Risk factors of oropharyngeal carriage of Pseudomonas aeruginosa among patients from a Medical-Surgical Intensive Care Unit

Fortaleza, Carlos Magno Castelo Branco; Figueiredo, Ligia; Beraldo, Carolina Contador; Melo, Edson Carvalho de; Pola, Patrícia M. S.; Aragão, Valéria Drummond Nagem

doi:10.1590/s1413-86702009000300004

Cited by 7 publications

(4 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In regard to the role of antibiotics, the most striking finding of the present study was that fluoroquinolones were actually protective for the acquisition of P. aeruginosa and rather neutral for the acquisition of its resistance phenotypes. In critically ill patients, in the few previous studies in which researchers have specifically investigated P. aeruginosa acquisition, findings have been that fluoroquinolones are protective against it in the pharynx [ 46 ] or in any site [ 28 ]. In hospital-wide studies, levofloxacin (but not ciprofloxacin) has been reported to be protective against nosocomial infection due to fluoroquinolone-susceptible P. aeruginosa [ 12 ] and also against Gram-negative bacilli (including P. aeruginosa ) colonization or infection with chromosomally mediated cephalosporin resistance [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

et al. 2015

View full text Add to dashboard Cite

IntroductionThe objective of this work was to investigate the risk factors for the acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill patients, taking into account colonization pressure.MethodsWe conducted a prospective cohort study in an 8-bed medical intensive care unit during a 35-month period. Nasopharyngeal and rectal swabs and respiratory secretions were obtained within 48 hours of admission and thrice weekly thereafter. During the study, a policy of consecutive mixing and cycling periods of three classes of antipseudomonal antibiotics was followed in the unit.ResultsOf 850 patients admitted for ≥3 days, 751 (88.3%) received an antibiotic, 562 of which (66.1%) were antipseudomonal antibiotics. A total of 68 patients (8%) carried P. aeruginosa upon admission, and among the remaining 782, 104 (13%) acquired at least one strain of P. aeruginosa during their stay. Multivariate analysis selected shock (odds ratio (OR) =2.1; 95% confidence interval (CI), 1.2 to 3.7), intubation (OR =3.6; 95% CI, 1.7 to 7.5), enteral nutrition (OR =3.6; 95% CI, 1.8 to 7.6), parenteral nutrition (OR =3.9; 95% CI, 1.6 to 9.6), tracheostomy (OR =4.4; 95% CI, 2.3 to 8.3) and colonization pressure >0.43 (OR =4; 95% CI, 1.2 to 5) as independently associated with the acquisition of P. aeruginosa, whereas exposure to fluoroquinolones for >3 days (OR =0.4; 95% CI, 0.2 to 0.8) was protective. In the whole series, prior exposure to carbapenems was independently associated with carbapenem resistance, and prior amikacin use predicted piperacillin-tazobactam, fluoroquinolone and multiple-drug resistance.ConclusionsIn critical care settings with a high rate of antibiotic use, colonization pressure and non-antibiotic exposures may be the crucial factors for P. aeruginosa acquisition, whereas fluoroquinolones may actually decrease its likelihood. For the acquisition of strains resistant to piperacillin-tazobactam, fluoroquinolones and multiple drugs, exposure to amikacin may be more relevant than previously recognized.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0916-7) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

et al. 2015

View full text Add to dashboard Cite

show abstract

“…However, studies of the oropharyngeal colonization of healthcare professionals by Pseudomonas spp. are scant and the relevance of these carriers should be enlightened 3 , 4 , 11 , 12 . This research aimed to determine the prevalence of oral colonization and the antimicrobial susceptibility of Pseudomonas spp.…”

mentioning

confidence: 99%

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

Lima

Leão-Vasconcelos

Costa

et al. 2015

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

show abstract

“…22,25 However, the sensitivity of rectal swabs in detecting small inocula is suboptimal, 22 and patients with colonization at sites other than the intestinal tract may have been missed. 25,26 Our intention was to perform surveillance of patients with MR-PA infections in a real-life hospital setting with limited resources so that the surveillance program would be easy to accomplish. This may have been a limitation of our study, though, as well as our lack of use of selective antimicrobial media for rectal swabs to detect antibiotic-resistant P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

Gomes¹,

Machado²,

Conceição³

et al. 2011

Braz J Infect Dis

View full text Add to dashboard Cite

Introduction: Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting. Objective and Methods: Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates. Results: Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n = 10) or HTLV-1 infections (n = 5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical. Conclusions: Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.

show abstract

Risk factors of oropharyngeal carriage of Pseudomonas aeruginosa among patients from a Medical-Surgical Intensive Care Unit

Abstract: Oropharyngeal carriage of

Cited by 7 publications

References 15 publications

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

Contact Info

Product

Resources

About