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

Patel, Nimish; McNutt, Louise‐Anne; Lodise, Thomas P.

doi:10.1128/aac.00456-08

Cited by 14 publications

(8 citation statements)

References 18 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A previous Israeli case‐control report found that 82 multidrug‐resistant PA‐carrying patients were more often treated with prior broad‐spectrum antibiotics . In a study assessing different definitions of antibiotic exposure, ureidopenicillin resistance was associated with prior exposure to any antibiotics, depending on the cumulative burden of prior exposures . Our study is far larger than these previous analyses and presents patient‐unique data spanning two decades.…”

Section: Discussionmentioning

confidence: 85%

Exposure to ertapenem is possibly associated with Pseudomonas aeruginosa antibiotic resistance

Cohen

Block

Moses

et al. 2014

Clinical Microbiology and Infection

View full text Add to dashboard Cite

The role of antibiotic exposure in the evolution and emergence of resistance is challenging to assess. We used carbapenem-resistant Pseudomonas aeruginosa (PA) phenotypes to assess possible factors that are associated with the occurrence and prognosis of such a phenotype and to examine the possible contribution of antibiotic exposure to the evolution of antimicrobial resistance. We conducted a nested case-control study. Cases were defined as patients from whom carbapenem-resistant ureidopenicillin-sensitive PA (CRUS-PA) was isolated; matched controls were PA patients who did not have isolation of CRUS-PA. We analysed potential predictors of CRUS-PA isolation and assessed their clinical significance (mortality and eventual isolation of pan-resistant PA), taking into account antibiotic exposures. We matched 800 case-control pairs. Case patients were more likely to have been exposed to anti-PA carbapenems (OR = 6.9; 95% CI, 2.5-18.6). This finding did not apply to the administration of other antibiotics. The mortality among CRUS-PA patients was similar to that of the controls (HR, 0.8 95%; CI, 0.6-1.1). Subsequent isolation of pan-resistant PA was more frequent among case patients compared with non-pan-resistant controls (p-value <0.05). Among cases, the risk of eventual pan-resistant PA isolation was increased in ertapenem recipients, only after and not prior to the index specimen date (HR, 1.9, 95%; CI, 1.01-3.4). Therefore we suggest that the CRUS-PA phenotype may represent pan beta-lactam resistance and that antibiotic exposure is associated with evolution of PA resistance phenotypes. We demonstrate a novel association of ertapenem with sequentially appearing PA resistance patterns.

show abstract

Section: Discussionmentioning

confidence: 85%

Exposure to ertapenem is possibly associated with Pseudomonas aeruginosa antibiotic resistance

Cohen

Block

Moses

et al. 2014

Clinical Microbiology and Infection

View full text Add to dashboard Cite

show abstract

“…Similar to the previous studies in Turkey, we found that 44 of 120 P. aeruginosa strains (36.7%) strains were resistant to piperacillin-tazobactam. Different studies on resistant P. aeruginosa infections have shown that ICU stay is a major risk factor [ 26 – 28 ]. In the present study we classified our patients with respect to the type of ICU.…”

Section: Discussionmentioning

confidence: 99%

“…The use of TZP, MEM, and CIP within 30 days before isolation was significantly higher in the TZP-R Pa group. To date, studies have identified previous use of piperacillin-tazobactam, imipenem, aminoglycosides, vancomycin, and third-generation cephalosporins as independent risk factors [ 27 , 28 ]. Similar studies of hospital infections in the same settings have identified the use of broad spectrum cephalosporins, ciprofloxacin, and fluoroquinolones within 30 days before isolation as an independent risk factor [ 26 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused byPseudomonas aeruginosa

Sönmezer

Ertem

Erdinç

et al. 2016

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11–10.0]; p = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31–9.76]; p = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21–14.07]; p = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5–11.98]; p = 0.006) and mechanical ventilator application (OR = 11.7; CI 95% [2.24–61.45]; p = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections.

show abstract

“…Age, APACHE II score and SOFA score were introduced into the models as dichotomous variables, taking the median as the cutoff value, whereas colonization pressure was dichotomized by the highest observed value (95th percentile). In multivariate models predicting the acquisition of strains resistant to each antipseudomonal agent and multiple drugs, a cutoff of 72 hours was used to dichotomize antibiotic exposure because in previous studies it appeared to be the best time span for defining the minimal duration of exposure associated with resistance [ 39 , 40 ]. Variables with a P -value <0.3 in the univariate analysis were introduced into the multivariate model.…”

Section: Methodsmentioning

confidence: 99%

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

et al. 2015

View full text Add to dashboard Cite

IntroductionThe objective of this work was to investigate the risk factors for the acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill patients, taking into account colonization pressure.MethodsWe conducted a prospective cohort study in an 8-bed medical intensive care unit during a 35-month period. Nasopharyngeal and rectal swabs and respiratory secretions were obtained within 48 hours of admission and thrice weekly thereafter. During the study, a policy of consecutive mixing and cycling periods of three classes of antipseudomonal antibiotics was followed in the unit.ResultsOf 850 patients admitted for ≥3 days, 751 (88.3%) received an antibiotic, 562 of which (66.1%) were antipseudomonal antibiotics. A total of 68 patients (8%) carried P. aeruginosa upon admission, and among the remaining 782, 104 (13%) acquired at least one strain of P. aeruginosa during their stay. Multivariate analysis selected shock (odds ratio (OR) =2.1; 95% confidence interval (CI), 1.2 to 3.7), intubation (OR =3.6; 95% CI, 1.7 to 7.5), enteral nutrition (OR =3.6; 95% CI, 1.8 to 7.6), parenteral nutrition (OR =3.9; 95% CI, 1.6 to 9.6), tracheostomy (OR =4.4; 95% CI, 2.3 to 8.3) and colonization pressure >0.43 (OR =4; 95% CI, 1.2 to 5) as independently associated with the acquisition of P. aeruginosa, whereas exposure to fluoroquinolones for >3 days (OR =0.4; 95% CI, 0.2 to 0.8) was protective. In the whole series, prior exposure to carbapenems was independently associated with carbapenem resistance, and prior amikacin use predicted piperacillin-tazobactam, fluoroquinolone and multiple-drug resistance.ConclusionsIn critical care settings with a high rate of antibiotic use, colonization pressure and non-antibiotic exposures may be the crucial factors for P. aeruginosa acquisition, whereas fluoroquinolones may actually decrease its likelihood. For the acquisition of strains resistant to piperacillin-tazobactam, fluoroquinolones and multiple drugs, exposure to amikacin may be more relevant than previously recognized.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0916-7) contains supplementary material, which is available to authorized users.

show abstract

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

Cited by 14 publications

References 18 publications

Exposure to ertapenem is possibly associated with Pseudomonas aeruginosa antibiotic resistance

Exposure to ertapenem is possibly associated with Pseudomonas aeruginosa antibiotic resistance

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused byPseudomonas aeruginosa

Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure

Contact Info

Product

Resources

About