The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit

Özkurt, Zülal; Ertek, Mustafa; Erol, Serpil; Altoparlak, Ülkü; Akçay, Müfide Nuran

doi:10.1016/j.burns.2005.04.015

Cited by 54 publications

(61 citation statements)

References 22 publications

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“…to ceftazidime and ciprofloxacin, has developed [19]. Meropenem has been identified as an important reserve antibiotic to which most P. aeruginosa and Acinetobacter are susceptible [19], but resistance to the carbapenems has developed [37][38][39]. A study at eight centers in the United States found that 15% of P. aeruginosa isolates recovered from burn ICUs were resistant to ceftazidime and 20% were resistant to imipenem [40].…”

Section: Treatment Of Multi-resistant Pathogensmentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

294

174

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Background: Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drugresistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. Methods: We reviewed 398 severely burned patients (burns >40% total body surface area [TBSA]) admitted to our hospital between 2000 and 2006. Patients who did not contract multi-drug-resistant gram-negative organisms during their hospital course and received our standard antibiotic regimen-vancomycin and piperacillin= tazobactam-served as controls (piperacillin=tazobactam; n ¼ 280). The treatment group consisted of patients who, during their acute hospital stay, developed infections with multi-drug-resistant gram-negative pathogens and were treated with vancomycin and colistin for at least three days (colistin; n ¼ 118). Results: Gram-negative organisms continue to cause the most severe infections in burn patients. Colistin has reemerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns. Patients who required colistin therapy had a significantly larger average total and full-thickness burn than patients treated with piperacillin=tazobactam and vancomycin, and the mortality rate was significantly higher in the colistin group (p < 0.05). However, there was no significant difference between the colistin and piperacillin= tazobactam groups in the incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity. The main fungal pathogens in burn patients are Candida spp., Aspergillus spp., and Fusarium spp. A definitive diagnosis is more difficult to obtain than in bacterial infections. Amphotericin B and voriconazole remain the two most important anti-fungal substances in our practice. Conclusions: Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.

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Section: Treatment Of Multi-resistant Pathogensmentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

294

174

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“…Previous studies have described that the increased use of carbapenems is associated with the emergence of carbapenem-resistant P. aeruginosa. [1][2][3] Therefore, the appropriate use of carbapenems is essential in order to prevent an increase in the rate of resistance in P. aeruginosa. There are several reports about the relationship between carbapenem consumption and carbapenem susceptibility among P. aeruginosa; however, the results of these reports have been inconsistent, perhaps due to difference in antimicrobial susceptibility profile and antimicrobial prescribing practices in each country.…”

mentioning

confidence: 99%

Correlation between the Consumption of Meropenem or Doripenem and Meropenem Susceptibility of <i>Pseudomonas aeruginosa</i> in a University Hospital in Japan

Miyawaki

Miwa

Seki

et al. 2012

Biological & Pharmaceutical Bulletin

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The appropriate use of carbapenems is essential in order to prevent resistance in Pseudomonas aeruginosa. We investigated the correlation between the consumption of meropenem or doripenem and the susceptibility of P. aeruginosa to meropenem in a Japanese university hospital from 2004 to 2009. The susceptibility data of P. aeruginosa and the annual consumption of meropenem or doripenem were analyzed. The consumption of meropenem or doripenem was calculated using the Anatomic Therapeutic Chemical classification and defined daily doses methodology. Meropenem consumption decreased and doripenem consumption increased and throughout the entire investigation period, total consumption of meropenem plus doripenem was stable. Although the annual number of isolated P. aeruginosa has not changed, the annual number of isolated multidrug resistant P. aeruginosa decreased by measures against nosocomial infection. The rate of meropenemresistant P. aeruginosa decreased in a time-dependent manner. Meropenem consumption was positively correlated with the meropenem resistance rate among P. aeruginosa (r 0.9455, p<0.01). The total consumption of meropenem and doripenem was not correlated with the meropenem resistance rate (r 0.6601, p>0.1). These results suggested that even if the total consumption of meropenem plus doripenem was not changed, meropenem susceptibility among P. aeruginosa improved by the decrease of meropenem consumption. Although meropenem and doripenem have been suggested to show cross-resistance with each other, the reduction of meropenem consumption might be effective for preventing an increase of meropenem-resistant P. aeruginosa.Key words meropenem; doripenem; Pseudomonas aeruginosa; susceptibility; consumption Pseudomonas (P.) aeruginosa is an important nosocomial pathogen because it can cause complicated infections in immunodeficient patients and in compromised patients who have lost their ability to defend against infection. P. aeruginosa has developed resistance to its treatment by many antimicrobials.Carbapenems are recognized as one of the most effective antimicrobial agents against P. aeruginosa, and they tend to be used extensively for the treatment of P. aeruginosa infections in Japan. Previous studies have described that the increased use of carbapenems is associated with the emergence of carbapenem-resistant P. aeruginosa.1-3) Therefore, the appropriate use of carbapenems is essential in order to prevent an increase in the rate of resistance in P. aeruginosa. There are several reports about the relationship between carbapenem consumption and carbapenem susceptibility among P. aeruginosa; however, the results of these reports have been inconsistent, perhaps due to difference in antimicrobial susceptibility profile and antimicrobial prescribing practices in each country. [4][5][6] Although imipenem-, panipenem-, and biapenem-resistance are affected by the loss or reduction of the outer membrane porin protein OprD for influx, meropenem-and doripenemresistance are derived by both the loss of OprD for infl...

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“…Cross-resistance and genetic loci are important factors in this problem (Neely and Holder, 1999). The length of hospitalization is another factor for drug resistance in bacteria (Oncul, 2002;Ozkurt et al, 2005;Savas et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Such bacteria are inherently resistant to common antibiotics, even surviving common antiseptics; therefore, eradication of organisms from patients and the environment is difficult (Oncul et al, 2002). Colonized patients and staff are a major source of cross-contamination of other patients (Ozkurt et al, 2005). Therefore, recognition of infectious persons is necessary to prevent transmission of infection.…”

Section: Discussionmentioning

confidence: 99%

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Bacteriology of burns and antibiogram in an Iranian burn care center

Beheshti¹,

Zia²

2011

Afr. J. Pharm. Pharmacol.

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Burn patients face an obviously high risk for infections due to the immunocompromising effects of their injury. This study aimed to detect and identify bacteria isolated from patients and hospital environment in the burn unit and determine their antibiogram pattern in response to commonly used antimicrobial agents; in order to give recommendations for management of bacterial infections and drug-resistance. Materials of this study were 100 samples of burn wounds and multiple swab samples of different hospital environments. One hundred and twelve isolates were analyzed, from which there was a single agent in the majority of cases (73.3%). Pseudomonas aeruginosa was the most common isolate (32.2%), followed by Enterobacter spp. (16.9%), coagulase-negative staphylococci (12.5%), Acinetobacter spp. (11.7%), Klebsiella spp. (8.9%), Staphylococcus aureus (7.2%), -hemolytic streptococci (4.4%), and others (6.2%). The most commonly detected isolate from hospital environment was P. aeruginosa (35%) followed by Enterobacter spp., Klebsiella spp., coagulase-negative staphylococci. P. aeruginosa was the most resistant to third-and fourth-generation cephalosporins (100%), whereas other gram-negative bacteria were resistant to ciprofloxacin and cephalosporin (70 to 100%). Restriction in the abuse of antibiotics and establishment of an infection control unit will help lower the incidence of infection.

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The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit

Cited by 54 publications

References 22 publications

Emerging Infections in Burns

Emerging Infections in Burns

Correlation between the Consumption of Meropenem or Doripenem and Meropenem Susceptibility of <i>Pseudomonas aeruginosa</i> in a University Hospital in Japan

Bacteriology of burns and antibiogram in an Iranian burn care center

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