Risk Factors and Outcomes Associated with Isolation of Meropenem High-Level-Resistant Pseudomonas aeruginosa

2009 ◽  
Vol 30 (8) ◽  
pp. 746-752 ◽  
Author(s):  
Kathryn J. Eagye ◽  
Joseph L. Kuti ◽  
David P. Nicolau
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Pseudomonas Aeruginosa ◽  
Foley Catheter ◽  
Antibiotic Use ◽  
Control Measures ◽  
Administrative Database ◽  
Control Group ◽  
Infection Control Measures ◽  
High Level

Objective.To determine risk factors and outcomes for patients with meropenem high–level-resistant Pseudomonas aeruginosa (MRPA) (minimum inhibitory concentration [MIC] ≥ 32 μg/mL).Design.Case-control-control.Setting.An 867-bed urban, teaching hospital.Patients.Fifty-eight MRPA case patients identified from an earlier P. aeruginosa study; 125 randomly selected control patients with meropenem-susceptible P. aeruginosa (MSPA) (MIC ≤ 4 μg/mL), and 57 control patients without P. aeruginosa (sampled by case date/location).Methods.Patient data, outcomes, and costs were obtained via administrative database. Cases were compared to each control group while controlling for time at risk (days between admission and culture, or entire length of stay [LOS] for patients without P. aeruginosa).Results.A multivariable model predicted risks for MRPA versus MSPA (odds ratio [95% confidence interval]): more admissions (in the prior 12 months) (1.41 [1.15, 1.74]), congestive heart failure (2.19 [1.03, 4.68]), and Foley catheter (2.53 [1.18, 5.45]) (adj. R2 = 0.28). For MRPA versus no P. aeruginosa, risks were age (in 5-year increments) (1.17 [1.03, 1.33]), more prior admissions (1.40 [1.08, 1.81]), and more days in the intensive care unit (1.10 [1.03, 1.18]) (adj. R2 = 0.32). Other invasive devices (including mechanical ventilation) and previous antibiotic use (including carbapenems) were nonsignificant. MRPA mortality (31%) did not differ from that of MSPA (15%) when adjusted for time at risk (P = .15) but did from mortality without P. aeruginosa (9%) (P = .01 ). Median LOS and costs were greater for MRPA patients versus MSPA patients and patients without P. aeruginosa: 30 days versus 16 and 10 (P < .01 ) and $88,425 versus $28,620 and $22,605 (P <.01).Conclusions.Although antibiotic use has been shown to promote resistance, our data found that prior antibiotic use was not associated with MRPA acquisition. However, admission frequency and Foley catheters were, suggesting that infection control measures are essential to reducing MRPA transmission.

scholarly journals Virulence genes and antibiotic resistance of Pseudomonas aeruginosa isolated from patients in the Northwestern of Morocco

2019 ◽  
Vol 13 (10) ◽  
pp. 892-898
Author(s):  
Chaimae Elmouaden ◽  
Amin Laglaoui ◽  
Latifa Ennanei ◽  
Mohammed Bakkali ◽  
Mohammed Abid
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Nosocomial Infections ◽  
Virulence Genes ◽  
Health Workers ◽  
Control Measures ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Infection Control Measures ◽  
Antibiotic Susceptibility Patterns ◽  
High Level

Introduction: Pseudomonas aeruginosa is an ubiquitous bacterium causes various community-acquired and nosocomial infections. In this investigation, we aimed to screen the antibiotic susceptibility patterns and the prevalence of virulence factor genes in a set of Pseudomonas aeruginosa isolated from nosocomial and community-acquired infections in the Northwestern of Morocco. Methodology: A total of 155 of Pseudomonas aeruginosa strains were collected (January 2015 - December 2016) from nosocomial and community-acquired infections at hospital centers and clinical laboratories in the Northwestern of Morocco. Antimicrobial susceptibility test was performed by the standard disk diffusion method. In addition, PCR assays were used for screening five virulence encoding genes (lasB, algD, plcH, exoA, and exoS). Results: Our results revealed that high level of antimicrobial resistance was detected towards aztreonam (27.1%) followed by meropenem (14.2%). The resistance to imipenem was significantly higher in strains isolated from nosocomial infections (12.7%) than strains isolated from community-acquired infections (1.5%). The results highlighted that lasB (98.7%) and exoS (98.7%) were the most frequent virulence genes. Conclusions: This survey provides data about phenotypic and genotypic properties of Pseudomonas aeruginosa emerged in the Northwestern of Morocco. It could be helpful for the health workers to improve infection control measures and to establish a surveillance system.

Clostridium difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control

1997 ◽  
Vol 18 (09) ◽  
pp. 628-632 ◽  
Author(s):  
Kwan Kew Lai ◽  
Zita S. Melvin ◽  
Mary Jane Menard ◽  
Helen R. Kotilainen ◽  
Stephen Baker
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Respiratory Tract ◽  
Infection Control ◽  
Attack Rate ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Control Measures ◽  
Infection Control Measures ◽  
Tract Infections

Abstract Objectives: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development. Setting: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year. Methods: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD. Results: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P=.0001 and .0203, respectively) were found to be significant. Conclusion: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.

Epidemiology and risk factors for faecal extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage derived from residents of seven nursing homes in western Shanghai, China

2015 ◽  
Vol 144 (4) ◽  
pp. 695-702 ◽  
Author(s):  
S.-Y. ZHAO ◽  
J. ZHANG ◽  
Y.-L. ZHANG ◽  
Y.-C. WANG ◽  
S.-Z. XIAO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Homes ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Control Measures ◽  
Cross Sectional ◽  
Antibiotic Resistant ◽  
Infection Control Measures ◽  
Extended Spectrum ◽  
Faecal Carriage

SUMMARYNursing homes (NHs) have been implicated as significant reservoirs of antibiotic-resistant organisms causing severe infectious disease. We investigated the prevalence and molecular epidemiology of, and risk factors for, faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). A multicentre cross-sectional study was conducted in seven NHs in Shanghai between March 2014 and May 2014. Antimicrobial susceptibility testing and polymerase chain reaction were used to detect genes coding for ESBLs and carbapenemases. NH records at individual-resident level and facility level were examined for potential risk factors. Four hundred and fifty-seven Enterobacteriaceae isolates were collected of which 183 (46·92%) were colonized by ESBL-E. CTX-M enzymes (198/200, 99%) predominated, with CTX-M-14 (84/200, 42%) the most common types. Two carbapenemase producers harboured blaKPC-2. Resistance rates to carbapenems, TZP, AK, FOS, CL and TGC were low. History of invasive procedures [odds ratio (OR) 2·384, 95% confidence interval (CI) 1·318–4·310, P = 0·004], narrow-spectrum cephalosporins (OR 1·635, 95% CI 1·045–2·558, P = 0·031) and broad-spectrum cephalosporins (OR 3·276, 95% CI 1·278–8·398, P = 0·014) were independently associated with ESBL-E carriage. In conclusion, NH residents have a very high prevalence of faecal carriage of ESBL-E. Continuous and active surveillance is important, as are prudent infection control measures and antibiotic use to prevent and control the spread of these antibiotic-resistant strains.

IDENTIFICATION AND ASSESSMENT OF RISK FACTORS ROLE IN MYOCARDIAL INFARCTION DEVELOPMENT

2019 ◽  
Vol 72 (5) ◽  
pp. 779-783
Author(s):  
Victor A. Ognev ◽  
Anna A. Podpriadova ◽  
Anna V. Lisova
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Cardiovascular System ◽  
Control Group ◽  
Biological Factors ◽  
Prevention And Treatment ◽  
High Level ◽  
Social Importance ◽  
The Impact

Introduction:The high level of morbidity and mortality from cardiovascular disease is largely due toinsufficient influence on the main risk factors that contribute to the development of myocardial infarction.Therefore, a detailed study and assessment of risk factors is among the most important problems of medical and social importance. The aim: To study and evaluate the impact of biological, social and hygienic, social and economic, psychological, natural and climatic risk factors on the development of myocardial infarction. Materials and methods: A sociological survey was conducted in 500 people aged 34 to 85. They were divided into two groups. The main group consisted of 310 patients with myocardial infarction. The control group consisted of 190 practically healthy people, identical by age, gender and other parameters, without diseases of the cardiovascular system. Results: It was defined that 30 factors have a significant impact on the development of myocardial infarction.Data analysis revealed that the leading risk factors for myocardial infarction were biological and socio-hygienic. The main biological factors were: hypertension and hypercholesterolemia. The man socio-hygienic factor was smoking. Conclusions: Identification of risk factors provides new opportunities for the development of more effective approaches for the prevention and treatment of myocardial infarction.

scholarly journals Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach

2021 ◽  
pp. 003335492199939
Author(s):  
Elizabeth Noyes ◽  
Ellis Yeo ◽  
Megan Yerton ◽  
Isabel Plakas ◽  
Susan Keyes ◽  
...  
Keyword(s):  
Young Adults ◽  
Harm Reduction ◽  
Community Care ◽  
Control Measures ◽  
Adolescents And Young Adults ◽  
People Who Use Drugs ◽  
Staff Members ◽  
Infection Control Measures ◽  
Semistructured Interviews ◽  
High Level

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

scholarly journals Detection of VIM and NDM-1 metallo-beta-lactamase genes in carbapenem-resistant Pseudomonas aeruginosa clinical strains in Bahrain

2019 ◽  
Vol 11 (02) ◽  
pp. 138-143 ◽  
Author(s):  
Ronni Mol Joji ◽  
Nouf Al-Rashed ◽  
Nermin Kamal Saeed ◽  
Khalid Mubarak Bindayna
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Multiple Drug Resistance ◽  
Infectious Agent ◽  
Carbapenem Resistance ◽  
Conventional Polymerase Chain Reaction ◽  
Control Measures ◽  
Multiple Drug ◽  
Beta Lactamase ◽  
Infection Control Measures ◽  
Carbapenem Resistant

Abstract INTRODUCTION: Carbapenem-resistant Pseudomonas aeruginosa has emerged as a life-threatening infectious agent worldwide. Carbapenemase genes are reported to be some of the most common mechanisms for carbapenem resistance in P. aeruginosa. No reports are available from the Kingdom of Bahrain about carbapenem resistance and the underlying cause. In this study, we determined to study the presence of the metallo-beta-lactamase (M β L) genes of VIM family and NDM-1 in carbapenem-resistant P. aeruginosa strains. METHODOLOGY: Fifty carbapenem-resistant P. aeruginosa isolates were obtained from three main hospitals of Bahrain. They were subjected to antimicrobial susceptibility testing by disc diffusion test. Subsequently, MβL was detected by imipenem-ethylene diamine tetraacetic acid (EDTA) combined disc test and conventional polymerase chain reaction. RESULTS: Among 50 P. aeruginosa strains, 40 (80%) were imipenem resistant. Among the 40 imipenem-resistant strains, 35 (87.5%) strains were positive for the imipenem-EDTA combined disc test, and 21 (52%) were carrying MβL genes. Nineteen (47.5%) strains were positive for the VIM gene; one (2.5%) strain was carrying the NDM-1 gene, while one strain was carrying both the VIM and NDM-1 genes. None of the imipenem sensitive strains carried the VIM or NDM-1 gene. CONCLUSION: This is the first study to report the presence of the VIM family gene and NDM-1 genes in imipenem-resistant P. aeruginosa isolates in the Kingdom of Bahrain. The study also confirms the multiple drug resistance by the MβL strains, attention should therefore from now on, be focused on prevention of further spread of such isolates by firm infection control measures, and to reduce its threat to public health.

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

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

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.

Risk Factors for gyrA and parC Mutations in Pseudomonas aeruginosa

2015 ◽  
Vol 36 (4) ◽  
pp. 387-393 ◽  
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

Investigation of an Epidemic of Multi-Drug Resistant Pseudomonas aeruginosa

1982 ◽  
Vol 3 (6) ◽  
pp. 456-460 ◽  
Author(s):  
Susan A. Murray ◽  
David R. Snydman
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Case Control Study ◽  
Environmental Control ◽  
Foley Catheter ◽  
Antibiotic Use ◽  
Case Control ◽  
Drug Resistant ◽  
Infected Case ◽  
Environmental Reservoir ◽  
Control Study

AbstractInter- and intrahospital epidemics of nosocomial infections due to gram-negative bacilli resistant to many antimicrobials have been well-documented. Prospective studies on the use of isolation along with epidemiologic analysis and appropriate environmental control have been lacking. In the six-month period from November 1978 to April 1979 Pseudomonas aeruginosa (MDR) resistant to all antibiotics except amikacin was isolated from 15 patients. This organism had not previously been seen in our hospital. Epidemiologic assessment of infected patients revealed that nine of 15 patients had contact either with a previously infected case or contaminated area. All strains of P. aeruginosa were identical by pyocin typing and antibiogram. The organism was present in an environmental reservoir, the urine graduated cylinder, and was found in three of eight receptacles (p = 0.002 vs. other environmental cultures). A case control study of patient risk factors showed aminoglycoside use, other antibiotic use, surgery, intravenous lines, Foley catheter use and mechanical ventilation to be no more frequent in cases than controls. The use of aminoglycosides in only 40% of cases suggests that antibiotic pressure was not the sole factor in perpetuating the epidemic.

A Bundle of Measures to Control an Outbreak of Pseudomonas aeruginosa Associated With P-Trap Contamination

2018 ◽  
Vol 39 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Houssein Gbaguidi-Haore ◽  
Amélie Varin ◽  
Pascal Cholley ◽  
Michelle Thouverez ◽  
Didier Hocquet ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Bacterial Load ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Pipe System ◽  
Infection Control Measures ◽  
Cross Transmission ◽  
Proactive Measures

OBJECTIVETo describe an outbreak of multidrug-resistant Pseudomonas aeruginosa in which the hospital waste-pipe system was the likely source of contamination and to report the bundle of measures that facilitated the long-term control of the outbreak.DESIGNOutbreak investigation.SETTINGThe hematology unit of a tertiary-care referral center.PATIENTSPatients who were colonized or infected with P. aeruginosa belonging to the clonal outbreak.METHODSPatients admitted to our 15-bed stem-cell transplantation hematology unit were screened for P. aeruginosa carriage. Pseudomonas aeruginosa isolates were also obtained from diagnostic samples. We assessed the microbiological contamination of P-traps, water and toilets for 42 months. Extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) were screened and identified by polymerase chain reaction (PCR) and sequencing. Molecular typing of ESBL- or MBL-producing isolates was carried out using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).RESULTSFrom 2009 to 2013, a biclonal outbreak of IMP-19–producing ST235 (11 cases) and IMP-29–producing ST111 (10 cases) of P. aeruginosa occurred. The environmental investigation strongly suggested that P-traps were the reservoirs for the outbreak strains. A bundle of infection control measures, including engineering interventions on water outlets and disinfection of P-traps, controlled the outbreak.CONCLUSIONSWe report a prolonged outbreak of IMP-producing high-risk clones of P. aeruginosa, for which P-traps seems to play a major role in cross-transmission. It appears essential to implement proactive measures to limit the bacterial load in water fittings of high-risk units.Infect Control Hosp Epidemiol 2018;39:164–169

Sign in / Sign up

Export Citation Format

Share Document