Impact of ertapenem use on Pseudomonas aeruginosa and Acinetobacter baumannii imipenem susceptibility rates: collateral damage or positive effect on hospital ecology?

Sousa, Dolores; Corral, Laura Castelo; Gutiérrez-Urbón, José-María; Molina, Francisca; López‐Calviño, Beatriz; Bou, Germán; Llinares, Pedro

doi:10.1093/jac/dkt091

Cited by 30 publications

(26 citation statements)

References 25 publications

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“…However, isolation rates of CRAB increased continuously during the implementation of the antibiotic-stewardship program. Similarly, a statistically significant reduction in CRAB rates was not observed previously following the implementation of a comprehensive antibiotic-stewardship program [15], [22], [26]. These findings suggest that the development of antibiotic resistance is multifactorial.…”

Section: Discussionmentioning

confidence: 46%

“…This study, like previous studies, demonstrated an association between the increased use of Group 2 carbapenems and increased rates of CRAB isolates; by contrast, no statistically significant association was observed between the consumption of ertapenem and the rates of CRAB isolates [16], [24], [25]. These findings suggest that ertapenem use did not affect the cross-resistance of nonfermentative gram-negative bacilli to Group 2 carbapenems, and this had a positive impact on the hospital ecology by suppressing the selection pressure exerted by Group 2 carbapenems [14], [26].…”

Section: Discussionmentioning

confidence: 83%

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Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Yoon¹,

Yang

Lee

2014

PLoS ONE

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ObjectiveAntimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems.MethodsA before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1–18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19–36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37–54).ResultsDuring the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031).ConclusionsImplementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 83%

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Yoon¹,

Yang

Lee

2014

PLoS ONE

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“…En varios estudios contemporáneos se ha evaluado el impacto del uso de ertapenem en la emergencia de microorganismos resistentes y, aunque los resultados son contradictorios, la mayoría de los hallazgos apuntan a que no hay asociación (12,23). En el estudio de Sousa, et al, su empleo se relacionó con un menor uso de imipenem y con la mayor sensibilidad de P. aeruginosa a este medicamento (24 El uso de quinolonas fue otro factor de riesgo estadísticamente significativo en este estudio, al igual que en otras investigaciones y en un metaanálisis (OR=2,73; IC 95% 1,27-5,87) (25). Se ha observado que las concentraciones inhibitorias de ciprofloxacina crean una presión de selección a favor de mutantes con un incremento en la expresión del adenosín monofosfato (AMP) cíclico (26), mientras que los niveles no inhibidores incrementan la frecuencia de la mutación de resistencia a carbapenémicos mediante el aumento de la regulación de la bomba de flujo MexEFOprM y a niveles reducidos de la porina OprD, lo que afecta especialmente a meropenem y, probablemente, es el mecanismo que mejor explica esta resistencia inducida (27).…”

Section: Discussionunclassified

Factores de riesgo para bacteriemia adquirida en el hospital por Pseudomonas aeruginosa resistente a carbapenémicos en un hospital colombiano

et al. 2016

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Contribución de los autores:Todos los autores participaron en el diseño del estudio, el análisis e interpretación de los resultados, y en la redacción y aprobación del manuscrito. Introducción. Las bacteriemias por Pseudomonas aeruginosa resistentes a carbapenémicos son un problema de salud pública por las pocas alternativas de tratamiento disponibles, el aumento de la estancia hospitalaria, los costos que genera y el aumento en el riesgo de mortalidad. Objetivo. Evaluar los factores de riesgo de bacteriemia por P. aeruginosa resistente a carbapenémicos adquirida en el Hospital Universitario San Ignacio, durante el periodo comprendido entre enero de 2008 y junio de 2014. Materiales y métodos. Se hizo un estudio de casos y controles. Los casos eran de pacientes que presentaban bacteriemia por P. aeruginosa resistente a carbapenémicos y los controles eran pacientes con P. aeruginosa sensible a este grupo de antibióticos. Se midieron variables como el uso de meropenem o ertapenem, la inmunosupresión y la neoplasia, y se determinaron la mortalidad y el tiempo de estancia hospitalaria. Resultados. Se evaluaron 168 pacientes, 42 casos y 126 controles. En el modelo multivariado se encontraron los siguientes factores de riesgo relacionados con la bacteriemia por P. aeruginosa resistente a carbapenémicos y adquirida en el hospital: uso de nutrición parenteral (odds ratio, OR=8,28; IC 95% 2,56-26,79; p=0), uso de meropenem (OR=1,15; IC 95% 1,03-1,28; p=0,01) y uso de ciprofloxacina (OR=81,99; IC 95% 1,14-5884; p=0,043). Conclusión. Para el control de la aparición de P. aeruginosa resistente a carbapenémicos, se deben fortalecer los programas de control de antimicrobianos, promover el uso prudente de carbapenémicos y quinolonas, y vigilar el uso adecuado de la nutrición parenteral. Factores de riesgo para bacteriemia por Pseudomonas aeruginosa resistente a carbapenémicos adquirida en un hospital colombiano Palabras clave:Pseudomonas aeruginosa, factores de riesgo, bacteriemia, nutrición parenteral, ciprofloxacina. doi: http://dx.doi.org/10.7705/biomedica.v36i2.2784Risk factors for hospital-acquired bacteremia due to carbapenem-resistant Pseudomonas aeruginosa in a Colombian hospital Introduction: Bacteremia due to Pseudomonas aeruginosa resistant to carbapenems is a public health problem due to the limitations it places on therapeutic options, as well as the increased time patients must spend in hospital, costs and the risk of mortality. Objective: To evaluate the risk factors for presentation of bacteremia due to carbapenem-resistant P. aeruginosa acquired in the Hospital Universitario San Ignacio between January 2008 and June 2014. Materials and methods: This was a case control study in which the case patients presented bacteremia due to P. aeruginosa resistant to carbapenems and the control group included patients with P. aeruginosa susceptible to this group of antibiotics. Variables such as the previous use of meropenem and ertapenem, immunosuppression and neoplasia were measured. Mortality and duration of hospital wer...

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“…In fact, several studies suggest that ertapenem is not associated with increased carbapenem resistance in P. aeruginosa (25,26); however, these reports drew their conclusions from ecological analyses. Other studies have examined the effect of introducing ertapenem into a hospital on the susceptibility of P. aeruginosa to group 2 carbapenems (27,28); in these studies, the authors suspected that the improved susceptibility of P. aeruginosa to group 2 carbapenems was related to decreased fluoroquinolone use. However, in line with our finding, a recent patient-centered analysis provided a possible association of ertapenem with the appearance of P. aeruginosa resistance patterns (9).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Pressure Is a Major Risk Factor for Rectal Colonization by Multidrug-Resistant Pseudomonas aeruginosa in Critically Ill Patients

Gómez-Zorrilla

Camoez

Tubau

et al. 2014

Antimicrob Agents Chemother

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The intestinal reservoir is central to the epidemiology of Pseudomonas aeruginosa, but the dynamics of intestinal colonization by different phenotypes have been poorly described. To determine the impact of antimicrobial exposure on intestinal colonization by multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa, we screened intensive care unit (ICU) patients for rectal colonization on admission and at weekly intervals. During an 18-month study period, 414 ICU patients were enrolled, of whom 179 (43%) were colonized; 112 (63%) of these were identified at ICU admission and 67 (37%) during their ICU stay. At 10 days after ICU admission, the probabilities of carriage were 44%, 24%, and 24% for non-MDR, MDR-non-XDR, and XDR P. aeruginosa strains, respectively (log rank, 0.02). Pulsed-field gel electrophoresis showed 10 pairs of non-MDR P. aeruginosa and subsequent MDR-non-XDR strains isolated from the same patients to be clonally identical and another 13 pairs (8 MDR-non-XDR and 5 XDR) to be unrelated. There was one specific clone between the 8 MDR-non-XDR strains and an identical genotype in the 5 XDR isolates. The Cox regression analysis identified MDR P. aeruginosa acquisition as associated with the underlying disease severity (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.22 to 3.18; P ‫؍‬ 0.006) and prior use of fluoroquinolones (aHR, 1.02; 95% CI, 1.00 to 1.04; P ‫؍‬ 0.039), group 2 carbapenems (aHR, 1.03; 95% CI, 1.00 to 1.07; P ‫؍‬ 0.041), and ertapenem (aHR, 1.08; 95% CI, 1.02 to 1.14; P ‫؍‬ 0.004). The epidemiology of MDR P. aeruginosa is complex, and different clusters may coexist. Interestingly, ertapenem was found to be associated with the emergence of MDR isolates. Pseudomonas aeruginosa is one of the most common nosocomial pathogens worldwide, and continuously evolving resistance to multiple antimicrobial agents has become a significant health problem. The control of multidrug-resistant (MDR) P. aeruginosa in intensive care units (ICUs) is an important method for preserving the limited number of drugs available for treating P. aeruginosa infections. However, this control is difficult to achieve because the path of emergence and dissemination of MDR P. aeruginosa is not fully understood. As an endogenous source of endemic or epidemic infection with Gram-negative bacilli (GNB), the intestinal reservoir is central to the epidemiology of P. aeruginosa because prior rectal colonization is typically present in most patients developing GNB infections (1).Several studies have demonstrated that prior antimicrobial drug exposure is also a strong risk factor for colonization with a drug-resistant pathogen (2, 3). In fact, we have previously reported an association between carbapenem and fluoroquinolone consumption with the probability of colonization by carbapenem-resistant P. aeruginosa in ICU patients (4).In recent years, important changes have occurred in the epidemiology of MDR P. aeruginosa. First, in addition to the characteristic polyclonal pattern of endogenous ...

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Impact of ertapenem use on Pseudomonas aeruginosa and Acinetobacter baumannii imipenem susceptibility rates: collateral damage or positive effect on hospital ecology?

Abstract: Use of ertapenem was directly associated with a downward trend in the use of imipenem and ciprofloxacin, which may have contributed to improve the susceptibility of P. aeruginosa to imipenem. Ertapenem use had no impact on the susceptibility of A. baumannii to imipenem.

Cited by 30 publications

References 25 publications

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Factores de riesgo para bacteriemia adquirida en el hospital por Pseudomonas aeruginosa resistente a carbapenémicos en un hospital colombiano

Antibiotic Pressure Is a Major Risk Factor for Rectal Colonization by Multidrug-Resistant Pseudomonas aeruginosa in Critically Ill Patients

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