Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa

Abstract

IntroductionAlthough Pseudomonas aeruginosa is a leading pathogen responsible for ventilator-associated pneumonia (VAP), the excess in mortality associated with multi-resistance in patients with P. aeruginosa VAP (PA-VAP), taking into account confounders such as treatment adequacy and prior length of stay in the ICU, has not yet been adequately estimated.MethodsA total of 223 episodes of PA-VAP recorded into the Outcomerea database were evaluated. Patients with ureido/carboxy-resistant P. aeruginosa (PRPA) were compared with those with ureido/carboxy-sensitive P. aeruginosa (PSPA) after matching on duration of ICU stay at VAP onset and adjustment for confounders.ResultsFactors associated with onset of PRPA-VAP were as follows: admission to the ICU with septic shock, broad-spectrum antimicrobials at admission, prior use of ureido/carboxypenicillin, and colonization with PRPA before infection. Adequate antimicrobial therapy was more often delayed in the PRPA group. The crude ICU mortality rate and the hospital mortality rate were not different between the PRPA and the PSPA groups. In multivariate analysis, after controlling for time in the ICU before VAP diagnosis, neither ICU death (odds ratio (OR) = 0.73; 95% confidence interval (CI): 0.32 to 1.69; P = 0.46) nor hospital death (OR = 0.87; 95% CI: 0.38 to 1.99; P = 0.74) were increased in the presence of PRPA infection. This result remained unchanged in the subgroup of 87 patients who received adequate antimicrobial treatment on the day of VAP diagnosis.ConclusionsAfter adjustment, and despite the more frequent delay in the initiation of an adequate antimicrobial therapy in these patients, resistance to ureido/carboxypenicillin was not associated with ICU or hospital death in patients with PA-VAP.

The Effect of Infection Control Nurses on the Occurrence of Pseudomonas aeruginosa Healthcare-Acquired Infection and Multidrug-Resistant Strains in Critically-Ill Children

“…These data suggest that the interventions of the infection control nurses, for the control of HAIs yield prominent effects in critical pediatric patients in the PICU. Long-term endotracheal intubation was the most significant risk factor for PICU-acquired pneumonia [ 26 , 27 ]. In this study, the mortality for patients intubated for more than 48 hours was higher than the mortality for the general patients.…”

Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

“…This increasing antibiotic resistance makes the treatment of pneumonia caused by P. aeruginosa more difficult and more expensive. ( 21 ) The emergence of VAP episodes caused by ureido/carboxypenicillin-resistant P. aeruginosa was significantly associated with the administration of broad-spectrum antimicrobials, such as ureidopenicillins, carboxypenicillins, or fluoroquinolones, at admission to the ICU. ( 21 ) Pneumonias caused by metallo-β-lactamase-producing P. aeruginosa result in higher mortality rates.…”

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

“…(2011)Prospective ObservationalTertiary; BrazilRespiratoryCulture positive results for imipenem susceptible or resistant P. aeruginosa ; Isolates were screened for the presence of metallo-β-lactamases by using multiplex PCR.São Paulo Metallo-β-lactamase (SPM-1) producing imipenem resistant P. aeruginosa 5[68]Non-SPM-1-producing susceptible P. aeruginosa 24Gasink et al (2006)Retrospective ObservationalTertiary; USARespiratory, woundCulture positive results for fluoroquinolone susceptible or resistant P. aeruginosa Fluoroquinolone resistant P. aeruginosa 320[64]Susceptible P. aeruginosa 527Hirakata et al . (2003)Retrospective ObservationalTertiary; JapanGenitourinary, respiratory, woundCulture positive results for bla IMP -positive or negative P. aeruginosa ; control subjects selected at random from among inpatients; control subjects samples were bla IMP -negative P. aeruginosa bla IMP -positive P. aeruginosa 69[69] bla IMP -negative P. aeruginosa 247Kaminski et al (2011)Nested case cohortICU; FranceRespiratoryCulture positive results for Ureido/carboxypenicillin susceptible or resistant P. aeruginosa Ureido/carboxypenicillin-resistant P. aeruginosa 70[66]Susceptible P. aeruginosa 153Lambert et al (2011)Prospective ObservationalICU; EURespiratorySusceptibility testing in different centers was done according to local policiesCeftazidime resistant P. aeruginosa 366[31]Susceptible P. aeruginosa 1266Lautenbach et al (2010)Retrospective ObservationalTertiary; USAGenitourinary, respiratory wound, blood, tissueCulture positive results for imipenem susceptible or resistant P. aeruginosa Imipenem resistant P. aeruginosa 253[63]Susceptible P. aeru...…”