Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis

Abstract

BackgroundIncreasing rates of resistant and multidrug-resistant (MDR) P. aeruginosa in hospitalized patients constitute a major public health threat. We present a systematic review of the clinical and economic impact of this resistant pathogen.MethodsStudies indexed in MEDLINE and Cochrane databases between January 2000-February 2013, and reported all-cause mortality, length of stay, hospital costs, readmission, or recurrence in at least 20 hospitalized patients with laboratory confirmed resistant P. aeruginosa infection were included. We accepted individual study definitions of MDR, and assessed study methodological quality.ResultsThe most common definition of MDR was resistance to more than one agent in three or more categories of antibiotics. Twenty-three studies (7,881 patients with susceptible P. aeruginosa, 1,653 with resistant P. aeruginosa, 559 with MDR P. aeruginosa, 387 non-infected patients without P. aeruginosa) were analyzed. A random effects model meta-analysis was feasible for the endpoint of all-cause in-hospital mortality. All-cause mortality was 34% (95% confidence interval (CI) 27% – 41%) in patients with any resistant P. aeruginosa compared to 22% (95% CI 14% – 29%) with susceptible P. aeruginosa. The meta-analysis demonstrated a > 2-fold increased risk of mortality with MDR P. aeruginosa (relative risk (RR) 2.34, 95% CI 1.53 – 3.57) and a 24% increased risk with resistant P. aeruginosa (RR 1.24, 95% CI 1.11 – 1.38), compared to susceptible P. aeruginosa. An adjusted meta-analysis of data from seven studies demonstrated a statistically non-significant increased risk of mortality in patients with any resistant P. aeruginosa (adjusted RR 1.24, 95% CI 0.98 – 1.57). All three studies that reported infection-related mortality found a statistically significantly increased risk in patients with MDR P. aeruginosa compared to those with susceptible P. aeruginosa. Across studies, hospital length of stay (LOS) was higher in patients with resistant and MDR P. aeruginosa infections, compared to susceptible P. aeruginosa and control patients. Limitations included heterogeneity in MDR definition, restriction to nosocomial infections, and potential confounding in analyses.ConclusionsHospitalized patients with resistant and MDR P. aeruginosa infections appear to have increased all-cause mortality and LOS. The negative clinical and economic impact of these pathogens warrants in-depth evaluation of optimal infection prevention and stewardship strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/2047-2994-3-32) contains supplementary material, which is available to authorized users.

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

“…Finally, in the study by Dautzenberg et al [30] patients colonized with carbapenemase-producing Enterobacteriaceae had a 1.79 times higher hazard of dying in ICU than no colonized patients, primarily because of an increased length of stay. Additionally, 3 review articles summarizing the published data on this issue were identified [31][32][33] as well as another one presenting the clinical consequences of specific MDR pathogen, namely P. aeruginosa [34] . In the review by Shorr [33] , studies mostly conducted on general hospitalized population were included providing that among the studied patients a more than 39% of cases was hospitalized in the ICU.…”

Phenotypic and Molecular Detection of Metallo-Beta-Lactamase Genes Among Imipenem Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Strains Isolated From Patients with Burn Injuries

“…Treatment of wound infections is a challenge due to the biofilms formation and resistance to antibiotics (5). Also, inadequate initial therapy is associated with poor clinical outcomes, longer hospital stays and higher costs (6). Pseudomonas aeruginosa and Acinetobacter baumannii appear as important pathogens particularly in burn wards.…”

Molecular Analysis of Pseudomonas aeruginosa Strains Isolated from Burn Patients by Repetitive Extragenic Palindromic-PCR (rep-PCR)

“…It is most harmful to individuals whose immune systems have been compromised similar to those with in AIDS, cancer, burns, cystic fibrosis, and neutropenia. Several infections can be acquired in the hospital such as wound, burn, urinary tract, and eye and outer ear infections, as well as meningitis and necrotizing pneumonia (2).…”