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Antibiotics associated with acquisition of carbapenem-resistant Pseudomonas aeruginosa in ICUs: a multicentre nested

M Coppry1,2, C Jeanne-Leroyer3, P Noize2

  • 1Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000 Bordeaux, France.

The Journal of Antimicrobial Chemotherapy
|October 31, 2018
PubMed
Abstract

Insights

Exposure to certain beta-lactam antibiotics, besides carbapenems, increases the risk of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections. Understanding these risks is crucial for guiding antibiotic choices in intensive care units (ICUs).

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Carbapenem-resistant Pseudomonas aeruginosa (CRPA) causes severe infections, particularly in intensive care units (ICUs).
  • Previous antibiotic exposure, beyond carbapenems, may be linked to CRPA isolation.

Purpose of the Study:

  • To identify specific antibiotics, other than carbapenems, associated with the isolation of CRPA.
  • To differentiate risk factors for CRPA from those for carbapenem-susceptible P. aeruginosa (CSPA).

Main Methods:

  • A case-case-control study involving 1808 adult patients across 10 French ICUs.
  • Patients were screened for P. aeruginosa; cases had CRPA or CSPA, controls had no P. aeruginosa isolation.
  • Logistic regression models adjusted for carbapenem use and confounding factors were employed.

Main Results:

  • Exposure to carbapenems and beta-lactams inactive against P. aeruginosa were independent risk factors for CRPA isolation.
  • Beta-lactams active against P. aeruginosa showed a protective effect against CSPA isolation.
  • Fifty-nine CRPA, 83 CSPA, and 142 control patients were analyzed.

Conclusions:

  • Antibiotics like beta-lactams inactive against P. aeruginosa are specific risk factors for CRPA isolation, beyond carbapenem exposure.
  • Clinicians must weigh the benefits of these antibiotics against the elevated risk of CRPA infections.
  • This finding aids in optimizing antibiotic stewardship in critical care settings.

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