google Scholar
5.King, A, Shannon, K, Phillips, I. Resistance to imipenem in Pseudomonas aeruginosa. J Antimicrob Chemother 1995; 36:1037–1041.CrossRefGoogle ScholarPubMed
6.Piddock, LJV. Mechanisms of resistance to fluoroquinolones: state-of-the-art 1992-1994. Drugs 1995; 49(Suppl 2):29–35.CrossRefGoogle ScholarPubMed
7.Suvarna, SK, Al-Wali, WI, Locke, TJ. Morphological changes in Pseudomonas aeruginosa secondary to ciprofloxacin. Histopathology 1997; 31: 82–83.Google ScholarPubMed
8.Pai, H, Kim, JW, Kim, J, Lee, J, Choe, K, Gotoh, N. Carbapenem resistance mechanisms in Pseudomonas aeruginosa clinical isolates. Antimicrob Agents Chemother 2001; 45:480–484.Google Scholar
9.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.CrossRefGoogle ScholarPubMed
10.Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GQ, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001; 33:289–295.CrossRefGoogle ScholarPubMed
11.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45:613–619.Google Scholar
12.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing. NCCLS approved standard M100-S11. Wayne, PA: NCCLS; 2001.Google Scholar
13.Armitage, P. Test for linear trend in proportions and frequencies. Biometrics 1955; 11:375–386.CrossRefGoogle Scholar
14.Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologic research: principles and quantitative methods. New York: Van Nostrand Reinhold; 1982.Google Scholar
15.Mantel, N, Haenszel, W. Statistical aspects of the analysis of data from retrospective studies of disease. J National Cancer Institute 1959; 22:719–748.Google ScholarPubMed
16.Hosmer, DO, Lemeshow, SL. Applied logistic regression. New York: Wiley and Sons; 1989.Google Scholar
17.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
18.Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989; 129:125–137.CrossRefGoogle ScholarPubMed
19.Cao, B, Wang, H, Sun, H, Zhu, Y, Chen, M. Risk factors and clinical outcomes of nosocomial multidrug resistant Pseudomonas aeruginosa infections. J Hosp Infect 2004; 57:112–118.Google Scholar
20.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.CrossRefGoogle ScholarPubMed
21.Troillet, N, Samore, MH, Carmeli, Y. Imipenem-resistant Pseudomonas aeruginosa: risk factors and antibiotic susceptibility patterns. Clin Infect Dis 1997; 25:1094–1098.CrossRefGoogle ScholarPubMed
22.Fukuda, H, Hosaka, M, Hirai, K, Iyobe, S. New norfloxacin resistance gene in Pseudomonas aeruginosa PAO. Antimicrob Agents Chemother 1990; 34: 1757–1761.Google Scholar
23.Aubert, G, Pozzetto, B, Dorche, G. Emergence of quinolone-imipenem cross-resistance in Pseudomonas aeruginosa after fluoroquinolone therapy. J Antimicrob Chemother 1992; 29:307–312.Google Scholar
24.Kohler, T, Michea-Hamzehpour, M, Epp, SF, Pechere, JC. Carbapenem activities against Pseudomonas aeruginosa: respective contributions of OprD and efflux systems. Antimicrob Agents Chemother 1999; 43:424–427.Google Scholar
25.Livermore, DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis 2002; 34:634–640.Google Scholar
26.Ochs, MM, McCusker, MP, Bains, M, Hancock, RE. Negative regulation of the Pseudomonas aeruginosa outer membrane porin OprD selective for imipenem and basic amino acids. Antimicrob Agents Chemother 1999; 43:1085–1090.Google Scholar
27.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 Scholar
28.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.CrossRefGoogle ScholarPubMed