Risk Factors for Hospital-Acquired Pneumonia Caused by Imipenem-Resistant Pseudomonas Aeruginosa in an Intensive Care Unit

Furtado, Guilherme Henrique Campos; Gales, Ana Cristina; Perdiz, Luciana Baria; Santos, Amn; Wey, Sérgio Barsanti; Medeiros, Eduardo Alexandrino

doi:10.1177/0310057x1003800605

Cited by 23 publications

(14 citation statements)

References 39 publications

(80 reference statements)

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“…The most frequently assessed antibiotics included carbapenem and aminoglycosides (Supplemental Table 5). All of the examined predictors were reported as significant predictors for acquisition of resistant P. aeruginosa except for the following in three studies: Acute Physiology And Chronic Health Evaluation II (APACHE II) and hospital stay (1 study [20]), heart failure as a co-occurring disease (1 study [21]), and number of antibiotics used (1 study [24]).…”

Section: Results Of Studies Of Resistant P Aeruginosamentioning

confidence: 99%

“…The literature search identified a total of 165 citations; of which, 98 full-text articles were retrieved and assessed for eligibility. The systematic review included 19 articles (6 articles for AIAT versus IIAT [12][13][14][15][16][17]; 17 articles for acquisition of resistant or multidrug-resistant P. aeruginosa [12,[14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30] and 4 articles reported both outcomes [12,[14][15][16]) that met final eligibility criteria ( Fig. 1).…”

Section: Baseline Study and Population Characteristicsmentioning

confidence: 99%

“…Nineteen studies reported in 17 articles (two articles contributed to four studies) were included (Table 3) [12,[14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30]. A total of 3203 total subjects (1077 cases and 2126 controls) were examined for risk factors of acquisition of [29]).…”

Section: Risk Factors For Acquiring Resistant P Aeruginosamentioning

confidence: 99%

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Pseudomonas infections among hospitalized adults in Latin America: a systematic review and meta-analysis

et al. 2020

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Background: Treatment of resistant Pseudomonas aeruginosa infection continues to be a challenge in Latin American countries (LATAM). We synthesize the literature on the use of appropriate initial antibiotic therapy (AIAT) and inappropriate initial antibiotic therapy (IIAT) in P. aeruginosa infections, and the literature on risk factors for acquisition of resistant P. aeruginosa among hospitalized adult patients in LATAM.Methods: MEDLINE, EMBASE, Cochrane, and LILAC were searched between 2000 and August 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when studies were sufficiently similar.Results: The screening of 165 citations identified through literature search yielded 98 full-text articles that were retrieved and assessed for eligibility, and 19 articles conducted in Brazil (14 articles), Colombia (4 articles), and Cuba (1 article) met the inclusion criteria. Of 19 eligible articles, six articles (840 subjects) examined AIAT compared to IIAT in P. aeruginosa infections; 17 articles (3203 total subjects) examined risk factors for acquisition of resistant P. aeruginosa; and four articles evaluated both. Four of 19 articles were rated low risk of bias and the remaining were deemed unclear or high risk of bias. In meta-analysis, AIAT was associated with lower mortality for P. aeruginosa infections (unadjusted summary OR 0.48, 95% CI 0.28-0.81; I 2 = 59%), compared to IIAT and the association with mortality persisted in subgroup meta-analysis by low risk of bias (3 articles; unadjusted summary OR 0.46, 95% CI 0.28-0.81; I 2 = 0%). No meta-analysis was performed for studies evaluating risk factors for acquisition of resistant P. aeruginosa as they were not sufficiently similar. Significant risk factors for acquisition of resistant P. aeruginosa included: prior use of antibiotics (11 articles), stay in the intensive care unit (ICU) (3 articles), and comorbidity score (3 articles). Outcomes were graded to be of low strength of evidence owing to unclear or high risk of bias and imprecise estimates. Conclusion:Our study highlights the association of AIAT with lower mortality and prior use of antibiotics significantly predicts acquiring resistant P. aeruginosa infections. This review reinforces the need for rigorous and structured antimicrobial stewardship programs in the LATAM region.

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Section: Results Of Studies Of Resistant P Aeruginosamentioning

confidence: 99%

Section: Baseline Study and Population Characteristicsmentioning

confidence: 99%

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Pseudomonas infections among hospitalized adults in Latin America: a systematic review and meta-analysis

et al. 2020

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“…P. aeruginosa is associated with hospital-acquired infections frequently in pediatric patients ( 17 , 18 ). LPS is considered a major virulence factor of P. aeruginosa ( 19 , 20 ). LPS infection in pediatric patients may lead to the self-limited upper respiratory tract infection or may develop into severe lower respiratory tract disease often associated with airflow obstruction and high mortality among children.…”

Section: Discussionmentioning

confidence: 99%

Tremella polysaccharides inhibit cellular apoptosis and autophagy induced by Pseudomonasï¿½aeruginosa lipopolysaccharide in A549 cells through sirtuin 1 activation

Shi

Wei²,

Wang

2018

Oncol Lett

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In the present study, the role of Tremella polysaccharides in cellular apoptosis and autophagy induced by Pseudomonas aeruginosa lipopolysaccharide (LPS) in human epithelial A549 lung-cancer cells was investigated. Initially, it was demonstrated that LPS attenuated A549 cell viability in a time- and dose-dependent manner. Furthermore, LPS induced apoptotic cell death and autophagy in A549 cells and increased reactive oxygen species (ROS) production in a time-dependent manner. In addition, LPS treatment was demonstrated to markedly suppress sirtuin 1 (SIRT1) protein expression in A549 cells. Notably, it was demonstrated that Tremella polysaccharides activate SIRT1, leading to increased p62 expression, decreased p53 acetylation and B-cell lymphoma 2-associated X protein expression, and subsequently attenuate LPS-induced apoptotic cell death and autophagy. The results of the present study demonstrated that Tremella polysaccharides activate SIRT1 and inhibit LPS-induced ROS production, apoptosis and autophagy. This may have critical implications for the treatment of Pseudomonas aeruginosa infection.

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“…19 History of a hospitalization and transfer from a skilled nursing facility were also found to be important risk factors across both multivariable models, which is consistent with findings of several other studies. [19][20][21][22] Presence of a prior CR P aeruginosa infection was found to be the strongest predictor for CR and EBR. This finding was not surprising owing to the chronic, recurrent nature of many antibiotic-resistant P aeruginosa infections, especially among patients undergoing prolonged mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Development and Assessment of Risk Scores for Carbapenem and Extensive β-Lactam Resistance Among Adult Hospitalized Patients WithPseudomonas aeruginosaInfection

et al. 2018

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IMPORTANCE Treatment of patients with infections due to Pseudomonas aeruginosa has been complicated by increased antibiotic resistance rates, which contribute to delayed appropriate treatment and deleterious outcomes. OBJECTIVE To develop 2 clinical risk scores based on variables available at clinical presentation to estimate the risk of carbapenem resistance (CR) or extensive β-lactam resistance (EBR) among hospitalized, adult patients with P aeruginosa infections. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included adult (age, Ն18 years) members of Kaiser Permanente Southern California (KPSC) with a P aeruginosa infection during hospitalization from September 1, 2011, through August 31, 2016, who received antibiotic therapy within 2 days of the culture date. Data were analyzed from July 2, 2017, through August 15, 2018. EXPOSURES Demographic, clinical, and laboratory covariates 1 year before the index culture date were evaluated. MAIN OUTCOMES AND MEASURES Pseudomonas aeruginosa was categorized as antibiotic susceptible, CR, or EBR (nonsusceptibility to carbapenems, ceftazidime, and combined piperacillin sodium and tazobactam sodium). Patients were randomly split (1:1) into training and validation data sets. The training data set was used to develop 2 prediction models using high-performance logistic regression with variable selection by Schwarz-Bayesian criterion. The models were translated into risk scores, with risk score points equaling the weighted sums of regression coefficients from the prediction model. The patient's risk was estimated as the inverse logit of the risk score. RESULTS Of the 7775 patients with 11 502 P aeruginosa infections included in the analysis, most were male (4308 [55.4%]) and non-Hispanic white (3927 [50.5%]). The mean (SD) age was 70.3 (15.5) years. Among 11 502 P aeruginosa infections, 2324 (20.2%) were CR, 9178 (79.8%) were non-CR, 1033 (9.0%) were EBR, and 10 469 were non-EBR (91.0%). The strongest predictors of resistance in the CR and EBR models were history of CR P aeruginosa infection (odds ratios [ORs], 8.80 [95% CI, 6.74-11.49] and 5.04 [95% CI, 3.88-6.54], respectively), tracheostomy (ORs, 3.49 [95% CI, 2.92-4.16] and 3.13 [95% CI, 2.50-3.91], respectively), and carbapenem use in the prior 30 days (ORs, 4.18 [95% CI, 3.29-5.31] and 2.26 [95% CI, 1.74-2.93], respectively). The models for CR and EBR performed well, with areas under the receiver operating characteristics curve of 0.81 or greater for the training and validation data sets. (continued) Key Points Question Which hospitalized adult patients have an increased risk of carbapenem-resistant or extensive β-lactam-resistant Pseudomonas aeruginosa infections? Findings In this cohort study of 7775 hospitalized patients with 11 052 P aeruginosa infections, 20.2% of infections were carbapenem resistant and 9.0% were extensive β-lactam resistant. Risk scores that included history of carbapenem-resistant P aeruginosa infection, tracheostomy, and carbapenem use in the prior 30 days were associated with...

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Risk Factors for Hospital-Acquired Pneumonia Caused by Imipenem-Resistant Pseudomonas Aeruginosa in an Intensive Care Unit

Cited by 23 publications

References 39 publications

Pseudomonas infections among hospitalized adults in Latin America: a systematic review and meta-analysis

Pseudomonas infections among hospitalized adults in Latin America: a systematic review and meta-analysis

Tremella polysaccharides inhibit cellular apoptosis and autophagy induced by Pseudomonasï¿½aeruginosa lipopolysaccharide in A549 cells through sirtuin 1 activation

Development and Assessment of Risk Scores for Carbapenem and Extensive β-Lactam Resistance Among Adult Hospitalized Patients WithPseudomonas aeruginosaInfection

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