Risk Factors and Outcomes of Multidrug-resistant Pseudomonas aeruginosa in Kelantan, Malaysia: A Multicenter
Siti Norfairuz Md Salim1,2, Nurul Izzah Md Din3, Rosnita Rashid4
1Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia Health Campus, Kota Bharu, Malaysia.
Background:
Increasing trend and spread of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical settings is a great challenge in managing patients with infections caused by this pathogen.
Objective:
To determine the risk factors and outcomes of MDR-PA acquisition in the northeastern state of Malaysia. In addition, this study also reported on the susceptibility pattern and common resistant genes among MDR-PA.
Materials And Methods:
MDR-PA isolates obtained between March 2021 and February 2022 from all four major hospitals in the state of Kelantan, Malaysia, were submitted for susceptibility and resistant genes identification. The clinical data of the patients with MDR-PA were retrospectively reviewed. The risk factors and outcomes of MDR-PA acquired patients were analyzed by comparing with patients who acquired susceptible-PA while admitted to the same hospital during the study time.
Results:
A total of 100 MDR-PA and 100 susceptible-PA cases were included. Ceftolozane-tazobactam was susceptible in 41.3% of MDR-PA compared to only 4%-8% with other β-lactams. About half (46%) of the MDR-PA isolates harbored the bla -NDM-1 gene, but none had the bla -OXA-48 gene. Factors independently associated with MDR-PA acquisitions were age (OR: 1.02; P = 0.028), genitourinary disorder (OR: 6.89; P = 0.001), and central venous catheter (OR: 3.18; P = 0.001). In addition, MDR-PA acquisitions were found to be associated with antimicrobial treatment failure (41.1% vs. 25.0%; P = 0.001) and mortality (40.0% versus 6.0%; P <0.001).
Conclusion:
Most of the MDR-PA strains in Kelantan tertiary hospitals harbored the bla -NDM-1 gene, which is easily transmissible and can lead to an outbreak. Nonetheless, a significant number of the MDR-PA isolates were still susceptible to ceftolozane-tazobactam.
Insights
Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a growing threat. This study identified risk factors like age and catheters for MDR-PA acquisition, linked to treatment failure and mortality.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Epidemiology
Background:
- Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) poses a significant challenge in healthcare settings.
- The increasing prevalence of MDR-PA necessitates understanding its risk factors and resistance patterns.
Purpose of the Study:
- To investigate the risk factors and outcomes associated with MDR-PA acquisition in Kelantan, Malaysia.
- To analyze the susceptibility patterns and identify common resistance genes in MDR-PA isolates.
Main Methods:
- Retrospective review of clinical data from patients with MDR-PA and susceptible-PA.
- Susceptibility testing and identification of resistance genes (e.g., blaNDM-1, blaOXA-48) in MDR-PA isolates.
- Comparative analysis of risk factors and outcomes between MDR-PA and susceptible-PA groups.
Main Results:
- Ceftolozane-tazobactam showed susceptibility in 41.3% of MDR-PA, significantly higher than other beta-lactams.
- The blaNDM-1 gene was present in 46% of MDR-PA isolates; blaOXA-48 was absent.
- Independent risk factors for MDR-PA acquisition included advanced age, genitourinary disorders, and central venous catheter use.
- MDR-PA acquisition was associated with increased antimicrobial treatment failure (41.1% vs. 25.0%) and mortality (40.0% vs. 6.0%).
Conclusions:
- The blaNDM-1 gene, prevalent in Kelantan hospitals, poses a risk for outbreaks due to its transmissibility.
- A notable proportion of MDR-PA isolates remain susceptible to ceftolozane-tazobactam, offering a potential treatment option.
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