The quick loss of carbapenem susceptibility in Pseudomonas aeruginosa at intensive care units

Abstract

Background Patients colonized with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) strains upon admission to the intensive care unit (ICU) tend to be quickly followed by detected carbapenem-resistant P. aeruginosa strains after admission. Objective To assess the risk factors associated with the quick loss of carbapenem susceptibility and to identify time threshold of prior antimicrobial exposure for the loss during ICU stay. Setting A tertiary-care teaching hospital with 2560 beds located in the northwest region of China. Method A retrospective observational study was conducted between January 2013 and April 2016 at ICUs. Logistic regression analysis was used to assess risk factors, and receiver operating characteristic (ROC) analyses were constructed to identify the time threshold. Main outcome measure The time threshold and risk factors for the quick loss of carbapenem susceptibility. Results Among the 84 patients with CSPA initially, 32 (38.1%) patients were observed to have a loss of carbapenem susceptibility during ICU stay. Logistic regression analyses showed that previous carbapenem exposure was only independently associated with the loss of carbapenem susceptibility (odds ratio 13.16; 95% CI 3.13-55.24; p < 0.001). The optimal cut-off was 3.5 days on ROC curve, indicating the high risk for loss of susceptibility. Conclusion In order to alleviate selective pressure caused by antipseudomonal carbapenems exposure, continued research is needed to determine the most appropriate carbapenems treatment strategies.

Risk factors and outcome associated with coinfection with carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumanii: a descriptive analysis

“…The complex underlying medical conditions of our patients likely required the use of broad spectrum agents to provide adequate coverage but also predisposing them to infections caused by multidrug-resistant organisms. Specifically, carbapenem overuse is of particular concern, whereby overexposure may select for carbapenem-resistant organisms through different mechanisms such as porin deletion or mutation, efflux pump overexpression, and upregulation of carbapenem resistance genes such as bla KPC ( Park et al., 2011 ; Voor in 't holt et al., 2014 ; Palavutitotai et al., 2018 ; Tsao et al., 2018 ; Zou et al., 2018 ). By multivariate analysis, clinical features identified to be significantly associated with coinfection in our study cohort were invasive infections, use of any medical device, and prior carbapenem exposure.…”

Carbapenem Resistant Pseudomonas aeruginosa Infections in Elderly Patients: Antimicrobial Resistance Profiles, Risk Factors and Impact on Clinical Outcomes

“… 22 – 23 Long-term and high frequency usage of such antibiotics causes P. aeruginosa to undergo gene mutation or produce new drug resistance genes for survival under the pressure of antibiotics, resulting in changes in the drug resistance characteristics of bacteria. 24 – 25 Carbapenems had the shortest duration of prior antibiotic exposure for carbapenem-resistant P. aeruginosa (3.5 days), 26 whereas piperacillin-tazobactam for piperacillin-tazobactam-resistant P. aeruginosa (3 days). 27 Therefore, physicians may predict resistance development in accordance with previous carbapenems and third- or fourth-generation cephalosporins exposure and duration.…”