Risk factors for multidrug-resistant Pseudomonas aeruginosa acquisition. Impact of antibiotic use in a double case–control study

Montero, Milagro; Sala, María; Riu, Marta; Belvis, Francesc; Salvadó, M; Grau, Santiago; Horcajada, Juan Pablo; Álvarez-Lerma, Francisco; Terradas, Roser; Orozco-Levi, Mauricio; Castells, Xavier; Knobel, Hernando

doi:10.1007/s10096-009-0850-1

Cited by 48 publications

(42 citation statements)

References 14 publications

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“…Testing procedures were validated by determining the MICs for reference strains. P. aeruginosa isolates were classified in three categories according to the antibiotic susceptibility pattern to all studied agents as: 1) non-resistant P. aeruginosa when the organism was susceptible to all the agents studied; 2) multi-drug resistant (MDRPA) for strains resistant to carbapenems, b-lactams, quinolones, tobramycin, and gentamicin and sensitive to colistin and amikacin [5,8,14]; and 3) resistant P. aeruginosa all the possible remainder combinations.…”

Section: Methodsmentioning

confidence: 99%

“…This microorganism is a leading cause of nosocomial infections and is responsible for 10% of all hospital-acquired infections, ranking second among Gram-negative pathogens [5,6]. Multi-drug resistance to antipseudomonal antibiotics is a common and increasing problem in some hospitals [7,8]. Infections by multi-drug resistant P. aeruginosa (MDRPA) are associated with increased morbidity [9], mortality [7,10], and economic impact [11].…”

Section: Introductionmentioning

confidence: 99%

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Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

Morales

Cots

Sala

et al. 2012

BMC Health Serv Res

138

108

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BackgroundWe aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.MethodsA retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs.ResultsCost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively).ConclusionsP. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

Morales

Cots

Sala

et al. 2012

BMC Health Serv Res

138

108

View full text Add to dashboard Cite

show abstract

“…A study demonstrated that PA could be detected in [50 % cases of chronic refractory wounds [8]. The difficulty in treating PA in wound infection was primarily associated with the drug-resistant strains and bacterial biofilm formation [9,19,24]. Increasing antibiotics dose will not facilitate healing in this type of ulcer, therefore, new therapeutic methods that may locally eradicate PA and remove its biofilms are needed.…”

Section: Introductionmentioning

confidence: 98%

A clinical study of photodynamic therapy for chronic skin ulcers in lower limbs infected with Pseudomonas aeruginosa

et al. 2014

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The objective of this study is to evaluate the antimicrobial activity and healing-promoting effect of topical photodynamic therapy (ALA-PDT) on chronic skin ulcers infected with Pseudomonas aeruginosa (PA). A total of 26 patients with chronic skin ulcers in lower limbs infected with PA were enrolled. The surface areas of the ulcers were treated with either δ-aminolevulinic acid (ALA)-mediated PDT (20% ALA solution, 1.5 h incubation, 630 nm red light, 80 J/cm(2)) or red light alone, both once a week for two weeks. Before treatment, the wound areas and the bacteria levels in these two groups were comparable (p > 0.05). Results indicated that the bacteria levels in the skin ulcers of the light only group of 24 h post-treatment (3.4 × 10(7) ± 7.1 × 10(7) CFU/cm(2)) and pre-treatment (5.5 × 10(7) ± 1.6 × 10(8) CFU/cm(2)) were not significantly different. In contrast, the bacteria levels on the surfaces of the ulcers in the PDT group of 24 h post-treatment (6.3 × 10(5) ± 1.7 × 10(6) CFU/cm(2)) and pre-treatment (8.9 × 10(7) ± 1.7 × 10(8) CFU/cm(2)) were significantly different (p < 0.01). At seven days post treatment, the mean ulcer area in the red light group was reduced from 11.85 ± 6.83 to 7.8 ± 4.9 cm(2) (p < 0.01), that of PDT group from 12.72 ± 8.58 to 3.4 ± 3.4 cm(2) (p < 0.01). Better healing was seen in PDT group (p < 0.01). In conclusion, ALA-PDT is a potential modality to control PA infection and promote healing of chronic skin ulcers in lower limbs.

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“…There are several risk factors associated with antibiotic resistance, including antimicrobial use, previous hospitalization, severity of illness, surgery and immunosuppression [8,9,10]. The objective of the present study was to evaluate the risk factors for acquisition of cefepime resistance in Escherichia coli strains.…”

Section: Introductionmentioning

confidence: 99%

Cefepime Resistance and Associated Risk Factors among <i>Escherichia coli </i>Strains Isolated from Clinical Specimens

Mansouri

Ramazanzadeh²,

Norabadi³

2011

Chemotherapy

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Cefepime is active against bacteria producing chromosomally and plasmid-mediated extended broad-spectrum β-lactamase enzymes. The aim of this study was to evaluate risk factors for acquisition of cefepime resistance in Escherichia coli strains among hospitalized patients in a university hospital in Sanandaj, Iran. The study was a case-control investigation. A case patient was defined as a patient who had one isolate of a cefepime-resistant E. coli strain. A control patient was defined as a patient who had one isolate of a cefepime-sensitive E. coli strain. Cefepime resistance was determined by HiComb MIC tests (HIMEDIA, India). Out of the 255 total isolates, 73 (28.6%) were resistant to cefepime. The previous treatment of cefepime was a risk factor for acquisition of a cefepime-resistant isolate (OR = 6.32, 95% CI: 1.5–25.19, p < 0.007). The use of a ventilator was considered to be a risk for acquisition of a cefepime-resistant isolate (OR = 6.25, 95% CI: 1.86–21.02, p <0.002). The use of a catheter was also found to be a risk factor for acquisition of cefepime resistance (OR = 6.28, 95% CI: 1.86–21.02, p <0.001). There was a significant correlation between days of stay in hospital wards and cefepime resistance (p < 0.003). The main risk factors associated with cefepime resistance were previous treatment with cefepime, use of ventilator, use of catheter and days of stay in ward. More studies are needed to evaluate the role of these factors in order to control the spread of drug resistance.

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Risk factors for multidrug-resistant Pseudomonas aeruginosa acquisition. Impact of antibiotic use in a double case–control study

Cited by 48 publications

References 14 publications

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

A clinical study of photodynamic therapy for chronic skin ulcers in lower limbs infected with Pseudomonas aeruginosa

Cefepime Resistance and Associated Risk Factors among <i>Escherichia coli </i>Strains Isolated from Clinical Specimens

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