Effects of Carbapenem Exposure on the Risk for Digestive Tract Carriage of Intensive Care Unit-Endemic Carbapenem-Resistant Pseudomonas aeruginosa Strains in Critically Ill Patients

ABSTRACT To determine the epidemiology and risk factors for carbapenem-resistant Pseudomonas aeruginosa (CR-PA) digestive tract colonization, weekly rectal and pharyngeal swabs were obtained in two serial incidence surveys (266 patients). Forty-two (16%) patients were CR-PA colonized (12 [29%] on admission and 30 [71%] in intensive care units). Pulsed-field gel electrophoresis showed extensive clonal diversity, although one specific clone (type B) was isolated from 11 patients. The presence of similar genotypes of CR-PA colonizing 30% of the CR-PA-colonized patients suggests the occurrence of cross-colonization; in addition, 10 pairs of carbapenem-susceptible P. aeruginosa (CS-PA) and subsequent CR-PA strains isolated from the same patients were found to be clonally identical and were considered to have been endogenously acquired (33%). All endogenously acquired CR-PA strains were isolated after exposure to a carbapenem, and 80% showed a phenotype of imipenem resistance (IR pattern) alone, while 67% of the CR-PA strains acquired by cross-transmission exhibited a multiresistant (MR) phenotype, with previous carbapenem exposure in 44%. Logistic regression analysis identified severity of acute illness (odds ratio [OR], 1.0; 95% confidence interval [CI], 1.0 to 1.1), prior carbapenem use (OR, 7.8; 95% CI, 1.7 to 35.3), and prior use of fluoroquinolones (OR, 11.0; 95% CI, 1.7 to 67.9) as independent risk factors for CR-PA digestive tract colonization. Overall, the local epidemiology of CR-PA digestive tract colonization was characterized by polyclonal endemicity with phenotype patterns of IR and MR divided evenly between patients. Restricting the use of particular agents, such as carbapenems and fluoroquinolones, should be considered advisable to minimize the problem of this antibiotic resistance. However, the possible risk for development of collateral unexpected bacterial resistance patterns should be accurately monitored.

Download Full-text

Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital

Antibiotics ◽

10.3390/antibiotics10101221 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1221

Author(s):

Giancarlo Pérez-Lazo ◽

Susan Abarca-Salazar ◽

Renata Lovón ◽

Rocío Rojas ◽

José Ballena-López ◽

...

Keyword(s):

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Bacterial Resistance ◽

Antibiotic Consumption ◽

Antimicrobial Consumption ◽

Carbapenem Resistant ◽

Resistance Patterns ◽

Medical Wards ◽

Eskape Pathogens

A descriptive design was carried out studying the correlation between antimicrobial consumption and resistance profiles of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) in a Peruvian hospital, including the surgical, clinical areas and the intensive care unit (ICU) during the time period between 2015 and 2018. There was a significant correlation between using ceftazidime and the increase of carbapenem-resistant Pseudomonas aeruginosa isolations (R = 0.97; p < 0.05) and the resistance to piperacillin/tazobactam in Enterobacter spp. and ciprofloxacin usage (R = 0.97; p < 0.05) in the medical wards. The Pseudomonas aeruginosa resistance to piperacillin/tazobactam and amikacin in the intensive care unit (ICU) had a significant reduction from 2015 to 2018 (67% vs. 28.6%, 65% vs. 34.9%, p < 0.001). These findings give valuable information about the rates and dynamics in the relationship between antibiotic usage and antimicrobial resistance patterns in a Peruvian hospital and reinforce the need for continuous support and assessment of antimicrobial stewardship strategies, including microbiological indicators and antimicrobial consumption patterns.

Download Full-text

Characterization of Imipenem Unsusceptible Pseudomonas Aeruginosa Isolates from Inpatients without Carbapenem Treatment

Infection International ◽

10.1515/ii-2017-0033 ◽

2013 ◽

Vol 2 (1) ◽

pp. 1-5

Author(s):

Yi-hai Gu ◽

Xiao Zhu ◽

Jing-yun Li ◽

Jun Zhang ◽

Qing-yuan Zhou ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Wide Spectrum ◽

Mechanism Analysis ◽

Antimicrobial Susceptibility Test ◽

Resistance Development ◽

Carbapenem Resistant ◽

Drug Classes ◽

Imipenem Resistance

Abstract Objective To identify the risk factors for imipenem resistance development and transmission of clinical Pseudomonas aeruginosa isolates. Methods Thirty-seven imipenem unsusceptible Pseudomonas aeruginosa isolates collected from patients in absence of carbapenem treatment were characterized by antimicrobial susceptibility test, pulsed field gel electrophoresis (PFGE) and carbapenem resistant mechanism analysis. Results Before the collection of imipenem unsusceptible Pseudomonas aeruginosa isolates, the average time of patients treated with more than one antimicrobial (20.0 ± 9.5 days, n = 16) was significantly longer than those treated with only one antimicrobial (12.6 ± 4.4 days, n = 21; t-test, Welch, t = -2.9004, P < 0.01). And 32 isolates showed resistance to more than 3 classes of antimicrobials. Six PFGE clusters were identified and 26 isolates were grouped into one dominant cluster (C2). An ISpa1328 sequence insertion in oprD was detected in 33 isolates and the function of efflux was observed in all 37 isolates in the presence of a wide spectrum efflux inhibitor. Conclusions Our data demonstrated that exposure to non-carbapenem drug classes, especially fluoroquinolones and β-lactams, may be important risk factors for the spread of carbapenem resistant Pseudomonas aeruginosa.

Download Full-text

Integrons and Antiseptic Resistance Genes Mediate Resistance of Acinetobacter baumannii and Pseudomonas aeruginosa Isolates from Intensive Care Unit Patients with Wound Infections

Current Molecular Medicine ◽

10.2174/1566524019666190321113008 ◽

2019 ◽

Vol 19 (4) ◽

pp. 286-293

Author(s):

Walid F. Elkhatib ◽

Mahmoud A.F. Khalil ◽

Hossam M. Ashour

Keyword(s):

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Acinetobacter Baumannii ◽

Resistance Genes ◽

Bacterial Resistance ◽

Multiple Drug Resistance ◽

Multiple Drug ◽

High Prevalence ◽

Resistance Patterns

Background: Acinetobacter baumannii and Pseudomonas aeruginosa are of major concern for hospitalized patients. Methods: We evaluated antibiotic and antiseptic resistance of A. baumannii (n = 29) and P. aeruginosa (n = 37) isolates recovered from 66 intensive care unit (ICU) patients and determined the prevalence of qacE, qacEΔ1, and integrons in these clinical isolates. Antibiotic and antiseptic susceptibility testing was performed via Kirby Bauer disk diffusion and broth microdilution methods, respectively. The resistance genes and integrons were detected by PCR. A. baumannii and P. aeruginosa ICU isolates showed 100% and 70.3% antibiotic multiple drug resistance patterns, respectively. Results: The isolates also revealed high levels of resistance (MIC ≥ 16 µg/ml) against antiseptics commonly used in Egyptian hospitals (Benzalkonium, Benzethonium, and Chlorhexidine). The qacEΔ1 gene showed higher levels of prevalence in both A. baumannii and P. aeruginosa isolates (93.5% and 78%, respectively) as compared to that of qacE gene (52.0% and 33.0%, respectively). The intI1 was more prevalent among A. baumannii isolates (65.5%) compared to P. aeruginosa isolates (37.8%). P. aeruginosa resistance genotypes were significantly associated with antibiotic and antiseptic resistance patterns. A. baumannii resistance genotypes were associated with antiseptic-resistance patterns. Conclusion: The excessive usage of antiseptics may escalate bacterial resistance, especially with high prevalence of intI1 integron in these pathogens.

Download Full-text

Clinical and microbiological characteristics of nosocomial, healthcare-associated, and community-acquired Klebsiella pneumoniae infections in Guangzhou, China

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00910-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Tingting Le ◽

Ling Wang ◽

Chaoying Zeng ◽

Leiwen Fu ◽

Zhihua Liu ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Bacterial Resistance ◽

Empirical Therapy ◽

Clonal Diversity ◽

Extended Spectrum Beta Lactamase ◽

Microbiological Characteristics ◽

Carbapenemase Gene ◽

Cross Transmission ◽

Healthcare Associated

Abstract Background Klebsiella pneumoniae (K. pneumoniae) is a common pathogen associated with hospital and community-onset infections. This study aimed to compare the clinical and microbiological characteristics of nosocomial, healthcare-associated (HCA), and community-acquired (CA) K. pneumoniae infections. Methods Clinical data were extracted from electronic medical records and analyzed retrospectively. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) production were determined for all identified strains. Carbapenemase and ESBL genes were amplified by PCR. Genotyping of carbapenem-resistant K. pneumoniae (CRKP) and ESBL-producing strains was performed by pulsed-field gel electrophoresis (PFGE). Results Of 379 K. pneumoniae infections, 98 (25.9%) were nosocomial, 195 (51.5%) were healthcare-associated, and 86 (22.6%) were community-acquired. Hematological malignancy (OR = 4.467), and hypertension (OR = 2.08) and cerebral vascular disease (OR = 2.486) were associated with nosocomial and HCA infections respectively, when compared to CA infections. Overall, the incidence of antimicrobial resistance for the majority of agents tested was similar between nosocomial and HCA infections (P > 0.05) and both groups had a higher incidence than CA infections (P < 0.05). Moreover, 95.1% (78/82) of CRKP strains were isolated from the nosocomial and HCA groups. The blaKPC was the most prevalent carbapenemase gene among CRKP strains (80.5%, 66/82). ESBL-producing strains were prevalent among nosocomial (40.8%), HCA (35.9%) and CA groups (24.4%). The blaCTX-M-9-group and blaCTX-M-1-group genes were predominant in nosocomial (65.0%) and CA strains (66.7%), respectively. PFGE results showed ESBL-producing and CRKP strains were genetically diverse. Identical PFGE profiles were observed among HCA and nosocomial strains. Conclusions Nosocomial and HCA K. pneumoniae infections presented similar clinical features and antimicrobial resistance, and both two types of infections were different to CA infections. CRKP and ESBL-producing strains were disseminated mainly in HCA and nosocomial groups, and showed a clonal diversity. The cross transmission of CRKP was existed among HCA and nosocomial patients. This finding suggests that similar empirical therapy should be considered for patients with nosocomial and HCA K. pneumoniae infections and bacterial resistance surveillance of these infections is necessary.

Download Full-text

Cross-transmission of nosocomial pathogens in an adult intensive care unit: incidence and risk factors

Journal of Hospital Infection ◽

10.1016/j.jhin.2005.10.012 ◽

2006 ◽

Vol 63 (1) ◽

pp. 39-46 ◽

Cited By ~ 45

Author(s):

M. Halwani ◽

M. Solaymani-Dodaran ◽

H. Grundmann ◽

C. Coupland ◽

R. Slack

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Pathogens ◽

Adult Intensive Care Unit ◽

Cross Transmission

Download Full-text

Path to Resistance: Risk Factors Associated With Carbapenem-Resistant Pseudomonas aeruginosa

Journal of Patient-Centered Research and Reviews ◽

10.17294/2330-0698.1421 ◽

2016 ◽

Vol 3 (4) ◽

pp. 236

Author(s):

Kushal Patel ◽

Jessica J.F. Kram ◽

Dennis J Baumgardner

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Resistance Risk ◽

Factors Associated ◽

Carbapenem Resistant

Download Full-text

Multi-resistant pseudomonas aeruginosa: study of risk factors for its detection at intensive care unit admission

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a123 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

S Puerto Corrales ◽

◽

R Vara Arlanzón ◽

F Callejo-Torre ◽

JM Eiros Bouza ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Intensive Care Unit Admission

Download Full-text

Surveillance of healthcare-associated infections in a Tunisian university hospital

European Journal of Public Health ◽

10.1093/eurpub/ckz186.513 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Hannachi ◽

A Ben Cheikh ◽

S Bhiri ◽

H Ghali ◽

S Khefacha ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

University Hospital ◽

Healthcare Associated Infections ◽

Drug Resistant ◽

Healthcare Associated Infection ◽

Carbapenem Resistant ◽

Independent Risk Factors ◽

Healthcare Associated

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

Download Full-text