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

Abstract

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.

Factors associated with epidemic multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

“…2 In addition, persistent MR-PA infections have been observed in these patients. 2 therefore, understanding the predisposing factors for infection/colonization by MR-PA is critical to decrease the incidence and mortality rates of MR-PA infections in this special population.…”

“…the surveillance, description of MR-PA outbreaks, intervention control program, antibiotic susceptibility profile, and molecular characteristics of MR-PA isolates, as well as the clinical characteristics of patients with MR-PA infection/colonization were described in detail elsewhere. 2 During the five-year study period (April 2002 to February 2007), two outbreaks caused by MR-PA were detected. 2 Pulsed field gel electrophoresis (PFGE) typing performed on all randomly preserved MR-PA strains isolated during the study period, including strains from the outbreaks, the interepidemic period, and environmental samples collected close to MR-PA-positive patients, showed that all strains had the same genetic profile.…”

“…2 Pulsed field gel electrophoresis (PFGE) typing performed on all randomly preserved MR-PA strains isolated during the study period, including strains from the outbreaks, the interepidemic period, and environmental samples collected close to MR-PA-positive patients, showed that all strains had the same genetic profile. 2 Both cases and controls selected for this risk factor study were included only once. the study was approved by the institutional ethics committee.…”

“…this knowledge would be especially important in settings in which most admitted patients are immunocompromised and the pathogen causes outbreaks, persistence, and high mortality rates due to infections. 2 …”

Regulation of Rab5 GTPase activity during Pseudomonas aeruginosa-macrophage interaction

“…Pseduomonas aeruginosa resistant strains are commonly found as a secondary infection in immune-compromised patients with cystic fibrosis, COPD, AIDS, Cancer and even among diabetics (Rubin Grandis, Branstetter et al 2004;Krcmery, Koprnova et al 2006;Gomes, Machado et al 2011;Engler, Muhlemann et al 2012;Hogardt and Heesemann 2013) leaving serious blood stream infection with significant mortality and healthcare cost (Weinstein, Towns et al 1997;Wisplinghoff, Seifert et al 2003). The success in establishing P. aeruginosa pathogenecity is largely due to formation of intractable biofilms and secretion of myriads of virulent factors including LasA protease, LasB elastase, pyocyanin, pyoverdin, Type III secretion (T3S) effectors and alginate (Kessler, Safrin et al 1997;Lyczak, Cannon et al 2002;McIver, Kessler et al 2004;Lee, Smith et al 2005;).…”