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Replication of the Ordered, Nonredundant Library of Pseudomonas aeruginosa strain PA14 Transposon Insertion Mutants
Published on: May 4, 2018
Risk factors and outcomes associated with isolation of meropenem high-level-resistant Pseudomonas aeruginosa
Kathryn J Eagye1, Joseph L Kuti, David P Nicolau
1Center for Anti-Infective Research and Development, Hartford Hospital, CT 06102, USA.
Objective:
To determine risk factors and outcomes for patients with meropenem high-level-resistant Pseudomonas aeruginosa (MRPA) (minimum inhibitory concentration [MIC] > or = 32 microg/mL).
Design:
Case-control-control.
Setting:
An 867-bed urban, teaching hospital.
Patients:
Fifty-eight MRPA case patients identified from an earlier P. aeruginosa study; 125 randomly selected control patients with meropenem-susceptible P. aeruginosa (MSPA) (MIC < or = 4 microg/mL), and 57 control patients without P. aeruginosa (sampled by case date/location).
Methods:
Patient data, outcomes, and costs were obtained via administrative database. Cases were compared to each control group while controlling for time at risk (days between admission and culture, or entire length of stay [LOS] for patients without P. aeruginosa).
Results:
A multivariable model predicted risks for MRPA versus MSPA (odds ratio [95% confidence interval]): more admissions (in the prior 12 months) (1.41 [1.15, 1.74]), congestive heart failure (2.19 [1.03, 4.68]), and Foley catheter (2.53 [1.18, 5.45]) (adj. R(2) = 0.28). For MRPA versus no P. aeruginosa, risks were age (in 5-year increments) (1.17 [1.03, 1.33]), more prior admissions (1.40 [1.08, 1.81]), and more days in the intensive care unit (1.10 [1.03, 1.18]) (adj. R(2) = 0.32). Other invasive devices (including mechanical ventilation) and previous antibiotic use (including carbapenems) were nonsignificant. MRPA mortality (31%) did not differ from that of MSPA (15%) when adjusted for time at risk (P = .15) but did from mortality without P. aeruginosa (9%) (P = .01). Median LOS and costs were greater for MRPA patients versus MSPA patients and patients without P. aeruginosa: 30 days versus 16 and 10 (P<.01) and $88,425 versus $28,620 and $22,605 (P<.01).
Conclusions:
Although antibiotic use has been shown to promote resistance, our data found that prior antibiotic use was not associated with MRPA acquisition. However, admission frequency and Foley catheters were, suggesting that infection control measures are essential to reducing MRPA transmission.
Insights
Frequent hospital admissions and Foley catheter use are key risk factors for meropenem-resistant Pseudomonas aeruginosa (MRPA) infections. Infection control measures are crucial for reducing MRPA transmission, as prior antibiotic use was not a significant factor.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Meropenem-resistant Pseudomonas aeruginosa (MRPA) poses a significant healthcare challenge.
- Understanding risk factors for MRPA is crucial for effective infection control.
Purpose of the Study:
- To identify risk factors and patient outcomes associated with MRPA infections.
- To compare MRPA cases with both meropenem-susceptible P. aeruginosa (MSPA) and no P. aeruginosa.
Main Methods:
- A case-control study was conducted at an urban teaching hospital.
- MRPA cases were compared to control groups with MSPA and without P. aeruginosa.
- Patient data, outcomes, and costs were analyzed from administrative databases.
Main Results:
- Increased hospital admissions and Foley catheter use were significant risk factors for MRPA.
- MRPA patients experienced longer lengths of stay and higher costs compared to control groups.
- While MRPA mortality did not differ from MSPA, it was higher than in patients without P. aeruginosa.
Conclusions:
- Prior antibiotic use was not associated with MRPA acquisition in this study.
- Admission frequency and Foley catheter use are critical factors in MRPA transmission.
- Implementing robust infection control measures is essential to mitigate MRPA spread.
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