Imipenem Resistance in <i>Pseudomonas aeruginosa</i> Emergence, Epidemiology, and Impact on Clinical and Economic Outcomes

Lautenbach, Ebbing; Synnestvedt, Marie; Weiner, Mark G.; Bilker, Warren B.; Vo, Lien; Schein, Jeff; Kim, Myoung

doi:10.1086/649021

Cited by 112 publications

(91 citation statements)

References 29 publications

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“…The drug resistance rates are largely determined by the pattern of antibiotic usage in the hospital setting. Ciprofloxacin use has been reported to be an independent risk factor for development of fluoroquinolone and carbapenem resistance [12][13][14]. Therefore, several interventions aimed at modifying the antibiotic prescription pattern have been tried, to decrease the resistance rates.…”

Section: Discussionmentioning

confidence: 99%

Changing Trend in the Antibiotic Resistance Pattern of Pseudomonas Aeruginosa Isolated from Wound Swabs of Out-Patients and in-Patients of a Tertiary Care Hospital

Joseph

Devi²,

Shashikala³

et al. 2013

JCDR

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Section: Discussionmentioning

confidence: 99%

Changing Trend in the Antibiotic Resistance Pattern of Pseudomonas Aeruginosa Isolated from Wound Swabs of Out-Patients and in-Patients of a Tertiary Care Hospital

Joseph

Devi²,

Shashikala³

et al. 2013

JCDR

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“…Data from U.S. ICU studies, surveillance studies, the National Nosocomial Surveillance System, and the SENTRY Antimicrobial Surveillance Program have shown that overall susceptibilities within a 10-year period have declined significantly for all drug classes studied, and these trends are likely mirrored in individual institution antibiograms as well (82,135,182). Nationally, for example, multidrug resistance of P. aeruginosa to three or more antipseudomonal agents rose from 4% in 1993 to 14% in 2002 (P Ͻ 0.001), and it continues to rise (148,187).…”

Section: Arguments In Favor Of Combination Therapy Broad Spectrum Of mentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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“…To assess risk factor variables, we used a comprehensive clinical and administrative University of Pennsylvania health system database, which contains data for all hospitalizations since January 1, 2001, and has been used successfully for similar studies of antimicrobial drug resistance (19)(20)(21). Data elements obtained were age, sex, race, hospital (HUP or PPMC), admission as a transfer from another facility (i.e., outside hospital, longterm care facility, rehabilitation center), location within the hospital at the time of culture (i.e., intensive care unit or not intensive care unit), length of hospital stay before culture, prior admission to HUP or PPMC within the past 30 days, Charlson index (22), and all-patient refi ned-diagnosisrelated group (APR-DRG) classifi cation.…”

Section: Variablesmentioning

confidence: 99%

Cefepime-ResistantPseudomonas aeruginosa

Akhabue¹,

Synnestvedt²,

Weiner³

et al. 2011

Emerg. Infect. Dis.

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Resistance to extended-spectrum cephalosporins complicates treatment of Pseudomonas aeruginosa infections. To elucidate risk factors for cefepime-resistant P. aeruginosa and determine its association with patient death, we conducted a case-control study in Philadelphia, Pennsylvania. Among 2,529 patients hospitalized during 2001-2006, a total of 213 (8.4%) had cefepime-resistant P. aeruginosa infection. Independent risk factors were prior use of an extended-spectrum cephalosphorin (p<0.001), prior use of an extended-spectrum penicillin (p = 0.005), prior use of a quinolone (p<0.001), and transfer from an outside facility (p = 0.01). Among those hospitalized at least 30 days, mortality rates were higher for those with cefepimeresistant than with cefepime-susceptible P. aeruginosa infection (20.2% vs. 13.2%, p = 0.007). Cefepime-resistant P. aeruginosa was an independent risk factor for death only for patients for whom it could be isolated from blood (p = 0.001). Strategies to counter its emergence should focus on optimizing use of antipseudomonal drugs.P seudomonas aeruginosa is one of the most common gram-negative bacterial causes of health careacquired infections (1-3). These infections result in high Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.All other clinicians completing this activity will be issued a certifi cate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; (4) view/print certifi cate. Learning Objectives Upon completion of this activity, participants will be able to:• Distinguish the prevalence of cefepime-resistant P. aeruginosa• Analyze risk factors for the development of cefepime-resistant P. aeruginosa• Evaluate the effects of cefepime-resistant P. aeruginosa on the risk for mortality.

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Imipenem Resistance in Pseudomonas aeruginosa Emergence, Epidemiology, and Impact on Clinical and Economic Outcomes

Abstract: The prevalence of IRPA infection or colonization has increased significantly, with important implications for both clinical and economic outcomes. Interventions to curb this continued increase and strategies to optimize therapy are urgently needed.

Cited by 112 publications

References 29 publications

Changing Trend in the Antibiotic Resistance Pattern of Pseudomonas Aeruginosa Isolated from Wound Swabs of Out-Patients and in-Patients of a Tertiary Care Hospital

Changing Trend in the Antibiotic Resistance Pattern of Pseudomonas Aeruginosa Isolated from Wound Swabs of Out-Patients and in-Patients of a Tertiary Care Hospital

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Cefepime-ResistantPseudomonas aeruginosa

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