Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa

Kaminski, Catherine N.; Timsit, Jean‐François; Dubois, Yohann; Zahar, Jean‐Ralph; Garrouste-Orgeas, Maïté; Vesin, Aurélien; Azoulay, Élie; Féger, Céline; Dumenil, Anne-Sylvie; Adrie, Christophe; Cohen, Yves; Allaouchiche, Bernard

doi:10.1186/cc10136

Cited by 19 publications

(21 citation statements)

References 37 publications

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“…These data suggest that the interventions of the infection control nurses, for the control of HAIs yield prominent effects in critical pediatric patients in the PICU. Long-term endotracheal intubation was the most significant risk factor for PICU-acquired pneumonia [ 26 , 27 ]. In this study, the mortality for patients intubated for more than 48 hours was higher than the mortality for the general patients.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Infection Control Nurses on the Occurrence of Pseudomonas aeruginosa Healthcare-Acquired Infection and Multidrug-Resistant Strains in Critically-Ill Children

Liu

et al. 2015

PLoS ONE

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BackgroundHealthcare-acquired Pseudomonas aeruginosa (P. aeruginosa) infections in the Pediatric Intensive Care Unit (PICU), which have a high incidence, increase treatment costs and mortality, and seriously threaten the safety of critically ill children. It is essential to seek convenient and effective methods to control and prevent healthcare-acquired infections (HAIs). This research was conducted to study the effect of infection control nurses on the occurrence of P. aeruginosa HAIs and multi-drug resistance (MDR) strains in PICU.MethodsThe clinical data was divided into two groups, with the age ranging from 1 month to 14 years. One group of the critically ill patients(N = 3,722) was admitted to PICU from 2007 to 2010, without the management of infection control nurses. The other group of the critically ill patients (N = 3,943) was admitted to PICU from 2011 to 2013, with the management of infection control nurses. Compare the mortality, morbidity and the incidence of acquired P. aeruginosa infections to evaluate the effect of infection control nurses.ResultsAfter implementation of the post of infection control nurses, the patient's overall mortality fell from 4.81% to 3.73%. Among the patients with endotracheal intubation more than 48 hours, the incidence of endotracheal intubation-related pneumonia decreased from 44.6% to 34.32%. The mortality of patients with endotracheal intubation decreased from 16.96% to 10.17%, and the morbidity of HAIs with P. aeruginosa decreased from 1.89% to 1.07%. The mutual different rate (MDR) dropped from 67.95% to 44.23%. There were remarkable differences in these rates between the two groups (p<0.05).ConclusionImplementing the post of infection control nurses is associated with effectively reducing the HAI rate, especially the incidence and morbidity of P. aeruginosa HAIs, reducing PICU mortality, improving P. aeruginosa drug resistance.

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Section: Discussionmentioning

confidence: 99%

The Effect of Infection Control Nurses on the Occurrence of Pseudomonas aeruginosa Healthcare-Acquired Infection and Multidrug-Resistant Strains in Critically-Ill Children

Liu

et al. 2015

PLoS ONE

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“…This increasing antibiotic resistance makes the treatment of pneumonia caused by P. aeruginosa more difficult and more expensive. ( 21 ) The emergence of VAP episodes caused by ureido/carboxypenicillin-resistant P. aeruginosa was significantly associated with the administration of broad-spectrum antimicrobials, such as ureidopenicillins, carboxypenicillins, or fluoroquinolones, at admission to the ICU. ( 21 ) Pneumonias caused by metallo-β-lactamase-producing P. aeruginosa result in higher mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

et al. 2013

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OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

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“…(2011)Prospective ObservationalTertiary; BrazilRespiratoryCulture positive results for imipenem susceptible or resistant P. aeruginosa ; Isolates were screened for the presence of metallo-β-lactamases by using multiplex PCR.São Paulo Metallo-β-lactamase (SPM-1) producing imipenem resistant P. aeruginosa 5[68]Non-SPM-1-producing susceptible P. aeruginosa 24Gasink et al (2006)Retrospective ObservationalTertiary; USARespiratory, woundCulture positive results for fluoroquinolone susceptible or resistant P. aeruginosa Fluoroquinolone resistant P. aeruginosa 320[64]Susceptible P. aeruginosa 527Hirakata et al . (2003)Retrospective ObservationalTertiary; JapanGenitourinary, respiratory, woundCulture positive results for bla IMP -positive or negative P. aeruginosa ; control subjects selected at random from among inpatients; control subjects samples were bla IMP -negative P. aeruginosa bla IMP -positive P. aeruginosa 69[69] bla IMP -negative P. aeruginosa 247Kaminski et al (2011)Nested case cohortICU; FranceRespiratoryCulture positive results for Ureido/carboxypenicillin susceptible or resistant P. aeruginosa Ureido/carboxypenicillin-resistant P. aeruginosa 70[66]Susceptible P. aeruginosa 153Lambert et al (2011)Prospective ObservationalICU; EURespiratorySusceptibility testing in different centers was done according to local policiesCeftazidime resistant P. aeruginosa 366[31]Susceptible P. aeruginosa 1266Lautenbach et al (2010)Retrospective ObservationalTertiary; USAGenitourinary, respiratory wound, blood, tissueCulture positive results for imipenem susceptible or resistant P. aeruginosa Imipenem resistant P. aeruginosa 253[63]Susceptible P. aeru...…”

Section: Methodsmentioning

confidence: 99%

Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis

Nathwani

Raman

Sulham

et al. 2014

Antimicrob Resist Infect Control

272

184

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BackgroundIncreasing rates of resistant and multidrug-resistant (MDR) P. aeruginosa in hospitalized patients constitute a major public health threat. We present a systematic review of the clinical and economic impact of this resistant pathogen.MethodsStudies indexed in MEDLINE and Cochrane databases between January 2000-February 2013, and reported all-cause mortality, length of stay, hospital costs, readmission, or recurrence in at least 20 hospitalized patients with laboratory confirmed resistant P. aeruginosa infection were included. We accepted individual study definitions of MDR, and assessed study methodological quality.ResultsThe most common definition of MDR was resistance to more than one agent in three or more categories of antibiotics. Twenty-three studies (7,881 patients with susceptible P. aeruginosa, 1,653 with resistant P. aeruginosa, 559 with MDR P. aeruginosa, 387 non-infected patients without P. aeruginosa) were analyzed. A random effects model meta-analysis was feasible for the endpoint of all-cause in-hospital mortality. All-cause mortality was 34% (95% confidence interval (CI) 27% – 41%) in patients with any resistant P. aeruginosa compared to 22% (95% CI 14% – 29%) with susceptible P. aeruginosa. The meta-analysis demonstrated a > 2-fold increased risk of mortality with MDR P. aeruginosa (relative risk (RR) 2.34, 95% CI 1.53 – 3.57) and a 24% increased risk with resistant P. aeruginosa (RR 1.24, 95% CI 1.11 – 1.38), compared to susceptible P. aeruginosa. An adjusted meta-analysis of data from seven studies demonstrated a statistically non-significant increased risk of mortality in patients with any resistant P. aeruginosa (adjusted RR 1.24, 95% CI 0.98 – 1.57). All three studies that reported infection-related mortality found a statistically significantly increased risk in patients with MDR P. aeruginosa compared to those with susceptible P. aeruginosa. Across studies, hospital length of stay (LOS) was higher in patients with resistant and MDR P. aeruginosa infections, compared to susceptible P. aeruginosa and control patients. Limitations included heterogeneity in MDR definition, restriction to nosocomial infections, and potential confounding in analyses.ConclusionsHospitalized patients with resistant and MDR P. aeruginosa infections appear to have increased all-cause mortality and LOS. The negative clinical and economic impact of these pathogens warrants in-depth evaluation of optimal infection prevention and stewardship strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/2047-2994-3-32) contains supplementary material, which is available to authorized users.

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Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa

Cited by 19 publications

References 37 publications

The Effect of Infection Control Nurses on the Occurrence of Pseudomonas aeruginosa Healthcare-Acquired Infection and Multidrug-Resistant Strains in Critically-Ill Children

The Effect of Infection Control Nurses on the Occurrence of Pseudomonas aeruginosa Healthcare-Acquired Infection and Multidrug-Resistant Strains in Critically-Ill Children

Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis

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