Pseudomonas aeruginosa infection in burn patients in Sulaimaniyah, Iraq: risk factors and antibiotic resistance rates

Abstract Background Bacteremia due to Pseudomonas aeruginosa is associated with high mortality and inappropriate initial antimicrobial therapy leads to worse outcomes. We aimed to analyze clinical characteristics of P. aeruginosa bacteremia and risk factors for antibiotic resistance and investigate their antimicrobial susceptibility trends. Methods We retrospectively reviewed the medical records of patients with P. aeruginosa bacteremia admitted to a tertiary hospital between January 2009 and March 2019. Results A total of 242 patients were identified and the median age was 70 years [interquartile range (IQR) 57.6–75.4]. Hepatobiliary tract (28.5%) was most common primary site of infection, followed by respiratory tract (20.2%) and urinary tract (15.7%). Out of 197 (81.4%) patients treated with susceptible antibiotics and the median duration of active antibiotic therapy was 10 days (IQR 4–15.5). The percentages of susceptible P. aeruginosa to amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, colistin, gentamicin, imipenem, meropenem, piperacillin–tazobactam, and ticarcillin-clavulanate were 90.1%, 57.9%, 77.3%, 74.8%, 74.4%, 99.2%, 91.3%, 76.0%, 76.0%, 69.4%, and 51.2%. There were 24.8% carbapenem-resistant P. aeruginosa (CRPA), 36.4% multidrug-resistant P. aeruginosa (MDRPA), and 15.3% extensively drug-resistant P. aeruginosa (XDRPA). Susceptible P. aeruginosa to gentamycin and ticarcillin-clavulanate were significantly decreased in 2014–2019 than that in 2009–2013 (both; P < 0.001). Resistance rates to carbapenems and fluoroquinolones tended to increase over time. CRPA, MDRPA, and XDRPA were significantly associated with delayed active therapy (>48 h) (all; P < 0.001). Independent risk factors for CRPA were urinary tract infection (adjusted odds ratio [aOR], 3.4; 95% confidence interval [CI], 1.5–7.8), underlying hematologic malignancy (aOR, 3.0; 95% CI, 1.1–8.3) and cerebrovascular accident (aOR, 2.6; 95% CI, 1.1–5.9), hospital-acquired infection (aOR, 2.5; 95% CI, 1.0–6.1), and co-colonization with multidrug-resistant organisms (aOR, 2.2; 95% CI, 1.1–4.4). Conclusion The identification of risk factors for antibiotic resistance and analysis of antibiotics susceptibility are useful for early initiation of appropriate antibiotics in patients with P. aeruginosa bacteremia. Disclosures All authors: No reported disclosures.

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Risk factors for carbapenem-resistant Pseudomonas aeruginosa infection in a tertiary care hospital in Serbia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3516 ◽

2013 ◽

Vol 7 (09) ◽

pp. 686-690 ◽

Cited By ~ 6

Author(s):

Zorana Djordjevic ◽

Marko Folic ◽

Dejana Ruzic Zecevic ◽

Goran Ilic ◽

Slobodan Jankovic

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Full Text ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Carbapenem Resistant ◽

Pseudomonas Aeruginosa Infection

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Prevalence of Virulence Genes and Drug Resistance Profiles of Pseudomonas aeruginosa Isolated From Clinical Specimens

Jundishapur Journal of Microbiology ◽

10.5812/jjm.118452 ◽

2021 ◽

Vol 14 (8) ◽

Author(s):

Seyed Ali Bazghandi ◽

Mohsen Arzanlou ◽

Hadi Peeridogaheh ◽

Hamid Vaez ◽

Amirhossein Sahebkar ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Drug Resistance ◽

Antibiotic Resistance ◽

Virulence Genes ◽

Virulence Gene ◽

Clinical Isolates ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Clinical Specimens ◽

Resistance Rates

Background: Drug resistance and virulence genes are two key factors for the colonization of Pseudomonas aeruginosa in settings with high antibiotic pressure, such as hospitals, and the development of hospital-acquired infections. Objectives: The objective of this study was to investigate the prevalence of drug resistance and virulence gene profiles in clinical isolates of P. aeruginosa in Ardabil, Iran. Methods: A total of 84 P. aeruginosa isolates were collected from clinical specimens of Ardabil hospitals and confirmed using laboratory standard tests. The disk diffusion method was used for antibiotic susceptibility testing and polymerase chain reaction (PCR) for the identification of P. aeruginosa virulence genes. Results: The highest and the lowest antibiotic resistance rates of P. aeruginosa strains were against ticarcillin-clavulanate (94%) and doripenem (33.3%), respectively. In addition, the frequency of multidrug-resistant (MDR) P. aeruginosa was 55.9%. The prevalence of virulence factor genes was as follows: algD 84.5%, lasB 86.9%, plcH 86.9%, plcN 86.9%, exoU 56%, exoS 51.2%, toxA 81%, nan1 13.1%, and pilB 33.3%. A significant association was observed between resistance to some antibiotics and the prevalence of virulence genes in P. aeruginosa. Conclusions: Our results revealed a high prevalence of antibiotic resistance, especially MDR, and virulence-associated genes in clinical isolates of P. aeruginosa in Ardabil hospitals. Owing to the low resistance rates against doripenem, gentamicin, and tobramycin, these antibiotics are recommended for the treatment of infections caused by highly resistant and virulent P. aeruginosa strains.

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2049. Trends in Antibiotic Use and Antibiotic Resistance among Veterans Affairs Community Living Centers from 2011 to 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1729 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S690-S691

Author(s):

Haley Appaneal ◽

Aisling Caffrey ◽

Stephanie Hughes ◽

Vrishali Lopes ◽

Robin L Jump ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Antibiotic Use ◽

Veterans Affairs ◽

Fluoroquinolone Resistance ◽

Antibiotic Overuse ◽

Community Living Centers ◽

Resistance Rates ◽

Klebsiella Spp

Abstract Background Antibiotic resistance is a global public health crisis, with antibiotic overuse contributing to selection pressure, and thus driving antibiotic resistance. Strategies to reduce antibiotic overuse may slow the development of resistance, but large-scale studies assessing trends in antibiotic use and resistance among nursing homes at the national level are limited. We describe trends in antibiotic use and resistance nationally among Veterans Affairs (VA) Community Living Centers (CLCs). Methods We assessed antibiotic use and microbiological cultures among VA CLC residents from 2011 to 2017. Antibiotics were grouped into eight drug classes and annual days of antibiotic therapy per 1,000 bed-days were calculated. Facility-weighted annual antibiotic resistance rates were calculated. Joinpoint Software was used for regression analyses of trends over time and to estimate annual average percent changes (AAPC) with 95% confidence intervals (CI). Results Over 7 years and among 146 CLCs, several significant trends in decreasing antibiotic use and corresponding reductions in resistance were identified. Fluoroquinolone use decreased by 9.9% annually (95% CI −11.6 to −8.2%) and fluoroquinolone resistance decreased by 2.3% per year for Escherichia coli, 5.1% for Klebsiella spp., 1.8% for Proteus mirabilis, 4.9% for Pseudomonas aeruginosa, 12.6% for Enterobacter spp., and 3.2% for Enterococcus spp. Anti-pseudomonal penicillin use decreased by 6.6% annually (95% CI −10.6 to −2.4%) and anti-pseudomonal penicillin resistance rates decreased each year by 7.9% for Escherichia coli, 8.9% for Klebsiella spp., 15.2% for Proteus mirabilis and 4.2% for Pseudomonas aeruginosa. Anti-staphylococcal penicillin use decreased by 5.4% annually (95% CI −10.0 to −0.5%) and resistance in Staphylococcus aureus decreased 1.7% per year. Conclusion Nationally among VA CLCs, we observed significant reductions in the use of several classes of antibiotics with corresponding reductions in antibiotic resistance, including an impressive decline in fluoroquinolone use and corresponding decreases in fluoroquinolone resistance among six organisms. Future research should assess whether reductions in antibiotic use predict later reductions in antibiotic resistance and improvements in resident outcomes. Disclosures All authors: No reported disclosures.

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Prevalence Of Individual And Multiple Antibiotic Resistance Among Persons With Non-Cystic Fibrosis Bronchiectasis And Pseudomonas AerugINOSa Infection

10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4872 ◽

2011 ◽

Author(s):

Christopher A. Czaja ◽

Adrah Levin ◽

James R. Murphy ◽

Charles L. Daley

Keyword(s):

Cystic Fibrosis ◽

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Multiple Antibiotic Resistance ◽

Pseudomonas Aeruginosa Infection

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Pseudomonas aeruginosa Infection after Pancreatoduodenectomy: Risk Factors and Clinic Impacts

Surgical Infections ◽

10.1089/sur.2015.041 ◽

2015 ◽

Vol 16 (6) ◽

pp. 769-774 ◽

Cited By ~ 7

Author(s):

Jun-Feng Zhang ◽

Hong-Yan Zhu ◽

Yong-Wei Sun ◽

Wei Liu ◽

Yan-Miao Huo ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Pseudomonas Aeruginosa Infection

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Risk factors associated with unfavorable short-term treatment outcome in patients with documented Pseudomonas aeruginosa infection

International Journal of Clinical Pharmacy ◽

10.1007/s11096-015-0067-6 ◽

2015 ◽

Vol 37 (2) ◽

pp. 348-354 ◽

Cited By ~ 6

Author(s):

V. Paul DiMondi ◽

Mary L. Townsend ◽

Richard H. Drew

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Treatment Outcome ◽

Term Treatment ◽

Short Term ◽

Short Term Treatment ◽

Factors Associated ◽

Pseudomonas Aeruginosa Infection

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A Meta-Analysis of the Prevalence of Class 1 Integron and Correlation with Antibiotic Resistance in Pseudomonas aeruginosa Recovered from Iranian Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irz135 ◽

2019 ◽

Vol 40 (6) ◽

pp. 972-978 ◽

Cited By ~ 2

Author(s):

Siamak Heidarzadeh ◽

Yasamin Enayati Kaliji ◽

Reza Pourpaknia ◽

Alireza Mohammadzadeh ◽

Mehran Ghazali-Bina ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Meta Analysis ◽

Multidrug Resistant ◽

Burn Patients ◽

Eligibility Criteria ◽

Class 1 Integron ◽

Cross Sectional ◽

Class 1 Integrons ◽

Class 1

Abstract The role of integrons has been highlighted in antibiotic resistance among Pseudomonas aeruginosa isolates. Therefore, we here reviewed the prevalence of class 1 integrons and their correlations with antibiotic resistance of P. aeruginosa isolated from Iranian burn patients. This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Cross-sectional and cohort studies published from January 1, 2000 until December 31, 2018 were enrolled. Meta-analysis was performed by Comprehensive Meta-Analysis (CMA) software using the random effects model, Cochran’s Q, and I2 tests. Publication bias was estimated by Funnel plot and Egger’s linear regression test. Nine out of 819 studies met the eligibility criteria. The overall combined prevalence of class 1 integrons in P. aeruginosa isolates was 69% (95% confidence interval [CI]: 50.5–83%). The highest combined resistance was reported against Cloxacillin (87.7%), followed by Carbenicillin (79.1%) and Ceftriaxone (77.3%). The combined prevalence of multidrug-resistant (MDR) isolates was 79.3% (95% CI: 31.1–97%). Also, a significant correlation was noted between the presence of class 1 integrons and antibiotic resistance in 55.5% of the included studies (P < .05). The results showed high prevalence of class 1 integrons, antibiotic resistance, and MDR strains in P. aeruginosa isolated from Iranian burn patients. Also, most of the included studies showed a significant correlation between the presence of class 1 integrons and antibiotic resistance.

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