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Antibiotic exposure and resistance development in Pseudomonas aeruginosa and Enterobacter species in intensive care

David S Y Ong1, Irene P Jongerden, Anton G Buiting

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. d.s.y.ong@umcutrecht.nl

Critical Care Medicine
|June 28, 2011
PubMed
Abstract

Insights

Antibiotic exposure, particularly meropenem, significantly increases the risk of antibiotic resistance development in Pseudomonas aeruginosa in intensive care units. This highlights the need to monitor antibiotic use and resistance trends.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Antibiotic resistance is a growing global health threat, particularly in intensive care units (ICUs).
  • Pseudomonas aeruginosa and Enterobacter species are common ICU pathogens known for developing resistance.
  • Understanding the link between specific antibiotic exposures and resistance acquisition is crucial for antimicrobial stewardship.

Purpose of the Study:

  • To quantify the association between antibiotic exposure and the acquisition of antibiotic resistance in Pseudomonas aeruginosa and Enterobacter species.
  • To identify specific antibiotics that contribute to resistance development in ICU patients.

Main Methods:

  • A prospective cohort study involving 1,201 ICU patients.
  • Regular respiratory tract screening for P. aeruginosa and Enterobacter colonization.
  • Cox regression analysis to calculate hazard ratios for antibiotic resistance acquisition based on antibiotic exposure.
  • Genotyping and epidemiologic linkage were used to exclude cross-transmission.

Main Results:

  • Meropenem, ciprofloxacin, and ceftazidime were significantly associated with increased risk of resistance development in P. aeruginosa.
  • Meropenem exposure showed the highest adjusted hazard ratio (11.1) for P. aeruginosa resistance.
  • Ceftriaxone and ciprofloxacin exposure were linked to most antibiotic resistance acquisitions in Enterobacter species, though not significant in multivariate analysis.

Conclusions:

  • Meropenem exposure is strongly associated with the highest risk of resistance development in P. aeruginosa.
  • Increased carbapenem use may exacerbate antibiotic resistance in P. aeruginosa, especially with the rise of Gram-negative bacteria producing extended-spectrum beta-lactamases.

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