Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients

Martínez, José Antonio; Delgado, Esther; Martí, Sara; Marco, Francesc; Vila, Jordi; Torres, Antoni; Codina, Carles; Trilla, Antoni; Soriano, Álex; Alquézar, Aitor; Castro, Pedro; Nicolás, José M.

doi:10.1007/s00134-008-1326-y

Cited by 26 publications

(22 citation statements)

References 38 publications

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“…Previous studies on digestive colonization in ICU patients have shown that carbapenem exposure was associated with the acquisition of carbapenem-resistant P. aeruginosa strains, with odds ratios ranging from 3.4 to 7.8 (4,19). In addition, the ability of fluoroquinolones to promote P. aeruginosa-resistant strains was also comparable with that in previous reports (3,4,(19)(20)(21), although a recent study has shown a clear divergence in the role of fluoroquinolones in P. aeruginosa resistance (22).…”

Section: Discussionsupporting

confidence: 78%

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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Section: Discussionsupporting

confidence: 78%

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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“…Whether one type of carbapenem is more associated with emergence of resistance should be further explored. Earlier studies also showed that antipseudomonal antibiotics piperacillin/tazobactam, ceftazidime and ciprofloxacin were associated with the emergence of P. aeruginosa resistance in critically ill patients [7, 16, 17]. However, in our study, the significant effect disappeared after further adjustment with the length of stay, except for meropenem, which highlights meropenem as an antibiotic that selected for P. aeruginosa resistance.…”

Section: Discussioncontrasting

confidence: 51%

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

Yusuf

Herendael

Verbrugghe

et al. 2017

Ann. Intensive Care

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BackgroundAntibiotics are frequently used in intensive care units (ICUs), and their use is associated with the emergence of bacterial resistance to antibiotics. The aim of this study was to investigate the association between the emergence of Pseudomonas aeruginosa resistance and the duration of antibiotic exposure or mode of administration in an ICU unit.MethodsA 4-year cohort study of intensive care unit was performed in patients with P. aeruginosa isolates from clinical specimens, initially susceptible to the investigated antibiotics (piperacillin/tazobactam, ceftazidime, ciprofloxacin, meropenem and amikacin). Odds ratios (ORs) with 95% confidence interval (95% CI) of emergence of resistance were calculated using logistic regression analysis for various exposure periods to antibiotics (1–3, 4–7, 8–15 and >15 days) relative to no exposure with adjustment for age, sex, Simplified Acute Physiology Score 3 (SAPS 3) and length of stay. ORs on the emergence of P. aeruginosa resistance were also calculated for the various modes of administration.ResultsIncluded were 187 patients [mean age 61 years, 69% male, mean SAPS 3 score (SD): 59 (12.3)]. None of the antibiotics investigated showed the emergence of resistance within 1–3 days. Significant meropenem resistance emerged within 8–15 days [OR 79.1 (14.9–421.0)] after antibiotic exposure unlike other antibiotics (>15 days). No difference was observed between intermittent and extended administration of meropenem and between beta-lactam mono- or combined therapy.ConclusionsUse of meropenem was associated with the emergence of resistance as soon as 8 days after exposure to the antibiotic.

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“…We can provide valuable data concerning the CASR A. Previous studies used individual-level data to investigate the association between antibiotic exposure and acquisition of resistance, and few studies have investigated aggregated population-level data [12][13][14]. Aggregated population-level data may be more suitable for such investigations because they consider the exposure of an entire population [15,16].…”

Section: Discussionmentioning

confidence: 97%

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Zou

Liu

et al. 2014

Eur J Clin Microbiol Infect Dis

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The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (β = -10.504, p < 0.01). The resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (β = 34.94, p < 0.001), as did the correlation of P. aeruginosa to meropenem with antipseudomonal third-generation cephalosporins usage (β = 32.76, p < 0.01) and K. pneumoniae to amikacin with aminoglycosides usage (β = 22.01, p < 0.001). The decreased antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

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Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients

Abstract: In critically ill patients, quinolones and antipseudomonal cephalosporins may prevent the acquisition of P. aeruginosa and may have a negligible influence on the acquisition and emergence of resistance.

Cited by 26 publications

References 38 publications

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

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

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

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

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