Risk factors for extreme-drug resistant Pseudomonas aeruginosa infections in patients with hematologic malignancies

Liew, Yin-Xin; Tan, Thuan-Tong; Lee, Winnie; Ng, Jern-Lin; Chia, De-Qing; Wong, Gee-Chuan; Kwa, Andrea Lay Hoon

doi:10.1016/j.ajic.2012.02.025

Cited by 17 publications

(15 citation statements)

References 20 publications

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“…The length of stay in ICU emerged as a predominant risk factor. This factor has also been found in other studies, highlighting the need for strict control of this class of antibiotics when used in patients who have a prolonged stay in ICU [27,28].…”

Section: Discussionsupporting

confidence: 75%

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

Labaste

Grossac

Vardon-Bounes

et al. 2019

Eur J Clin Microbiol Infect Dis

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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.

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Section: Discussionsupporting

confidence: 75%

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

Labaste

Grossac

Vardon-Bounes

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…The extensively drug-resistant P. aeruginosa (XDR-PA) that remains susceptible to a maximum of two classes of antimicrobials is clinically highly relevant due to the limited treatment options, its frequent isolation from ICU patients [ 8 ] and the recently observed international spread [ 9 ]. Risk factors have been primarily determined for invasive disease with XDR-PA [ 10 ]-[ 12 ] but predictors of patient colonisation have not yet been described.…”

Section: Introductionmentioning

confidence: 99%

Clinical and treatment-related risk factors for nosocomial colonisation with extensively drug-resistant Pseudomonas aeruginosa in a haematological patient population: a matched case control study

et al. 2014

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BackgroundThis study aimed to investigate risk factors for colonisation with extensively drug-resistant P. aeruginosa (XDR-PA) in immunocompromised patients and to build a clinical risk score (CRS) based on these results.MethodsWe conducted a matched case–control study with 31 cases and 93 controls (1:3). Cases were colonised with XDR-PA during hospitalisation. Independent risk factors were determined using a three step conditional logistic regression procedure. A CRS was built with respect to the corresponding risk fraction of each risk factor, and its discriminatory power was estimated by receiver operating characteristic (ROC) analysis.ResultsThe presence of a central venous catheter (OR 7.41, P = 0.0008), the presence of a urinary catheter (OR 21.04, P < 0.0001), CRP > 10 mg/dl (OR 7.36, P = 0.0015), and ciprofloxacin administration (OR 5.53, P = 0.025) were independent risk factors. The CRS exhibited a high discriminatory power, defining a high risk population with an approximately fourteen times greater risk for XDR-PA colonisation.ConclusionsUnnecessary use of antibiotics, particularly ciprofloxacin should be avoided, and a high standard of infection control measures must be achieved when using medical devices. A CRS can be used for adaptation of the active screening culture policy to the local setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0650-9) contains supplementary material, which is available to authorized users.

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“…[3][4][5] P. aeruginosa clinical isolates are often resistant to most b-lactams and fluoroquinolones and, sometimes, resistant to aminoglycosides, such as gentamicin and amikacin, thus categorizing them as multi-drug resistant P. aeruginosa (MDRP). 4,[6][7][8][9] Limitations in the number of effective antimicrobial agents for treating MDRP infections leads to the high mortality rates associated with the acute lung injury induced by this bacterium. 5 While seeking new prophylactic or therapeutic strategies that do not rely on conventional antimicrobial agents, we have investigated the use of an immunotherapy approach that targets the P. aeruginosa type III secretion system.…”

Section: Introductionmentioning

confidence: 99%

The prophylactic effects of human IgG derived from sera containing high anti-PcrV titers against pneumonia-causingPseudomonas aeruginosa

Kinoshita

Kato

Yanagimoto

et al. 2016

Human Vaccines & Immunotherapeutics

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The PcrV cap structure of the type III secretory apparatus of Pseudomonas aeruginosa is a vaccine target. Human immunoglobulin G (IgG) molecules extracted from sera containing high or low antiPcrV titers were tested for their effects against P. aeruginosa pneumonia in a mouse model. Among 198 volunteers, we selected the top 10 high anti-PcrV titer sera and the bottom 10 low anti-PcrV titer sera and extracted the IgG fraction from each serum sample. First, we examined the effects of the IgG against virulent P. aeruginosa. A lethal dose of P. aeruginosa premixed with saline, low titer human IgG, high titer human IgG, or rabbit-derived polyclonal anti-PcrV IgG was intratracheally administered into the lungs of mice, and their survival and lung inflammation were evaluated for 24 h. The high anti-PcrV titer human IgG had a prophylactic effect. Next, the prophylactic effects of intravenous administration of extracted and pooled high or low anti-PcrV titer human IgG were examined. Here, prophylactic intravenous administration of pooled high anti-PcrV titer human IgG, which showed binding capacity to P. aeruginosa PcrV, was more effective than the administration of its low titer pooled equivalent, and the measured physiological and inflammatory parameters correlated with the anti-PcrV titer levels. This result indirectly implies that high anti-PcrV titers in blood can help to protect against virulent P. aeruginosa infections. In addition, the IgG fractions from such high titer sera have potential to be a source of specific intravenous immunoglobulin products for passive vaccination against virulent P. aeruginosa infections.

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Risk factors for extreme-drug resistant Pseudomonas aeruginosa infections in patients with hematologic malignancies

Cited by 17 publications

References 20 publications

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

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

Clinical and treatment-related risk factors for nosocomial colonisation with extensively drug-resistant Pseudomonas aeruginosa in a haematological patient population: a matched case control study

The prophylactic effects of human IgG derived from sera containing high anti-PcrV titers against pneumonia-causingPseudomonas aeruginosa

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