Identification of Patients WithPseudomonas aeruginosaRespiratory Tract Infections at Greatest Risk of Infection With Carbapenem-Resistant Isolates

Abstract

With carbapenem resistance rates among P. aeruginosa isolates on the rise at our institution, the challenge was to identify patients for whom carbapenems would remain an effective empirical agent, as well as the patients at greatest risk for infection with carbapenem-resistant strains. The clinical prediction tool accurately estimated carbapenem resistance among this risk-stratified cross-sectional study of patients with P. aeruginosa infection. This tool may be an effective way for clinicians to refine their selection of empirical antibiotic therapy and to maximize clinical outcomes by increasing the likelihood of appropriate antibiotic treatment.

Emergence of antimicrobial resistance to Pseudomonas aeruginosa in the intensive care unit: association with the duration of antibiotic exposure and mode of administration

“…The determinant variable was the duration of the relevant antibiotic used by the patients. The patients were divided into groups according to the number of days of antibiotic exposure according to the literature [6, 14] as follows: not exposed, 1–3, 4–7, 8–15 and >15 days.…”

“…Antimicrobial resistance is of particular importance in the intensive care unit (ICU) because antibiotic use in this setting is extremely common [4]. Several studies have explored the risk factors for P. aeruginosa antimicrobial resistance in non-critically ill patients [5, 6]. These studies showed that among antipseudomonas antibiotics, meropenem was associated with the highest risk of resistance emergence [4, 7].…”

Pharmaceutical analysis of different antibiotic regimens in the treatment of lower respiratory tract infection

“…Antibiotics are dominated in the clinical treatment of LRTI, and there are a variety of different therapeutic regimens. Injection therapy of large-dose antibiotics lead to enhanced drug resistance of pathogens (10,11). During treatment, the increase in the drug costs often lays a heavy economic burden on patients.…”

Relationship between Various Definitions of Prior Antibiotic Exposure and Piperacillin-Tazobactam Resistance among Patients with Respiratory Tract Infections Caused by Pseudomonas aeruginosa

“…Several studies have shown that previous antibiotic use increases the risk of a Pseudomonas aeruginosa infection that is resistant to many commonly used antimicrobials (8)(9)(10)(11)15). Contemporary literature lacks a definition of prior antibiotic exposure which captures all patients at risk of developing piperacillin-tazobactam (PT)-resistant P. aeruginosa (PTR-PA).…”

“…The same process was applied to categorize patients who had received at least 48 h and 72 h of prior antibiotics, respectively. Finally, the classification and regression tree (CART) technique was used to identify the critical threshold duration of antibiotic exposure for each drug class associated with a higher proportion of PTR-PA; the CART methodology has been employed in several previous publications to determine the prior antibiotic exposure most predictive of antibiotic resistance (3,7,10,11,18). Each definition of prior antibiotic exposure was examined in a separate analysis.…”