The quick loss of carbapenem susceptibility in Pseudomonas aeruginosa at intensive care units
Background Patients colonized with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) strains upon admission to the intensive care unit (ICU) tend to be quickly followed by detected carbapenem-resistant P. aeruginosa strains after admission. Objective To assess the risk factors associated with the quick loss of carbapenem susceptibility and to identify time threshold of prior antimicrobial exposure for the loss during ICU stay. Setting A tertiary-care teaching hospital with 2560 beds located in the northwest region of China. Method A retrospective observational study was conducted between January 2013 and April 2016 at ICUs. Logistic regression analysis was used to assess risk factors, and receiver operating characteristic (ROC) analyses were constructed to identify the time threshold. Main outcome measure The time threshold and risk factors for the quick loss of carbapenem susceptibility. Results Among the 84 patients with CSPA initially, 32 (38.1%) patients were observed to have a loss of carbapenem susceptibility during ICU stay. Logistic regression analyses showed that previous carbapenem exposure was only independently associated with the loss of carbapenem susceptibility (odds ratio 13.16; 95% CI 3.13–55.24; p < 0.001). The optimal cut-off was 3.5 days on ROC curve, indicating the high risk for loss of susceptibility. Conclusion In order to alleviate selective pressure caused by antipseudomonal carbapenems exposure, continued research is needed to determine the most appropriate carbapenems treatment strategies.
KeywordsAntibiotics resistance Carbapenem China Intensive care Time threshold Treatment strategy
The authors gratefully acknowledge the support by the National Natural Science Foundation of China (Grant Nos. 81473177, 81672954) and Shaanxi Provincial Natural Science Foundation (Grant No. 2016JM8015).
Conflicts of interest
All authors declare that they have no conflict of interest.
- 2.Walkty A, Lagace-Wiens P, Adam H, Baxter M, Karlowsky J, Mulvey MR, et al. Antimicrobial susceptibility of 2906 Pseudomonas aeruginosa clinical isolates obtained from patients in Canadian hospitals over a period of 8 years: results of the Canadian Ward surveillance study (CANWARD), 2008–2015. Diagn Microbiol Infect Dis. 2017;87:60–3.CrossRefPubMedGoogle Scholar
- 3.Ferreira ML, Dantas RC, Faria AL, Gonçalves IR, Silveira de Brito C, Queiroz LL, et al. Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa. J Med Microbiol. 2015;64:262–71.CrossRefPubMedGoogle Scholar
- 13.Cobos-Trigueros N, Solé M, Castro P, Torres JL, Hernández C, Rinaudo M, et al. Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure. Crit Care. 2015;19:218.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Riou M, Carbonnelle S, Avrain L, Mesaros N, Pirnay JP, Bilocq F, et al. In vivo development of antimicrobial resistance in Pseudomonas aeruginosa strains isolated from the lower respiratory tract of Intensive Care Unit patients with nosocomial pneumonia and receiving antipseudomonal therapy. Int J Antimicrob Agents. 2010;36:513–22.CrossRefPubMedGoogle Scholar
- 20.Gbaguidi-Haore H, Dumartin C, L’Hériteau F, Péfau M, Hocquet D, Rogues AM, et al. Antibiotics involved in the occurrence of antibiotic-resistant bacteria: a nationwide multilevel study suggests differences within antibiotic classes. J Antimicrob Chemother. 2013;68:461–70.CrossRefPubMedGoogle Scholar
- 22.Patel N, McNutt LA, Lodise TP. Relationship between various definitions of prior antibiotic exposure and piperacillin–tazobactam resistance among patients with respiratory tract infections caused by Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2008;52:2933–6.CrossRefPubMedPubMedCentralGoogle Scholar