Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

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blaVIM-2 and blaVIM-7 Carbapenemase-Producing Pseudomonas aeruginosa Isolates Detected in a Tertiary Care Medical Center in the United States: Report from the MYSTIC Program

Journal of Clinical Microbiology ◽

10.1128/jcm.01351-06 ◽

2006 ◽

Vol 45 (2) ◽

pp. 614-615 ◽

Cited By ~ 26

Author(s):

H. Aboufaycal ◽

H. S. Sader ◽

K. Rolston ◽

L. M. Deshpande ◽

M. Toleman ◽

...

Keyword(s):

United States ◽

Pseudomonas Aeruginosa ◽

Medical Center ◽

Tertiary Care ◽

The United States ◽

Tertiary Care Medical Center

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Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

Journal of Anesthesia ◽

10.1007/s00540-016-2266-2 ◽

2016 ◽

Vol 31 (1) ◽

pp. 120-126 ◽

Cited By ~ 6

Author(s):

Manuel C. Vallejo ◽

Ahmed F. Attaallah ◽

Robert E. Shapiro ◽

Osama M. Elzamzamy ◽

Michael G. Mueller ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Cesarean Delivery ◽

Medical Center ◽

Tertiary Care ◽

Site Infection ◽

Tertiary Care Medical Center ◽

Independent Risk Factors

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Risk Factors for Inpatient Hypoglycemia in a Tertiary Care Medical Center

10.1210/endo-meetings.2011.part4.p3.p3-450 ◽

2011 ◽

pp. P3-450-P3-450

Author(s):

Jeremy R Grogg ◽

Pooja Singal ◽

Abhilasha Jarori ◽

James P Walsh

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center

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PGI1 PREVALENCE AND RISK FACTORS FOR DIARRHEA AT A LARGE TERTIARY CARE MEDICAL CENTER

Value in Health ◽

10.1016/s1098-3015(10)62990-7 ◽

2005 ◽

Vol 8 (3) ◽

pp. 369-370

Author(s):

S Kachroo ◽

N Kumar ◽

G Graham ◽

L Gerard ◽

T Dao ◽

...

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center ◽

Large Tertiary Care

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Risk Factors for gyrA and parC Mutations in Pseudomonas aeruginosa

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2014.87 ◽

2015 ◽

Vol 36 (4) ◽

pp. 387-393 ◽

Cited By ~ 2

Author(s):

Valerie C. Cluzet ◽

Ebbing Lautenbach ◽

Irving Nachamkin ◽

Mark S. Cary ◽

Neil O. Fishman ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Risk Factor ◽

Control Group ◽

Case Group ◽

Topoisomerase Iv ◽

Gram Positive ◽

Major Mechanism ◽

Study Participants ◽

Control Study

OBJECTIVEThe major mechanism of fluoroquinolone (FQ) resistance in Pseudomonas aeruginosa (PSA) is modification of target proteins in DNA gyrase and topoisomerase IV, most commonly the gyrA and parC subunits. The objective of this study was to determine risk factors for PSA with and without gyrA or parC mutations.DESIGNCase-case-control studySETTINGTwo adult academic acute-care hospitalsPATIENTSCase 1 study participants had a PSA isolate on hospital day 3 or later with any gyrA or parC mutation; case 2 study participants had a PSA isolate on hospital day 3 or later without these mutations. Controls were a random sample of all inpatients with a stay of 3 days or more.METHODSEach case group was compared to the control group in separate multivariate models on the basis of demographics and inpatient antibiotic exposure, and risk factors were qualitatively compared.RESULTSOf 298 PSA isolates, 172 (57.7%) had at least 1 mutation. Exposure to vancomycin and other agents with extended Gram-positive activity was a risk factor for both cases (case 1 odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04–1.13; OR, 1.14; 95% CI, 1.03–1.26; case 2 OR, 1.09; 95% CI, 1.03–1.14; OR, 1.13; 95% CI, 1.01–1.25, respectively).CONCLUSIONSExposure to agents with extended Gram-positive activity is a risk factor for isolation of PSA overall but not for gyrA/parC mutations. FQ exposure is not associated with isolation of PSA with mutations.Infect Control Hosp Epidemiol 2015;00(0): 1–7

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Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

Infection Control and Hospital Epidemiology ◽

10.1086/502045 ◽

2002 ◽

Vol 23 (5) ◽

pp. 254-260 ◽

Cited By ~ 51

Author(s):

Gregory Bisson ◽

Neil O. Fishman ◽

Jean Baldus Patel ◽

Paul H. Edelstein ◽

Ebbing Lautenbach

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Healthcare Facility ◽

System A ◽

Extended Spectrum ◽

Tertiary Care Medical Center ◽

Duration Of Hospitalization ◽

Third Generation Cephalosporins ◽

Control Study

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

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Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4700 ◽

2015 ◽

Vol 9 (03) ◽

pp. 309-312 ◽

Cited By ~ 5

Author(s):

Aysegul Ulu-Kilic ◽

Emine Alp ◽

Dilek Altun ◽

Fatma Cevahir ◽

Gamze Kalın ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Tertiary Care ◽

Care Facility ◽

Multidrug Resistant ◽

University Hospital ◽

Control Group ◽

Case Group ◽

Icu Patients ◽

Thoracic Drainage ◽

Tertiary Care Facility

Introduction: The widespread use of tigecycline raises the question of increasing infection rates of Pseudomonas aeruginosa (PA) in ICUs which are not affected by this antibiotic. Objective: The aim of this study was to determine if treatment with tigecycline is a risk factor for PA infection in ICU patients. Methodology: A retrospective and observational study was conducted at Erciyes University Hospital, Turkey, between 2008 and 2010. The Erciyes University Hospital is a 1300-bed tertiary care facility. The patients included in this study were hospitalized in four adult ICUs. Patients with PA infections (case group) were compared with patients with nosocomial infection other than PA (control group). Results: A total of 1,167 patients with any nosocomial infections were included in the study. Two hundred and seventy eight (23.8%) of the patients had PA infection during their ICU stay. Fifty nine patients (21.2%) in the case group received tigecycline before developing PA infections, which were found to be significantly more frequent than in the controls (p < 0.01). Multivariate analysis showed that risk factors for PA infection were previous tigecycline use (4 times), external ventricular shunt (4.2 times), thoracic drainage catheter (2.5 times) and tracheostomy (1.6 times). Conclusion: Our results contribute to the need for new studies to determine the safety of tigecycline use, especially for the treatment of critically ill patients. Since tigecycline seems to be an alternative for the treatment of multidrug resistant (MDR) microorganisms, rational use of this antibiotic in ICU patients is essential.

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Impact of Bordetella pertussis Exposures on a Massachusetts Tertiary Care Medical System

Infection Control and Hospital Epidemiology ◽

10.1086/518352 ◽

2007 ◽

Vol 28 (6) ◽

pp. 708-712 ◽

Cited By ~ 20

Author(s):

Iva Zivna ◽

Diana Bergin ◽

Joanne Casavant ◽

Sally Fontecchio ◽

Susan Nelson ◽

...

Keyword(s):

Bordetella Pertussis ◽

Healthcare Workers ◽

Close Contact ◽

Medical Center ◽

Tertiary Care ◽

Medical System ◽

Secondary Case ◽

Tertiary Care Medical Center ◽

Outbreak Investigations ◽

The Impact

Objective.To assess the impact of outbreaks of Bordetella pertussis infection on a tertiary care medical system.Design.Retrospective study.Setting.Academic tertiary care medical center and affiliated ambulatory care settings.Subjects.All patients and healthcare workers (HCWs) who were in close contact with patients with laboratory-confirmed cases of B. pertussis infection from October 1, 2003, through September 30, 2004.Intervention.Direct and indirect medical center costs were determined, including low and high estimates of time expended in the evaluation and management of exposed patients and HCWs during outbreak investigations of laboratory-confirmed cases of B. pertussis infection.Results.During this period, 20 primary and 3 secondary laboratory-confirmed cases of B. pertussis infection occurred, with 2 primary pertussis cases and 1 secondary case occurring in HCWs. Outbreak investigations prompted screening of 353 medical center employees. Probable or definitive exposure was identified for 296 HCWs, and 287 subsequently received treatment or prophylaxis for B. pertussis infection. Direct medical center costs for treatment and prophylaxis were $13,416 and costs for personnel time were $19,500-$31,190. Indirect medical center costs for time lost from work were $51,300-$52,300. The total cost of these investigations was estimated to be $85,066-$98,456.Conclusions.Frequent B. pertussis exposures had a major impact on our facility. Given the impact of exposures on healthcare institutions, routine vaccination for HCWs may be beneficial.

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Risk Factors for Otolaryngological Foreign Bodies in Eastern Poland

Otolaryngology ◽

10.1177/0194599812455297 ◽

2012 ◽

Vol 147 (5) ◽

pp. 889-893 ◽

Cited By ~ 3

Author(s):

Beata Rybojad ◽

Artur Niedzielski ◽

Grażyna Niedzielska ◽

Paweł Rybojad

Keyword(s):

Risk Factors ◽

Foreign Body ◽

Elementary Education ◽

Urban Areas ◽

Foreign Bodies ◽

Medical Center ◽

Tertiary Care ◽

Case Series ◽

Psychomotor Development ◽

Tertiary Care Medical Center

Objective To identify the sociodemographic characteristics and risk factors associated with suspected foreign bodies in the ear, nose, throat, airway, and esophagus among Polish children. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods A retrospective analysis of the medical records of patients hospitalized for a suspected foreign body (FB) between 1998 and 2008 was conducted. Data regarding place of residence, presence of siblings, parents’ educational status, seasonality, psychomotor development, age, and sex were collected and statistically analyzed. Results Of the 1011 patients with suspected foreign body insertion, 849 (84%) had a positive diagnosis. Of the confirmed foreign bodies, 96 were found in the tracheobronchial tree, 142 were found in the esophagus, and 611 were located in the external auditory canals, nasopharyngeal passage, tonsils, auricles, or lips. Sociodemographically, 596 of the children came from urban areas, with a preponderance of males (55%). Objects were removed more frequently in summer and autumn (60%). Children with siblings (53%) predominated. The majority of patients (52%) had parents with an elementary education. Food was the most frequent foreign body in children under 3 years of age. Patients with delayed psychomotor development constituted 1.6% of the analyzed population. Conclusions Being male, 1 to 3 years of age, belonging to an urban family with siblings, and having parents with an elementary education increased the risk of foreign body insertion. Training caregivers about proper nutrition and safety rules when playing with children can reduce the risk of accidents related to foreign body insertion.

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