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Meropenem as predictive risk factor for isolation of multidrug-resistant Pseudomonas aeruginosa

https://doi.org/10.1016/j.jhin.2012.10.005Get rights and content

Summary

The objective of this study was to explore independent risk factors for the isolation of multidrug-resistant (MDR) Pseudomonas aeruginosa in a Japanese university hospital between January 1997 and December 2010. MDR P. aeruginosa was defined when the organism was resistant or intermediately susceptible to all five antimicrobials tested. In all, 159 patients with MDR P. aeruginosa were identified over the 14-year period. Multivariate logistic regression analysis revealed that prolonged hospital stay, prior exposure to meropenem and fluoroquinolones, and patients suffering from diabetes mellitus or receiving surgery were predictive risk factors for the isolation of MDR P. aeruginosa.

Introduction

Infections caused by resistant strains of Pseudomonas aeruginosa are associated with a higher rate of mortality, an increase in the length of hospital stay, and a considerable increase in healthcare costs.1 The interplay of various resistance mechanisms results in antimicrobial resistance being simultaneously identified, thereby conferring multidrug-resistant (MDR) phenotypes.2 Among the risk factors for nosocomial MDR P. aeruginosa, previous antimicrobial chemotherapy may be a key element in promoting the emergence and spread of MDR P. aeruginosa. In this study, we aimed to determine independent risk factors for the isolation of MDR P. aeruginosa in hospitalized patients over a 14-year study period.

Section snippets

Methods

This study was retrospectively conducted between January 1997 and December 2010 at Juntendo University Hospital, Tokyo, Japan, a 1020-bed tertiary-care teaching hospital. We reviewed annual microbiological data of all clinical isolates obtained from inpatients, except for faeces and nasal swabs. Antimicrobial consumption of products for intravenous injection was calculated in terms of the number of defined daily doses per 100 bed-days. When P. aeruginosa isolates with different susceptibility

Results

A total of 36,732 bacterial isolates were detected from hospitalized patients over the 14-year period; of these, 6287 (17%) were P. aeruginosa. Susceptibility testing showed that 32 different phenotypes of P. aeruginosa were identified. Of these, the phenotype resistant to all five antimicrobials (MDR phenotype) was identified in 192 isolates (3%). A total of 183 patients with MDR P. aeruginosa were identified between 1997 and 2010. Longitudinal observation showed that the number of patients

Discussion

The increasing rate of antimicrobial resistance among P. aeruginosa is a worldwide problem, including Japan.2, 5 In this study, 159 patients with MDR P. aeruginosa were identified over the 14-year period. This rate was consistent with that of nationwide surveillance in Japan.5 Multiple stepwise regression analysis showed a positive correlation between the incidence of patients with MDR P. aeruginosa and antimicrobial consumption of total carbapenems and MEPM. Multivariate logistic regression

Conflict of interest statement

None declared.

Funding source

None.

References (10)

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