scholarly journals Combined Resistance to Ceftolozane-Tazobactam and Ceftazidime-Avibactam in Extensively Drug-Resistant (XDR) and Multidrug-Resistant (MDR) Pseudomonas aeruginosa: Resistance Predictors and Impact on Clinical Outcomes besides Implications for Antimicrobial Stewardship Programs

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1224
Author(s):  
Marianna Meschiari ◽  
Gabriella Orlando ◽  
Shaniko Kaleci ◽  
Vincenzo Bianco ◽  
Mario Sarti ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Stewardship ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Attributable Mortality ◽  
Retrospective Case ◽  
Comorbidity Score ◽  
Charlson Comorbidity Score ◽  
Clinical Surveillance

A retrospective case-control study was conducted at Modena University Hospital from December 2017 to January 2019 to identify risk factors and predictors of MDR/XDR Pseudomonas aeruginosa (PA) isolation with resistance to ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T), and of mortality among patients infected/colonized. Among 111 PA isolates from clinical/surveillance samples, 60 (54.1%) were susceptible to both drugs (S-CZA-C/T), while 27 (24.3%) were resistant to both (R-CZA-C/T). Compared to patients colonized/infected with S-CZA-C/T, those with R-C/T+CZA PA had a statistically significantly higher Charlson comorbidity score, greater rate of previous PA colonization, longer time before PA isolation, more frequent presence of CVC, higher exposure to C/T and cephalosporins, longer hospital stay, and higher overall and attributable mortality. In the multivariable analysis, age, prior PA colonization, longer time from admission to PA isolation, diagnosis of urinary tract infection, and exposure to carbapenems were associated with the isolation of a R-C/T+CZA PA strain, while PA-related BSI, a comorbidity score > 7, and ICU stay were significantly associated with attributable mortality. C/T and CZA are important therapeutic resources for hard-to-treat PA-related infections, thus specific antimicrobial stewardship interventions should be prompted in order to avoid the development of this combined resistance, which would jeopardize the chance to treat these infections.

scholarly journals 2254. Multicenter Evaluation of Ceftazidime–Avibactam for Multidrug-Resistant Pseudomonas aeruginosa Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S771-S772
Author(s):  
Sarah C J Jorgensen ◽  
Trang D Trinh ◽  
Evan J Zasowski ◽  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Multidrug Resistant ◽  
Culture Collection ◽  
Apache Ii Score ◽  
Multicenter Cohort Study ◽  
Carbapenem Resistant ◽  
Complex Patients ◽  
Previous Infection ◽  
Charlson Comorbidity Score ◽  
Hospital Acquired

Abstract Background Ceftazidime–avibactam (CZA) is a novel cephalosporin/β-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae (CRE) and multidrug-resistant (MDR) Pseudomonas aeruginosa (PA). Real-world experience with CZA for CRE infections is accumulating but data on its use for MDR PA infections remains limited. Methods Retrospective, multicenter cohort study describing the clinical characteristics and outcomes of patients treated with CZA (≥ 72 hours) for MDR PA infections between 2015 and 2018. Results Fifty-one patients were included. The median (IQR) age was 61 (43, 71) years. Most patients had MDR risk factors including recent hospitalization (74.5%), recent antimicrobial exposure (84.3%), and/or previous infection or colonization with an MDR pathogen (58.8%). The median Charlson Comorbidity score was 4 (2, 6) and the median APACHE II score was 20 (12, 29). Infections were predominantly (68.6%) hospital-acquired and 52.9% of patients were in the ICU at infection onset. The common sources were respiratory tract (60.8%), osteoarticular (11.8%) and skin and soft tissue (11.8%). Two patients had positive blood cultures. PA antibiotic susceptibilities were as follows: ceftazidime 52.6% (n = 51), CZA 92.0% (n = 25), ciprofloxacin 10% (n = 30), meropenem 19.6% (n = 46), piperacillin–tazobactam 30.4% (n = 4) and tobramycin 72.9% (n = 48). Most (60.8%) infections were polymicrobial including 15 (29.4) CRE co-infections. CZA was started 97 (50, 170) hours after culture collection and continued for 9 (7, 14) days. Only 8 patients (15.7%) received active antibiotic therapy before CZA. Combination CZA therapy was used 35.3%, most often an aminoglycoside (8/18, 44.4%). Clinical cure or improvement was achieved in 40 patients (78.4%), and 42 (82.4%) were discharged alive. Among patients with repeat cultures (n = 11), CZA resistance development was not detected. Three patients (5.9%) experienced infection recurrence within 30 days of completing therapy. Conclusion The use of CZA was associated with high rates of favorable outcomes in complex patients with MDR PA infections. Future studies evaluating long-term outcomes and comparative studies are needed to more precisely define the role of CZA for MDR PA infections. Disclosures All authors: No reported disclosures.

scholarly journals Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use

2015 ◽  
Vol 9 (03) ◽  
pp. 309-312 ◽  
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.

Molecular epidemiology of multidrug-resistant Pseudomonas aeruginosa in a French university hospital

2010 ◽  
Vol 76 (4) ◽  
pp. 316-319 ◽  
Author(s):  
P. Cholley ◽  
H. Gbaguidi-Haore ◽  
X. Bertrand ◽  
M. Thouverez ◽  
P. Plésiat ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Molecular Epidemiology ◽  
Multidrug Resistant ◽  
University Hospital

scholarly journals Pseudomonas aeruginosa Nosocomial Pneumonia: Impact of Pneumonia Classification

2015 ◽  
Vol 36 (10) ◽  
pp. 1190-1197 ◽  
Author(s):  
Scott T. Micek ◽  
Marin H. Kollef ◽  
Antoni Torres ◽  
Catherine Chen ◽  
Jordi Rello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Multidrug Resistance ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Multidrug Resistant ◽  
Resistant Isolate ◽  
Antibiotic Administration ◽  
Specific Risk ◽  
Charlson Comorbidity Score

OBJECTIVETo describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).DESIGNWe conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).SETTINGTwelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).PATIENTS/PARTICIPANTSA total of 742 patients with Pa-NP.RESULTSHospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.CONCLUSIONSAmong patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.Infect Control Hosp Epidemiol 2015;36(10):1190–1197

scholarly journals Otitis External Infections Among Jordanian Patients with Emphasis on Pathogenic Characteristics of Pseudomonas aeruginosa Isolates

2019 ◽  
Vol 13 (1) ◽  
pp. 292-296
Author(s):  
Lubna Y. ALjaafreha ◽  
Mohmmed Tawalbeh ◽  
Asem A. Shehabi
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Virulence Genes ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Biochemical Tests ◽  
Accurate Identification ◽  
Antimicrobial Resistance Genes ◽  
Positive Growth ◽  
Staphylococcus Epidermis ◽  
Bacteria And Fungi

Introduction: Otitis external infection is an inflammation of the ear canal frequently caused by Pseudomonas aeruginosa, followed by Staphylococcus epidermis and Staphylococcus auerus. Objective: This study investigated the spectrum of bacterial and fungal agents that cause otitis external infection in Jordanian patients with an emphasis on important antimicrobial resistance genes and putative virulence factors of P. aeruginosa isolates using molecular PCR methods. Methods: A total of 128 ear swab samples were obtained from outpatients with otitis external infection of Ear-Nose-Throat Clinic (ENT) from the Jordan University Hospital (JUH). All samples were cultured for bacteria and fungi and their growth was identified by macroscopic and microscopic examination as well as recommended biochemical tests. Results: Positive growth of bacteria and fungi were found in 105/128 (82%) of the examined cases. A total of 28 (22%) of the recovered organisms from ear samples were P. aeruginosa. A total of 11/28 (39%) of P. aeruginosa isolates were Multidrug-Resistant (MDR) which are resistant to three or more antibiotic classes. Both blaIMP-15 and VIM genes were not detected, while KPC genes were found in 57% among all isolates. The rates of the potential virulence genes found among 28 P. aeruginosa isolates were as follows: lasB, algD, toxA, exoU PilB and exoS at 100%, 100%, 82%, 72%, 54% and 25%, respectively. All isolates produced beta hemolysis on both human and sheep blood agar and showed either the pigment pyoverdin (57.1%) or pyocyanin (42.8%). Conclusion: Accurate identification of the causative agent of otitis external infection and its susceptibility to antibiotics especially P.aeruginosa is highly important for successful treatment. No significant relationship has been found between MDR P. aeruginosa and the presence of virulence genes.

scholarly journals Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution

2019 ◽  
Author(s):  
Pritam Bawankar ◽  
Harsha Bhattacharjee ◽  
Manabjyoti Barman ◽  
Ronel Soibam ◽  
Hemalata Deka ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cataract Surgery ◽  
Genomic Dna ◽  
Trypan Blue ◽  
Dna Typing ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Postoperative Endophthalmitis ◽  
Retrospective Case ◽  
Multiple Drugs

Purpose: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes. Methods: This was a hospital-based, retrospective case study with 13 consecutive patients who had manual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environmental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relationship between bacterial isolates recovered from study patients and contaminated surveillance samples. Results: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients. Conclusion: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.

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