Risk Factors for Recovery of Imipenem- or Ceftazidime-Resistant <i>Pseudomonas aeruginosa</i> Among Patients Admitted to a Teaching Hospital in Brazil

Fortaleza, Carlos Magno Castelo Branco; Freire, Maristela Pinheiro; Filho, Djalma de Carvalho Moreira; Ramos, Marcelo de Carvalho

doi:10.1086/507288

Cited by 35 publications

(47 citation statements)

References 21 publications

(17 reference statements)

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“…Adicionalmente, encontramos que por cada día de estancia el riesgo calculado para adquirir una infección por este microorganismo es de 3%, sin asociarse con mayor estancia hospitalaria después del aislamiento microbiológico, contrario a lo reportado por otros autores 26 . En el presente estudio se evaluó el uso de varios grupos de antimicrobianos en el mes previo al aislamiento del microorganismo MR y sólo se encontró significancia estadística en el análisis bivariado, con el uso de carbapenémicos y aminoglucósidos; sin embargo, en el análisis multivariado, el uso de aminoglucósidos fue el único relacionado con el desarrollo de infección por P. aeruginosa MR, hallazgo descrito por otros autores 25,26 . Esto es debido probablemente a que estos antimicrobianos tienen un impacto en la microbiota normal de los pacientes, predisponiendo para la adquisición de nuevas cepas o aumentando la expresión de microorganismos resistentes ya albergados por los mismos, además hay que tener en cuenta que el uso de aminoglucosidos en microorganismos MR, no se realiza en monoterapia y encontramos que el estar expuesto a dos o más antibacterianos sí favorece el desarrollo de infecciones por esta bacteria.…”

Section: Artículo Originalunclassified

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Ossa-Giraldo

Echeverri-Toro

Santos

et al. 2014

Rev. chil. infectol.

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Section: Artículo Originalunclassified

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Ossa-Giraldo

Echeverri-Toro

Santos

et al. 2014

Rev. chil. infectol.

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“…This is especially true for the common finding of imipenem use as a risk factor for the acquisition of imipenem-resistant P. aeruginosa strains 5,6 . Strong correlations between amikacin use and resistance must be emphasized, since they contradict the traditional belief that combination therapy (beta-lactams plus aminoglycosides) prevents resistance 6,13 . On the other hand, ceftazidime seems to play a lesser role than imipenem in the selection of resistant strains 6,14 .…”

Section: Conflict Of Interest Referencesmentioning

confidence: 99%

“…Most of these studies assess individual risk factors using case-control designs [4][5][6] . However, the spread of multidrug-resistant pathogens is the result of several factors that act directly or in indirectly on individuals at risk.…”

Section: Palavras-chavesmentioning

confidence: 99%

Antimicrobial use and incidence of multidrug-resistant Pseudomonas aeruginosa in a teaching hospital: an ecological approach

Neves

Lorenzo

Almeida

et al. 2010

Rev. Soc. Bras. Med. Trop.

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Introduction: Multidrug-resistant Pseudomonas aeruginosa is a major threat in healthcare settings. The use of antimicrobials can influence the incidence of resistant strains by direct and indirect mechanisms. The latter can be addressed by ecological studies. Methods: Our group attempted to analyze the relation between the use of antipseudomonal drugs and the incidence of MDR-PA among 18 units from a 400-bed teaching hospital. The study had a retrospective, ecological design, comprising data from 2004 and 2005. Data on the use of four antimicrobials (amikacin, ciprofloxacin, ceftazidime and imipenem) were tested for correlation with the incidence of MDR-PA (defined as isolates resistant to the four antimicrobials of interest) in clinical cultures. Univariate and multivariate linear regression analyses were performed. Results: Significant correlations were determined between use and resistance for all antimicrobials in the univariate analysis: amikacin (standardized correlation coefficient = 0.73, p = 0.001); ciprofloxacin (0.71, p = 0.001); ceftazidime (0.61, p = 0.007) and imipenem (0.87, p < 0.001). In multivariate analysis, only imipenem (0.67, p = 0.01) was independently related to the incidence of multidrug-resistant strains. Conclusions: These findings share similarities with those reported in individual-based observational studies, with possible implications for infection control.

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“…Studies performed prior to ertapenem's approval attempted to define risk factors for Pseudomonas resistance (6,11). Lautenbach et al (11) found not only a higher mortality rate (31.1%) for patients infected with an imipenem-resistant P. aeruginosa than for those infected with imipenem-susceptible strains (16.7%) but also concluded that the only independent risk factor for imipenem resistance was fluoroquinolone use.…”

mentioning

confidence: 99%

Introduction of Ertapenem into a Hospital Formulary: Effect on Antimicrobial Usage and Improved In Vitro Susceptibility of Pseudomonas aeruginosa

Goldstein¹,

Citron²,

Peraino³

et al. 2009

Antimicrob Agents Chemother

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After ertapenem was added to the formulary of a 344-bed community teaching hospital, we retrospectively studied its effect on antimicrobial utilization and on the in vitro susceptibility of various antimicrobial agents against Pseudomonas aeruginosa. Three study periods were defined as preintroduction (months 1 to 9), postintroduction but before the autosubstitution of ertapenem for ampicillin-sulbactam (months 10 to 18), and after the policy of autosubstitution (months 19 to 48) was initiated. Ertapenem usage rose slowly from introduction to a range of 36 to 48 defined daily doses/1,000 patient days (DDD) with a resultant decrease in ampicillinsulbactam usage due to autosubstitution. Imipenem usage peaked 6 months after the introduction of ertapenem and started to decline coincidently with the increased use of ertapenem. During the second period, imipenem usage decreased (slope ‫؍‬ ؊1.28; P ‫؍‬ 0.002). Prior to the introduction of ertapenem, the susceptibility of P. aeruginosa to imipenem increased from 61 to 81% at month 7 but then decreased slightly to 67% at month 9. After the introduction of ertapenem, susceptibility continued to increase; the increasing trend was significant (slope ‫؍‬ 1.74; P < 0.001). In the third period, the median susceptibility (interquartile range) was 88% (82 to 95%). This change appeared related to decreased imipenem usage. For every unit decrease in the monthly DDD of imipenem, there was an increase of 0.38% (P ‫؍‬ 0.008) in the susceptibility of P. aeruginosa to imipenem in the same month. Ertapenem was effective in our antimicrobial stewardship program and may have helped improve the P. aeruginosa antimicrobial susceptibility to imipenem by decreasing the unnecessary usage and selective pressure of antipseudomonal agents.

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Risk Factors for Recovery of Imipenem- or Ceftazidime-Resistant Pseudomonas aeruginosa Among Patients Admitted to a Teaching Hospital in Brazil

Abstract: Our study suggests a definite role for several classes of antimicrobials as risk factors for recovery of IRPA but not for recovery of CRPA. Limiting the use of only imipenem and ceftazidime may not be a wise strategy to contain the spread of resistant P. aeruginosa strains.

Cited by 35 publications

References 21 publications

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Antimicrobial use and incidence of multidrug-resistant Pseudomonas aeruginosa in a teaching hospital: an ecological approach

Introduction of Ertapenem into a Hospital Formulary: Effect on Antimicrobial Usage and Improved In Vitro Susceptibility of Pseudomonas aeruginosa

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