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Imipenem-resistant Pseudomonas aeruginosa: risk factors and antibiotic susceptibility patterns
N Troillet1, M H Samore, Y Carmeli
1Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Abstract:
Potential risk factors for the detection of imipenem-resistant Pseudomonas aeruginosa in hospitalized patients were assessed by a case-control study. Forty patients whose first P. aeruginosa isolate was resistant or intermediate to imipenem were more likely than 387 controls to have received imipenem (odds ratio [OR] = 16.9; P < .0001) and to have undergone organ transplantation (OR = 3.9; P = .008). No significant difference was found for treatments with other antibiotics, other underlying diseases, demographic characteristics, different exposures to the hospital environment, or the culture site. Imipenem-resistant P. aeruginosa isolates were more likely to be resistant to other common antipseudomonal agents than were imipenem-susceptible isolates. It is concluded that treatment with imipenem, but not with other beta-lactam drugs, is a major risk factor for the detection of imipenem-resistant P. aeruginosa in hospitalized patients, that these organisms may relatively often be resistant to other antipseudomonal agents, and that the hospital environment per se might not play a major role in their epidemiology.
Insights
Imipenem treatment is a major risk factor for detecting imipenem-resistant Pseudomonas aeruginosa in hospitals. Organ transplantation also increases risk, while the hospital environment plays a minor role.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Pseudomonas aeruginosa is a common opportunistic pathogen in healthcare settings.
- The emergence of antibiotic resistance, particularly to carbapenems like imipenem, poses a significant clinical challenge.
- Understanding risk factors for imipenem-resistant P. aeruginosa is crucial for infection control.
Purpose of the Study:
- To identify potential risk factors associated with the detection of imipenem-resistant Pseudomonas aeruginosa in hospitalized patients.
- To compare characteristics of patients with imipenem-resistant P. aeruginosa to a control group.
Main Methods:
- A case-control study was conducted.
- Cases included 40 patients with the first P. aeruginosa isolate resistant or intermediate to imipenem.
- Controls included 387 patients with susceptible P. aeruginosa isolates.
Main Results:
- Imipenem treatment (OR = 16.9) and organ transplantation (OR = 3.9) were significant risk factors for imipenem-resistant P. aeruginosa.
- No significant differences were observed for other antibiotic treatments, underlying diseases, demographics, hospital environment exposure, or culture site.
- Imipenem-resistant isolates were more frequently resistant to other antipseudomonal agents compared to susceptible isolates.
Conclusions:
- Treatment with imipenem is a primary risk factor for detecting imipenem-resistant P. aeruginosa, distinct from other beta-lactam drugs.
- Imipenem-resistant P. aeruginosa often exhibits co-resistance to other antipseudomonal agents.
- The hospital environment itself may not be a major driver of imipenem-resistant P. aeruginosa epidemiology.