Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

Abstract

The emergence of carbapenemases in gram-negative aerobes is worrying. The aim of this prospective study was to estimate the incidence of acquisition of carbapenem-resistance during treatment in ICU and to identify the risk factors. This was a prospective, observational, cohort study. This study was conducted at intensive care unit, academic medical center, Toulouse Rangueil University Hospital. Patients were included if they received antibiotic treatment with carbapenem for more than 48 h. Biological samples were taken in accordance with current practice in the unit. The main endpoint was the occurrence of bacterial resistance to carbapenems occurring between the onset of treatment and the patient's exit from the ICU. Uni-and multi-variate analyses were carried out. Of the 364 patients admitted to the unit between May and November 2014, 78 were included in our study and 16 (20.51%) developed resistance. The two main risk factors were a length of stay in ICU of more than 29 days (HR = 3.61, p = 0.01) and the presence of Pseudomonas aeruginosa in the samples taken before the start of treatment (HR = 5.31, p = 0.002). No resistance due to carbapenemase production was observed in this study. The prescription of carbapenems in the ICU setting must adhere to the expert guidelines. In light of our results, special attention must be paid to patients whose stay in intensive care is prolonged, and those in whom Pseudomonas aeruginosa is isolated from bacteriological samples taken before the beginning of antibiotic therapy.

Detection of blaOXA-10 and blaOXA-48 Genes in Pseudomonas aeruginosa Clinical Isolates by Multiplex PCR

“…A 10-year longitudinal surveillance study in Taiwan, among 78 non-duplicated imipenem-resistant P. aeruginosa isolates collected from patients with blood infections, reported an imipenem resistance of 5.9% [33]. A possible cause of the difference in the results of these studies with the present study might be extended hospitalization at the intensive care unit (≥29 days) that can lead to the acquisition of carbapenem resistance [34].…”

Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018

“…On the individual patient level, previous carbapenem exposure has also been identified as risk factor for CRPA [31].…”

“…On the other hand, in a before–after study from a French ICU, a reduction in quinolone and carbapenem use was associated with a decrease in CRPA, although total antibiotic use increased [ 30 ]. On the individual patient level, previous carbapenem exposure has also been identified as risk factor for CRPA [ 31 ].…”

Evaluating the antimicrobial resistance patterns and molecular frequency of blaoxa-48 and blaGES-2 genes in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from burn wound infection in Tehran, Iran

“…Both P. aeruginosa and A. baumannii are opportunistic and nosocomial pathogens that can induce several infections including otitis media, and respiratory tract, burn and wound infections with high mortality in patients, especially in immunocompromised individuals hospitalized in various wards of a hospital [ [28] , [29] , [30] ]. Antibiotic resistance among P. aeruginosa and A. baumannii has been accepted as a global public health problem around the world [ 31 ]. Based on a report by the WHO in 2017, carbapenem-resistant P. aeruginosa , carbapenem-resistant A. baumannii complex and carbapenem-resistant or ESBL-producing Enterobacteriaceae are critical priority pathogens [ 32 , 33 ].…”

“…reported low-level resistance [ 35 ]. According to the results of a published study, it can be concluded that two independent risk factors that include (a) prolonged hospitalization at the intensive care unit (>29 days) and (b) the existence of P. aeruginosa in the bacteriological specimens taken before treatment can lead to the acquisition of carbapenem resistance [ 31 ]. The present study also revealed that ceftazidime, in comparison with other antibiotics, showed the lowest resistance rate against P. aeruginosa isolates.…”