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Borgatta B, Lagunes L, Imbiscuso AT, Larrosa MN, Lujàn M, Rello J. Infections in intensive care unit adult patients harboring multidrug-resistant Pseudomonas aeruginosa: implications for prevention and therapy. Eur J Clin Microbiol Infect Dis 2017; 36:1097-1104. [PMID: 28093651 DOI: 10.1007/s10096-016-2894-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/27/2016] [Indexed: 01/31/2023]
Abstract
The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC50 to meropenem was 16 μg/mL and the MIC90 was >32 μg/mL, with 60.4% of respiratory samples being MIC >32 μg/mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.
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Affiliation(s)
- B Borgatta
- Critical Care Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron, 119-129, 08035, Barcelona, Spain. .,CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - L Lagunes
- CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - A T Imbiscuso
- Anesthesiology Department, Institut Hypnos, Hospital General de Catalunya, Barcelona, Spain
| | - M N Larrosa
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Lujàn
- Respiratory Medicine Department, Fundació Sanitària Parc Taulí, Sabadell, Spain
| | - J Rello
- CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERES, Madrid, Spain
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