<i>Pseudomonas aeruginosa</i> Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

Harris, Anthony D.; Jackson, Sarah; Robinson, Gwen; Pineles, Lisa; Leekha, Surbhi; Thom, Kerri A.; Wang, Yuan; Doll, Michelle; Pettigrew, Melinda M.; Johnson, J. Kristie

doi:10.1017/ice.2015.346

Cited by 44 publications

(41 citation statements)

References 20 publications

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“…Studies that investigate PA colonization as a risk factor for subsequent PA infection are very scarce, and they do not perform multivariate time-to-event analysis in combination with competing risk analyses [3, 4, 7–9]. …”

Section: Discussionmentioning

confidence: 99%

P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

Paling

Wolkewitz

Depuydt

et al. 2017

Antimicrob Resist Infect Control

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ObjectiveTo determine the incidence of P. aeruginosa (PA) ICU pneumonia and its independent association with PA colonization at ICU admission.MethodsThis was a post-hoc analysis of a prospectively collected cohort study. Adult ICU patients with a length of stay of ≥48 h were included and assessed for microbiologically confirmed PA ICU pneumonia. Multivariate survival analysis was performed, including the covariates age, gender, PA colonization at ICU admission, ICU admission specialty and mechanical ventilation at ICU admission, while taking into account the effect of competing risks.ResultsWe included 5093 patients, 2447 (48%) were tested for colonization; of those 226 (9.2%) were PA colonized at ICU admission. The incidence of PA ICU pneumonia was 1.34% (n = 68). PA colonization was an independent risk factor (subdistribution hazard ratio [SHR] 8.8; 95% confidence interval [CI] 4.9–15.7), as was mechanical ventilation (SHR 5.3, 95% CI 2.7–10.6).ConclusionIn this study the incidence of P. aeruginosa ICU pneumonia was 1.34%. Hazard ratios for PA colonized patients compared to non-colonized to develop PA ICU pneumonia were 8.8. The high risk associated with P. aeruginosa colonization for subsequent infection may offer a target for future interventions.

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Section: Discussionmentioning

confidence: 99%

P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

Paling

Wolkewitz

Depuydt

et al. 2017

Antimicrob Resist Infect Control

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“…21 A study by Harris et al to investigate the prevalence of P. aeruginosa colonisation on ICU admission, revealed that of the 1 840 patients, 213 (11.6%) were colonised with P. aeruginosa on ICU admission. 22 In another study on frequency of multi-drug resistant (MDR) P. aeruginosa in intensive care unit (ICU)-acquired pneumonia (ICUAP), P. aeruginosa was the most frequent aetiology of ICUAP (64, 29%). 23 These are in line with our studies where 82% of the isolates were recovered from the ICUs.…”

Section: Discussionmentioning

confidence: 99%

Molecular characterisation of multidrug-resistant Pseudomonas aeruginosa from a private hospital in Durban, South Africa

Adjei

Govinden

Moodley

et al. 2017

Southern African Journal of Infectious Diseases

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Background: Multi-drug resistant Pseudomonas aeruginosa pose a clinical challenge globally. This study delineated the molecular mechanisms of resistance to β-lactam antibiotics in multidrug-resistant P. aeruginosa isolated from a single private hospital in Durban, South Africa and ascertained clonality with regard to the isolates carrying β-lactamase genes. Methods: Seventeen P. aeruginosa isolates recovered from sputum, urine, catheter tips, pus swabs, nasal swabs and endotracheal aspirates underwent MIC determination, and phenotypic screening using the Double Disk Synergy Test (DDST) and Modified Hodge Test (MHT) to identify putative extended-spectrum β-lactamases (ESBLs), metallo-β-lactamases and other carbapenemases. Selected β-lactamase encoding genes were genotypically confirmed by PCR and sequencing. REP-PCR was conducted to determine the clonal relatedness of the 11 isolates carrying β-lactamase genes. Results: Sixteen isolates (94%) were resistant to aztreonam and piperacillin, 15 isolates (88%) were resistant to imipenem and ticarcillin, 14 (82%) were resistant to meropenem, and 13 isolates (76%) were resistant to ceftazidime and piperacillin/tazobactam. Resistance to ciprofloxacin and amikacin were 82% and 29% respectively. Of the 17 isolates tested, GES-2, VIM-2 and OXA-21 were present in 10 (59%) four (24%) and one (6%) of the isolates respectively. Three of the isolates harboured both GES-2 and VIM-2 and one isolate harboured OXA-21 and VIM-2. REP-PCR revealed seven clusters with clusters A and F having two (18%) and four (36%) isolates respectively, while the remaining five isolates were unrelated. Conclusion: GES-2 and VIM-2 enzymes were predominantly responsible for carbapenemase resistance. Clones A and F intimated patient-to-patient spread within the ICU and surgical ICU. This apparent dissemination as well as the multi-drug resistance observed points to sub-optimal infection prevention and control and dwindling antibiotic treatment options for P. aeruginosa respectively in this institution.

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“…In this study and in prior studies, the positive and negative predictive values of the fields in the electronic medical record/central data repository were greater than 99%. 10-13 …”

Section: Methodsmentioning

confidence: 99%

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

Harris

Sbarra

Leekha

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To analyze whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use. PATIENTS Patients aged ≥18 years admitted to the University of Maryland Medical Center between November 7, 2015, and May 31, 2017. METHODS Comorbid conditions were assessed using the Elixhauser comorbidity index. The Elixhauser comorbidity index and the comorbid condition components were calculated using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes extracted from electronic medical records. Bivariate associations between CDI and potential covariates for multivariable regression, including antibiotic use, gastric acid suppression therapy use, as well as comorbid conditions, were estimated using log binomial multivariable regression. RESULTS After controlling for antibiotic use, age, proton-pump inhibitor use, and histamine-blocker use, the Elixhauser comorbidity index was a significant risk factor for predicting CDI. There was an increased risk of 1.26 (95% CI, 1.19-1.32) of having CDI for each additional Elixhauser point added to the total Elixhauser score. CONCLUSIONS An increase in Elixhauser score is associated with CDI. Our study and other studies have shown that comorbid conditions are important risk factors for CDI. Electronically available comorbid conditions and scores like the Elixhauser index should be considered for risk-adjustment of CDC CDI rates. Infect Control Hosp Epidemiol 2018;39:297-301.

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Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

Cited by 44 publications

References 20 publications

P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

Molecular characterisation of multidrug-resistant Pseudomonas aeruginosa from a private hospital in Durban, South Africa

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

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