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Published on: June 5, 2012
Endemic multidrug-resistant Pseudomonas aeruginosa in critically ill patients
Bryan Ortega1, A B Johan Groeneveld, Constance Schultsz
1Intensive Care Unit, Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, The Netherlands.
Objective:
To describe the epidemiology of endemic multidrug-resistant Pseudomonas aeruginosa colonizations and infections in critically ill patients.
Design:
Prospective study on bacterial strain typing and retrospective cohort study of charts of patients in the intensive care unit (ICU).
Patients:
Fifty-three patients with P. aeruginosa isolated from clinical cultures in 2001 were selected, divided into those with P. aeruginosa in vitro resistant to at least two classes of antibiotics (multidrug-resistant, n = 18) and those susceptible to all or resistant to only one antibiotic (susceptible, n = 35).
Results:
Risk factors for multidrug-resistant P. aeruginosa included maxillary sinusitis, long-dwelling central venous catheters, prolonged use of certain antibiotics, a high lung injury score, and prolonged mechanical ventilation and duration of stay. The frequency of colonization (approximately 50%) versus infection (ie, ventilator-associated pneumonia) did not differ between the groups. On amplified fragment-length polymorphism analysis, 64% of the multidrug-resistant strains had been potentially transmitted via cross-colonization and 36% had probably originated endogenously. ICU mortality was 22% in the multidrug-resistant group and 23% in the susceptible group, although the duration of mechanical ventilation was longer in the former.
Conclusions:
Patients with sinusitis who stayed in the ICU longer, were ventilated longer because of acute lung injury, received antibiotics for longer durations, and had long-dwelling central venous catheters ran an elevated risk of acquiring multidrug-resistant P. aeruginosa. These patients did not have a higher mortality than patients with susceptible P. aeruginosa. Prevention of the emergence of multidrug-resistant strains requires changes in infection control measures and antibiotic policies in our ICU.
Insights
Multidrug-resistant Pseudomonas aeruginosa colonization and infection in critically ill patients are linked to factors like sinusitis and prolonged ventilation. While mortality rates were similar, prevention requires updated infection control and antibiotic policies in ICUs.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Endemic multidrug-resistant Pseudomonas aeruginosa (MDRP) poses a significant threat in intensive care units (ICUs).
- Understanding the epidemiology of MDRP colonization and infection is crucial for effective patient management and control.
Purpose of the Study:
- To investigate the epidemiology of endemic multidrug-resistant Pseudomonas aeruginosa colonizations and infections.
- To identify risk factors associated with MDRP in critically ill patients.
Main Methods:
- Prospective bacterial strain typing and retrospective chart review of ICU patients.
- Analysis of 53 patients with P. aeruginosa, divided into multidrug-resistant (n=18) and susceptible (n=35) groups.
- Amplified fragment-length polymorphism (AFLP) used for strain typing.
Main Results:
- Risk factors for MDRP included sinusitis, central venous catheters, prolonged antibiotic use, acute lung injury, and extended mechanical ventilation/ICU stay.
- Colonization and infection frequencies did not differ between MDRP and susceptible groups.
- AFLP indicated 64% of MDRP strains were potentially cross-colonized, 36% endogenous. ICU mortality was similar (22% vs. 23%).
Conclusions:
- Critically ill patients with sinusitis, prolonged ventilation, and invasive devices face higher MDRP acquisition risk.
- MDRP acquisition did not increase patient mortality compared to susceptible strains.
- Enhanced infection control and antibiotic stewardship are essential to prevent MDRP emergence in ICUs.
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