Short versus prolonged courses of antimicrobial therapy for patients with uncomplicated Pseudomonas aeruginosa bloodstream infection: a retrospective study

2021 ◽  
Author(s):  
Moonsuk Bae ◽  
Yunseo Jeong ◽  
Seongman Bae ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infection ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Propensity Score Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Course ◽  
Significant Difference

Abstract Background The optimal duration of antimicrobial therapy for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) is unknown. We compared the outcomes of short and prolonged courses of antimicrobial therapy in adults with uncomplicated pseudomonal BSI. Methods All patients with uncomplicated P. aeruginosa BSI admitted at a tertiary-care hospital from April 2010 to April 2020 were included. We compared the primary outcome (a composite of the rate of recurrent P. aeruginosa infection and mortality within 30 days after discontinuing antimicrobial therapy) among patients who underwent short (7‒11 days) and prolonged (12‒21 days) courses of antimicrobial therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1477 patients with P. aeruginosa BSI; of them, 290 met the eligibility criteria who received antimicrobial agents with in vitro activity, including 97 (33%) who underwent short-course therapy [median of 9 (IQR = 8‒11) days] and 193 (67%) who underwent prolonged-course therapy [median of 15 (IQR = 14‒18) days]. We found no significant difference in the risk of recurrence or 30 day mortality between the prolonged-course and short-course groups [n = 30 (16%) versus n = 11 (11%); IPTW-adjusted HR = 0.68, 95% CI = 0.34 − 1.36, P = 0.28]. The prolonged-course therapy did not significantly reduce the risk of the recurrence of P. aeruginosa infection within 180 days compared with short-course therapy [n = 37 (19%) versus n = 12 (12%); IPTW-adjusted HR = 0.57, 95% CI = 0.29 − 1.10, P = 0.09]. Conclusions Short-course antimicrobial therapy could be as effective as prolonged-course therapy for uncomplicated P. aeruginosa BSI.

scholarly journals 61. Short- versus prolonged-courses of antimicrobial therapy for patients with uncomplicated Pseudomonas aeruginosa bloodstream infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
Moonsuk Bae ◽  
Yun-Seo Jeong ◽  
Seongman Bae ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infection ◽  
Antimicrobial Therapy ◽  
Propensity Score Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Eligibility Criteria ◽  
Short Course ◽  
Significant Difference ◽  
The Difference

Abstract Background The optimal duration of antimicrobial therapy for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) is unknown. We compared the outcomes of short and prolonged courses of antimicrobial therapy in adults with uncomplicated pseudomonal BSI. Methods All patients with uncomplicated P. aeruginosa BSI admitted at a tertiary-care hospital from May 2016 to September 2020 were included. We compared the rate of recurrent P. aeruginosa infection and 30-day mortality among patients who underwent short (7‒11 days) and prolonged (12‒21 days) courses of antimicrobial therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1,477 patients with uncomplicated P. aeruginosa BSI; of them, 290 met the eligibility criteria, including 97 (33%) who underwent short-course therapy (9 [interquartile range (IQR), 8‒11] days) and 193 (67%) who underwent prolonged-course therapy (15 [IQR, 14‒18] days). We found no significant difference in the risk of recurrence or 30-day mortality between the prolonged-course and short-course groups (n=10, 11% vs. n=32, 16%; IPTW-adjusted hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.30−1.24; p=0.17). The recurrence of P. aeruginosa infection at any site within 180 days of completing therapy occurred significantly more in the prolonged-course group (n=10, 10% vs. n=38, 20%; IPTW-adjusted HR 0.48; 95% CI 0.24−0.96, p=0.04). The resistance acquisition in subsequent P. aeruginosa isolates was more frequent in the prolonged-course group, although the difference was not statistically significant (n=2, 20% vs. n=12, 32%; p=0.70). Conclusion Short-course antimicrobial therapy could be as effective as prolonged-course therapy for uncomplicated P. aeruginosa bloodstream infection. Disclosures All Authors: No reported disclosures

scholarly journals Association of Antimicrobial Susceptibility and Treatment Outcome in Acne Vulgaris Patients: A Pilot Study

2020 ◽  
Vol 12 (04) ◽  
pp. 233-238
Author(s):  
Ashvini K. Yadav ◽  
Suneel Bhooshan ◽  
Allen Johnson ◽  
Dinesh P. Asati ◽  
Shashwati Nema ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Antimicrobial Susceptibility ◽  
Acne Vulgaris ◽  
Tertiary Care ◽  
Care Hospital ◽  
In Vitro Susceptibility ◽  
Persistent Infections ◽  
Significant Difference ◽  
Cutibacterium Acnes

Abstract Purpose Cutibacterium acnes (C. acnes) is an emerging pathogen that is highly resistant to antibiotics and is capable of causing persistent infections that are difficult to treat. Methods & Materials Acne vulgaris patients visiting dermatology OPD of our tertiary care hospital during the study period of 2 months were recruited. Skin swabs were collected, and the sample was processed on 5% sheep-blood agar for anaerobic culture by the GasPak method. Isolates were identified by the standard biochemical test. Antimicrobial susceptibility testing was performed for clinically relevant antibiotics by the E-strip method. The clinical response was evaluated after 1-month follow-up to the prescribed antibiotics. Results Minocycline, doxycycline, ceftriaxone, and tetracycline were the most effective antibiotics. Nonsusceptibility to clindamycin and erythromycin were observed in 11.9% and 31% isolates, respectively, with 9.5% isolates being nonsusceptible to both. For none of the antibiotics we found significant difference in the proportion of susceptible and nonsusceptible isolates between mild, moderate, and severe grades of acne vulgaris. For none of the antibiotic regimens, significant difference was observed between nonresponders and responders. Twenty-seven patients received clindamycin and among them 16 of 19 responders and 6 of 8 nonresponders yielded growth of clindamycin-susceptible isolates (p = 0.57). Conclusion We observed significant prevalence of resistant strains of C. acnes among patients with acne vulgaris. No association was observed between in vitro susceptibility results and treatment outcome.

scholarly journals 522. In Vitro Antimicrobial Activity of Ceftazidime/Avibactam Compared with Ceftolozane/Tazobactam Against Real-world Clinical Isolates of Pseudomonas aeruginosa at a Large Academic Tertiary Care Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S251-S252
Author(s):  
Twisha S Patel ◽  
Keith S Kaye ◽  
Vince Marshall ◽  
Jay Krishnan ◽  
John Mills ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Real World ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Vitro Activity ◽  
Clinical Isolates ◽  
Care Hospital ◽  
In Vitro Activity ◽  
Routine Testing

Abstract Background Ceftazidime/avibactam (CZA) and ceftolozane-tazobactam (CT) are new additions to the antibiotic armamentarium with activity against gram-negative pathogens, most notably drug-resistant Pseudomonas aeruginosa (PSA). The purpose of this study was to compare the in vitro activity of CZA and CT against a large real-world sample of clinical isolates of PSA displaying different phenotypes of resistance to conventional β-lactams at an institution where both CZA and CT are routinely tested on all isolates. Methods All cultures from patient infections with PSA from May 2018 to February 2019 at Michigan Medicine were included. Minimum inhibitory concentrations (MICs) for all β-lactams were determined using TREK broth microdilution panels and isolates were considered susceptible to CZA if the MIC was ≤8 mg/L and CT if the MIC was ≤4 mg/L. Results A total of 2,972 isolates of PSA from clinical specimens were included. Table 1 compares CZA and CT susceptibility, MIC50, MIC90, and MIC range for all isolates including those displaying resistance to various β-lactams. Among all isolates of PSA, CZA (96.2% susceptible) was slightly more active than CT (94.2%) and both agents were ~10% more active than the closest comparator (ceftazidime, 86.6%). In vitro activity of cefepime, piperacillin/tazobactam, and meropenem were 84.8%, 78%, and 80.3%, respectively. The activity of both CZA and CT dropped significantly among isolates with pan-β-lactam resistance (i.e., resistance to all conventional anti-pseudomonal β lactams, PBR) but CZA remained more active than CT (59.4% vs. 41.5%, P < 0.001). Of isolates displaying resistance to CT, 84 (48.6%) were susceptible to CZA. However, of those with resistance to CZA, only 24 (21.2%) were susceptible to CT (Table 2). Conclusion CZA was the most active β-lactam against PSA isolates at Michigan Medicine. Among PSA with PBR, CZA demonstrated superior activity compared with CT. Additionally, a significant number of isolates with resistance to CT were susceptible to CZA. Our findings are unique compared with other published reports where CT has consistently demonstrated greater activity than CZA against resistant P. aeruginosa and suggest routine testing of both CT and CZA should occur. Disclosures All authors: No reported disclosures.

scholarly journals Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Nicole Ng ◽  
Pamela Bailey ◽  
Rachel Pryor ◽  
Lillian Fung ◽  
Christine Veals ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Adverse Drug Events ◽  
Tertiary Care ◽  
Healthcare Spending ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Barriers And Challenges

Abstract Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System’s experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

scholarly journals 1042. Antibiotic Stewardship Program (ASP) Implementation of Short-course Antimicrobials for Low-Risk Enterobacteriaceae Blood Stream Infection (EBSI) at a Tertiary Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S367-S367
Author(s):  
J Alex Viehman ◽  
Gordon Scott ◽  
Eli S Goshorn ◽  
Peter Volpe ◽  
Rachel V Marini ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Low Risk ◽  
Common Source ◽  
Uncomplicated Urinary Tract Infection ◽  
Active Therapy ◽  
Post Intervention ◽  
Short Course ◽  
Significant Difference

Abstract Background Literature demonstrates short course (e.g., 7 days) of antibiotic therapy for EBSI is appropriate in low-risk patients. Real-world experience with the implementation of this approach is not known. Methods In January 2019, a prospective ASP pathway was implemented to review all ESBI. The ASP contacted treatment teams of patients (patients) with low-risk ESBI between day 4–6 of antibiotic therapy to recommend short-course antimicrobial therapy (SC, ≤10 days). Low-risk ESBI was defined as: (1) venous catheter-associated infection (with removal), or an uncomplicated urinary tract infection (UTI), and 2) absence of: organ transplant, polymicrobial or persistent bacteremia ( ≥3d), or lack of improvement at 72h. Controls were pre-intervention patients with low-risk EBSI between July 2016-December 2017. Carbapenem-resistant isolates were excluded; multi-drug-resistant (MDR, ≥3 class acquired resistance) and extended-spectrum β-lactamase (ESBL) bacteria were included. Results Pre-intervention, 107 patients met low-risk ESBI criteria. In the intervention period, 15 patients had low-risk ESBI. The ASP pathway was executed in 13/15 patients (87%) with an 85% success rate. Charlson Comorbidity Index scores and Pitt Bacteremia Scores were similar pre- and post-intervention. The post-intervention group was older (median 71y vs. 63y, P = 0.02). Otherwise, clinical characteristics did not differ pre- and post-intervention: cirrhosis (8 vs. 13%), renal failure (4% vs. 0%), ICU admission (29% vs. 33%) and BSI with ESBL or MDR bacteria (8% vs. 7%) and (21% vs. 20%). UTI was the most common source pre- and post-intervention (61% and 73%) Time to active therapy did not differ (median 0.15d vs. 0.12d). The median duration of active therapy for ESBI was 15d pre-intervention and 8d post-intervention (P < 0.001). SC rate improved from 11% to 67% post-intervention. There was no significant difference in recurrence (2% vs. 0%), mortality (2% vs. 0%) or readmission rates (25% vs. 20%) at 30d. Conclusion A multidisciplinary ASP pathway for low-risk ESBI resulted in the decreased duration of antimicrobial therapy without increased rates of recurrence, readmission, or morality at 30d. SC therapy was also effective for BSI due to MDR or ESBL producing bacteria. Disclosures All authors: No reported disclosures.

Comparative activity of antimicrobials against Pseudomonas aeruginosa, Achromobacter xylosoxidans and Stenotrophomonas maltophilia keratitis isolates

2018 ◽  
Vol 102 (5) ◽  
pp. 708-712 ◽  
Author(s):  
Oriel Spierer ◽  
Darlene Miller ◽  
Terrence P O’Brien
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Stenotrophomonas Maltophilia ◽  
Antimicrobial Agents ◽  
Achromobacter Xylosoxidans ◽  
Eye Drops ◽  
Beta Lactams ◽  
Intrinsic Resistance ◽  
Significant Difference ◽  
Susceptibility Rate

Background/aimsAchromobacter xylosoxidans and Stenotrophomonas maltophilia are emerging corneal pathogens, which are closely related to Pseudomonas aeruginosa, and have intrinsic resistance to many commonly available antimicrobials. The purpose of this study is to compare the in vitro efficacy of 12 antimicrobial agents against A. xylosoxidans, S. maltophilia and P. aeruginosa isolates recovered from clinical cases of keratitis.MethodsRecovered corneal isolates (n=58) were identified and extracted from the Microbiology Data Bank of the Bascom Palmer Eye Institute. Comparative in vitro minimum inhibitory concentration (MIC) susceptibility profiles for fluoroquinolones, aminoglycosides, beta-lactams and miscellaneous antibiotics were recorded using the E-test methodology. Pharmacodynamic indices (Cmax/MIC) were calculated.ResultsA. xylosoxidans and S. maltophilia isolates were resistant to fluoroquinolones, aminoglycosides and ceftazidime (susceptibility rate ranging from 0% to 30%) while P. aeruginosa isolates showed a susceptibility rate of 95%–100% to these antimicrobials (P<0.00001 for the various antimicrobials). Exception was moxifloxacin with 80% of susceptibility rate to S. maltophilia isolates and Cmax/MIC=10.19. Ninety to 100% susceptibility rates were found for minocycline and trimethoprim/sulfamethoxazole for both A. xylosoxidans and S. maltophilia. One hundred per cent of the A. xylosoxidans isolates were susceptible to piperacillin/tazobactam and ticarcillin/clavulanic acid.ConclusionsThere is a significant difference in susceptibility patterns between A. xylosoxidans, S. maltophilia and P. aeruginosa. Fluoroquinolones and aminoglycosides may not be effective against A. xylosoxidans and S. maltophilia. Antibiotics that are not commercially available as eye drops, such as beta-lactams for A. xylosoxidans, and trimethoprim/sulfamethoxazole and minocycline for both A. xylosoxidans and S. maltophilia should be considered.

scholarly journals Comparative study among clinical and commensal isolates of Enterococcus faecalis for presence of esp gene and biofilm production

2010 ◽  
Vol 5 (05) ◽  
pp. 365-369 ◽  
Author(s):  
Giridhara PM Upadhyaya ◽  
Umapathy B Lingadevaru ◽  
Ravikumar K Lingegowda
Keyword(s):  
Nosocomial Infection ◽  
Enterococcus Faecalis ◽  
Biofilm Formation ◽  
Tertiary Care ◽  
Care Hospital ◽  
Biofilm Production ◽  
Significant Difference ◽  
High Production ◽  
Stool Specimens

Introduction: Because of increasing difficulty in treating enterococcal infections, effort is being devoted to understanding factors that are responsible for causing nosocomial infection, with a focus toward targeting these factors with new therapeutics. Evidence has emerged that the esp gene mediates biofilm formation in vitro, which helps the organism colonize and cause infection. Methodology: This study was conducted over a four-year period in a tertiary-care hospital. There were 200 clinical pathogenic strains isolated from nosocomial infections and 100 commensals from stool specimens of healthy individuals. The study compared the production of biofilm and detection of the esp gene among clinical and commensal isolates. Results: Among 200 clinical isolates of Enterococcus faecalis 65 (32.5%) isolates were positive for biofilm production and 60 (30%) for the esp gene by PCR. Among 100 commensal isolates, 16     (8%) and 14 (7%) were positive for biofilm formation and the esp gene, respectively. Five clinical and two commensal isolates produced biofilm without any amplification of the esp gene. Conclusion: The study shows a significant difference in production of biofilm and presence of the esp gene between clinical and commensal isolates (P < 0.002). Therefore, it can be concluded that biofilm production has an important role in causing nosocomial infection. Although detection of the esp gene correlates with biofilm production, it may not be the only factor determining the formation of biofilm since few isolates produced biofilm without the esp gene. Strains isolated from indwelling medical devices showed high production of biofilm and esp gene.

scholarly journals Biofilm production and its correlation with antibiotic resistance pattern among clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital in north-east India

2018 ◽  
Vol 5 (4) ◽  
pp. 964 ◽  
Author(s):  
Swarnatrisha Saha ◽  
Ksh Mamta Devi ◽  
Shan Damrolien ◽  
Kh. Sulochana Devi ◽  
Krossnunpuii . ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antibiotic Susceptibility ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Resistance Pattern ◽  
Care Hospital ◽  
North East ◽  
Biofilm Production ◽  
Antibiotic Susceptibility Test

Background: Pseudomonas aeruginosa is an ubiquitous pathogen capable of surviving in a variety of environmental conditions. It is increasingly gaining importance as a multidrug resistant nosocomial pathogen. Biofilm acts as a barrier, reducing the penetration of these drugs and consequently, preventing them from exercising their actions. The aim of this study is to isolate and identify Pseudomonas aeruginosa from various clinical specimen and to find out their production of biofilms and their correlation with antibiotic susceptibility pattern.Methods: All Pseudomonas aeruginosa over a period of 1 year were isolated and identified from clinical specimens and antibiotic susceptibility test was done following standard operative procedures. Biofilm detection was done by Congo Red Agar method (CRA).Results: 134 isolates of Pseudomonas aeruginosa was isolated. Maximum isolates were isolated from sputum samples 55 (41%) and most were from wards 68 (51%) giving a probability of increased healthcare associated infections. Biofilm production by the isolates was seen in 39 (29%). All the biofilm producing isolates shows more resistant pattern in comparison to non-biofilm producers. 69% of Imipenem and 82% of Meropenem resistant isolates produce biofilm. All the P. aeruginosa including MDR and biofilm forming strains were sensitive to Colistin.Conclusions: Resistance to antimicrobial agents is the most important feature of biofilm infections. Ability of P. aeruginosa to form biofilms renders antibiotic treatments inefficient and therefore promotes chronic infectious diseases.  As a result, infections caused by bacterial biofilms are persistent and very difficult to eradicate.

scholarly journals Therapeutic guidelines for antimicrobial use in chronic suppurative otitis media for a tertiary care hospital in Sub Himalayan region

2018 ◽  
Vol 7 (3) ◽  
pp. 416
Author(s):  
Sushma Sawaraj ◽  
Sunder Singh Dogra ◽  
Dinesh Kansal ◽  
Kamlesh Thakur ◽  
Parveen Kumar Sharma
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Otitis Media ◽  
Antimicrobial Therapy ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Chronic Suppurative Otitis Media ◽  
Care Hospital ◽  
Suppurative Otitis Media ◽  
Sensitivity Pattern

Background: The battle against micro-organisms, in their role as primary cause of the disease and infective complications of medical and surgical techniques, has not decreased in spite of modern antimicrobial therapy. Chronic suppurative otitis media (CSOM) is a disease with worldwide prevalence having potentially serious long term effects. The disease remains an important global public health problem leading to hearing impairment, and due to wide spread irrational use microbial resistance is very common to these antibiotics, thereby leading to treatment failure. Hence it is important to know the type of bacteria and their sensitivity pattern so that appropriate antibiotics may be given for treatment and prevention of complications.Methods: 428 patients of otitis media were enrolled from ENT OPD of Tertiary Care Hospital. Ear swab was taken from diagnosed cases of CSOM and culture and sensitivity were done.Results: The microbiology of the swab showed no growth in (25.4%) of samples. Staphylococcus aureus (26%) and Pseudomonas (25%) were the main organisms isolated. Staphylococcus aureus isolated was sensitive to vancomycin, clindamycin, cefixime, gentamicin and cefipime in descending order. Pseudomonas aeruginosa was sensitive to ceftazidime, imipenem, piperacillin, gentamicin, cefipime. In the present study Staph. aureus and Pseudomonas were the predominant bacteria, it is suggested to undertake a gram staining in all patients. If gram positive organisms are isolated it is suggested that presumptive treatment should be directed against Staphylococcus aureus and if gram negative then against Pseudomonas aeruginosa. Such a treatment is not only likely to be effective but will also go a long way in preventing emergence of drug resistance.Conclusions: The antimicrobial therapy should be based on locally determined microbiological isolates and local sensitivity patterns to a particular antimicrobial agent. The presumptive antimicrobial therapy should therefore be directed against these organisms.

scholarly journals Comparison of Epidemiological and Antibiotic Susceptibility Pattern of Metallo-Beta-Lactamase-Positive and Metallo-Beta-Lactamase-Negative Strains of Pseudomonas Aeruginosa

2014 ◽  
Vol 6 (02) ◽  
pp. 109-113 ◽  
Author(s):  
Shikha Ranjan ◽  
Banashankari GS ◽  
PR Sreenivasa Babu
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Total Sample ◽  
Multidrug Resistant ◽  
Adverse Outcomes ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Beta Lactamase

ABSTRACT Background: The infections caused by metallo-beta-lactamases (MBLs) producing Pseudomonas aeruginosa are associated with higher rates of mortality, morbidity, and overall healthcare costs compared to non-MBL P. aeruginosa infections. Purpose: To compare the epidemiologic factors and antibiograms of MBL-positive and MBL-negative P. aeruginosa isolates in a tertiary care hospital. Methods: In an observational study, from January 2011 to December 2012, all non-duplicate P. aeruginosa isolates were subjected to an antimicrobial sensitivity test against 10 antibiotics of five different classes. All P. aeruginosa strains showing resistance to at least one of the carbapenems were subjected to the MBL-E test. Epidemiological features and antibiograms of MBL-positive and MBL-negative strains were compared and statistically analyzed. Results: Out of 350 isolates (total sample = 5330) of P. aeruginosa, MBL was detected in 58 isolates by the E-test, resulting in a prevalence of 16.57%. Resistance to most of the antibiotics was significantly higher in the MBL-positive strains with 100% resistance to ciprofloxacin, tobramycin, and meropenem, followed by imipenem (93.10%) and gentamicin (89.66%). The prevalence of multidrug-resistant and pandrug-resistant strains was significantly higher among the MBL group as compared to that in the non-MBL group ((55.17 vs. 7.88% (P < 0.0001) and 8.62 vs. 0.68% (P = 0.0006)), respectively. Conclusions: MBL-positive P. aeruginosa strains showed very high resistance to various antibiotics, as compared to the non-MBL strains. Increasing prevalence of MBL-producing isolates in hospital settings makes it important to perform routine detection of MBL-positive P. aeruginosa strains by in vitro testing before antibiotic use, for the purposes of infection prevention, and control, and for minimizing the adverse outcomes of infections with MBL-producing strains.

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