Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units

Bertrand, Xavier; Thouverez, Michelle; Talon, D.; Boillot, A.; Capellier, Gilles; Floriot, C.; Hélias, J

doi:10.1007/s001340100979

Cited by 169 publications

(103 citation statements)

References 15 publications

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“…Crossed P. aeruginosa transmission seems to be a frequent cause of nosocomial acquisition. Close to half the isolates in that epidemic presented related electrophoretic patterns suggesting that this had been the mode of adquisition [20]. In an 18-bed ICU in France, 26% of the admitted patients acquired P. aeruginosa carriage or colonization.…”

Section: Discussionmentioning

confidence: 95%

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Cortés¹,

Cuervo²,

Urdaneta³

et al. 2009

Braz J Infect Dis

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Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

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Section: Discussionmentioning

confidence: 95%

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Cortés¹,

Cuervo²,

Urdaneta³

et al. 2009

Braz J Infect Dis

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“…Pseudomonas is a common pathogen in the intensive care unit, colonising the airways of up to 30% of ventilated patients. 5,6 From here it may readily contaminate the ocular surface, for example when dispersed by routine suction of the airway. 7 While Pseudomonas is unlikely to penetrate healthy corneal epithelium, it can invade the stroma via an abrasion within minutes of contact.…”

Section: Introductionmentioning

confidence: 99%

Screening for ocular surface disease in the intensive care unit

McHugh

Alexander

Kalhoro

et al. 2007

Eye

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Purpose Ventilated patients in the intensive care unit (ICU) often develop exposure keratopathy. This predisposes to the development of bacterial keratitis, which in ICU is often bilateral, with a high risk of perforation. As regular examinations of all ventilated patients by ophthalmologists would be impractical, the purpose of this study was to assess whether ICU staff can screen reliably for keratopathy. Methods A prospective study was performed in a general adult ICU. Twice each week, two junior ICU doctors examined the lid position and ocular surface of all patients who had been continuously sedated for more than 24 h, using fluorescein and a pen torch with a blue filter. An ophthalmologist performed similar examinations using a portable slit lamp. Results A total of 48 ocular examinations were performed in 18 patients. Exposure keratopathy was found by the ophthalmologist in 37.5% of examinations and by ICU doctors in 31.3% of examinations. ICU doctors had a sensitivity of 77.8% and a specificity of 96.7% in detecting keratopathy, when compared with the findings of the ophthalmologist. All cases missed by ICU doctors had punctate erosions of less than 5% of the corneal surface. Keratopathy was significantly commoner in patients with incomplete lid closure than in patients with closed lids (70.0 vs 28.9%; two-tailed Fisher's exact test P ¼ 0.027). Conclusions ICU staff can perform screening examinations for exposure keratopathy with reasonable sensitivity and specificity. Regular screening by ICU staff would facilitate appropriate treatment of exposure keratopathy and promote earlier identification of cases of keratitis.

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“…In addition, gastrointestinal carriage appears to Gomes be a prerequisite for P. aeruginosa colonization and/or infection at other sites, and the intestinal tract is considered the most important reservoir of P. aeruginosa. 22,25 However, the sensitivity of rectal swabs in detecting small inocula is suboptimal, 22 and patients with colonization at sites other than the intestinal tract may have been missed. 25,26 Our intention was to perform surveillance of patients with MR-PA infections in a real-life hospital setting with limited resources so that the surveillance program would be easy to accomplish.…”

Section: Discussionmentioning

confidence: 99%

“…22,25 However, the sensitivity of rectal swabs in detecting small inocula is suboptimal, 22 and patients with colonization at sites other than the intestinal tract may have been missed. 25,26 Our intention was to perform surveillance of patients with MR-PA infections in a real-life hospital setting with limited resources so that the surveillance program would be easy to accomplish. This may have been a limitation of our study, though, as well as our lack of use of selective antimicrobial media for rectal swabs to detect antibiotic-resistant P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

Gomes¹,

Machado²,

Conceição³

et al. 2011

Braz J Infect Dis

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Introduction: Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting. Objective and Methods: Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates. Results: Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n = 10) or HTLV-1 infections (n = 5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical. Conclusions: Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.

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Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units

Abstract: Cross-colonisation seems to play an important role in the general spread of P. aeruginosa in ICUs.

Cited by 169 publications

References 15 publications

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Screening for ocular surface disease in the intensive care unit

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

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