Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections

Abstract

BackgroundThe incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.MethodsWe retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014.ResultsOf the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08).ConclusionThe prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.

Distribution of Ambler Class A Β-lactamase Genes and Evaluation of Resistance Patterns in Multi-Drug and Extensively-Drug Resistant P. aeruginosa Clinical Isolates

“…However, this rate is lower than the rates reported by Katvoravutthichai (21,26,27). The prevalence of XDR strains (5%) in our study was lower than that reported by Palavutitotai et al (2018) in Thailand (22%) (28). We found no significant association between source of isolation and antibiotic resistance, but the frequency of MDR strains was highest in blood specimens.…”

Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

“…Another Spanish study [33] focused on BSIs in solid organ transplant recipients identified a higher mortality rate for patients with bacteremia due to XDR P. aeruginosa (n = 31) compared to those with BSI caused by other microorganisms (n = 287), and it was found to be an independent risk factor for mortality (20/22 studied strains showed the ST175 pattern). Other studies [34,35] have addressed the impact of XDR strains on different sources of infection, not exclusively in bacteremia. For instance, a Thai study of 255 patients with P. aeruginosa infections, including 56 XDR strains, found that an XDR phenotype was an independent factor of mortality attributable to infection when compared to non-XDR isolates [34].…”

“…Other studies [34,35] have addressed the impact of XDR strains on different sources of infection, not exclusively in bacteremia. For instance, a Thai study of 255 patients with P. aeruginosa infections, including 56 XDR strains, found that an XDR phenotype was an independent factor of mortality attributable to infection when compared to non-XDR isolates [34]. Samonis et al found the same association with mortality in a cohort of 89 P. aeruginosa infections (52 of them with bacteremia and 22 XDR isolates) in cancer patients in Greece [35].…”

Virulence genes and antibiotic resistance of Pseudomonas aeruginosa isolated from patients in the Northwestern of Morocco

“…Information regarding the antimicrobial susceptibility patterns of isolates is needed if we are to decrease the risk of the spread of resistant P. aeruginosa strains [10]. Ongoing microbiological surveillance has been recommended by the World Health Organization (WHO), to improve infection control measures especially in the healthcare setting and to guide the physicians in the choice of empirical or directed treatment [11].…”