National Surveillance of Antimicrobial Resistance in Pseudomonas aeruginosa Isolates Obtained from Intensive Care Unit Patients from 1993 to 2002

Abstract

Nosocomial infections caused by Pseudomonas aeruginosa in critically ill patients are often difficult to treat due to resistance to multiple antimicrobials. The purpose of this study was to evaluate antimicrobial resistance among P. aeruginosa isolates from intensive care unit patients in the United States from 1993 to 2002 by using the Intensive Care Unit Surveillance Study database. Over the 10-year period, susceptibility of 13,999 nonduplicate isolates of P. aeruginosa was analyzed. From 1993 to 2002, nationwide increases in antimicrobial resistance were greatest for ciprofloxacin, imipenem, tobramycin, and aztreonam. Rates of multidrug resistance (resistance to >3 of the following drugs: ceftazidime, ciprofloxacin, tobramycin, and imipenem) increased from 4% in 1993 to 14% in 2002. The lowest dual resistance rates were observed between aminoglycosides or fluoroquinolones with piperacillin-tazobactam while the highest were for those that included ␤-lactams and ciprofloxacin. Ongoing surveillance studies are crucial in monitoring antimicrobial susceptibility patterns and selecting empirical treatment regimens.Pseudomonas aeruginosa is one of the most common gramnegative pathogens associated with nosocomial infections (11). Unfortunately, resistance to available antipseudomonal agents is on the rise, jeopardizing selection of appropriate treatment and subsequently increasing morbidity and mortality in patients infected with this pathogen (1, 9). In fact, inadequate empirical therapy has been associated with mortality exceeding 30% (6), and delays in the initiation of appropriate therapy contribute to increased length of hospital stay and persistence of infection (8).The selection of appropriate antimicrobial therapy requires active surveillance of emerging resistance trends and continuing education among the health care providers and institution(s) involved. The objectives of this study were to analyze data from the Intensive Care Unit Surveillance Study (ISS) to assess the rates of resistance and multidrug resistance among P. aeruginosa isolates in intensive care units (ICUs) in the United States from 1993 to 2002 and to use these data to evaluate current recommendations for empirical antibiotic regimens.(These data were presented as a poster presentation at the 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy on 17 September 2003.) MATERIALS AND METHODSThe ISS is a national postmarketing surveillance program sponsored by Merck and Company Inc. (Rahway, N.J.) since 1989. Participating institutions submitted susceptibility data for approximately 100 to 200 consecutive gram-negative aerobic isolates from ICU patients annually. All organisms were identified to the species level and susceptibility testing was conducted at each institution using a standardized custom microdilution MIC panel (Microscan MKD MIC; Dade International MicroScan, Sacramento, Calif.) (10). The P. aeruginosa quality control strain ATCC 27853 was used weekly in each laboratory.In this study, independent of the res...

Efflux pump genes and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from lower respiratory tract infections acquired in an intensive care unit

“…10 Increasing resistance rates to the antibiotics in P. aeruginosa strains were reported by several studies during the last years. [10][11][12][13] In this study, 50 P. aeruginosa isolates from the patients with LRTIs in ICU were investigated for 13 genes, mostly for efflux proteins leading to antimicrobial resistance. To our knowledge, although there are studies investigating the resistance genes from Turkey, 14,15 there aren't any studies investigating a large number of resistance genes in P. aeruginosa strains isolated from nosocomial LRTIs.…”

Resistência antimicrobiana de Pseudomonas aeruginosa isolados de pescado e de cortes e de miúdos de frango

“…A redução de sua eficácia foi observada em hospitais em seis países na América Latina, incluindo o Brasil, por Andrade et al (2003). Em um programa de monitoramento da resistência deste microrganismo, realizado por um período de dez anos no ambiente hospitalar nos Estados Unidos, Obristsch et al (2004) registraram um aumento progressivo de resistência à ciprofloxacina, tobramicina, aztreonam e imipenem, reforçando o que na atualidade representa sério problema terapêutico.…”

Incidence of Antibiotic Resistance Bacteria in Jeddah's Ministry of Health Hospitals, Saudi Arabia

“…This high resistance clearly indicates the overuse of the latter antibiotics and insists the demand of a strictly respected comprehensive antibiotic stewardship program in our hospitals. In United States, a dramatic antimicrobial resistance increase to ciprofloxacin (from 15% to 32%) and ceftazidime (from 15% to 19%) over the ten-year period was recorded [21]. In Kuala Lumpur, Malaysia, approximately 10% of clinical isolates of P. aeruginosa were resistant to imipenem, while 11% showed resistance to ciprofloxacin, piperacillin and ceftazidime [22] [23].…”