[A control study on bacterial resistance and clinical features of lower respiratory tract infection with Pseudomonas aeruginosa in medical intensive care unit and general ward].
OBJECTIVE
To compare the bacterial resistance and clinical features of lower respiratory tact infection with Pseudomonas aeruginosa (PA) in medical intensive care units (MICU) and general wards (GW) and to analyze the predisposing factors to PA infection.


METHODS
Three hundred and twenty three patients with lower respiratory tract PA infection, aged from 30 to 91 years, admitted into Shanghai Zhongshan hospital from May 1997 to December 2001 (163 in MICU and 160 in GW) were included in this retrospective study. The predisposing factors, underlying diseases, clinical presentations, laboratory data, treatment and outcome of these patients were analyzed. On the other hand, the susceptibility patterns to antibiotics of 1 387 PA strains (879 from MICU and 508 from GW) from the recorders of the bacteria culture chamber were investigated.


RESULTS
The underlying diseases of the patients mainly were chronic obstructive pulmonary disease (23.3% of patients in MICU and 12.5% in GW) and malignant tumor (14.7% in MICU and 14.4% in GW). A relatively high resistant rates of PA strains to common antibiotics were found in both groups: cefoperazone/sulbactam 1.0% (MICU: 1.0%, GW: 1.1%), piperacillin/tazobactam 2.5% (MICU: 1.0%, GW: 5.0%), amikacin 6.1% (MICU: 7.0%, GW: 4.5%), ceftazidime 9.2% (MICU: 11.6%, GW: 2.7%), cefepime 11.3% (MICU: 12.2%, GW: 10.8%), imipenem 13.5% (MICU: 6.8%, GW: 25.2%), piperacillin 13.8% (MICU: 17.8%, GW: 6.9%), cefoperazone 16.4% (MICU: 22.1%, GW: 6.6%), ticarcillin/clavulanic acid 17.2% (MICU: 21.2%, GW: 17.3%), cidomycin 18.5% (MICU: 20.5%, GW: 14.9%), ciprofloxacin 20.2% (MICU: 27.2%, GW: 8.1%), ceftriaxone 44.4% (MICU: 53.6%, GW: 28.4%). Most of the resistant rates of strains from MICU were higher than those from GW. The susceptibilities of PA to ceftazidime and piperacillin changed little during the past 5 years and were above 80.00%. Since 1988, especially from 2000, the susceptibility of PA to most antibiotics became remarkably lower. With selected antibiotic treatment of the infections 196 patients were cured, 79 patients died in hospital. The mortality of patients in GW (16.25%, 26/160) was lower than that in MICU (32.52%, 53/163).


CONCLUSIONS
Precautions to PA infection is important in patients with predisposing factors. Patients with Lower respiratory tract PA infection in MICU had different clinical features, laboratory data and outcome compared to GW patients. The PA isolated from MICU patients had a higher resistant rate to many antibiotics than that from GW patients. It is important to perform antibiotic sensitivity test timely to help correct selection of drugs, especially for MICU patients.
Shao
Changzhou
C
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Qu
Jieming
J
He
Lixian
L
Ni
Caimei
C
Hu
Bijie
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology* / Q000503:physiopathology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012141:Respiratory Tract Infections / Q000382:microbiology* / Q000503:physiopathology; D012307:Risk Factors
D000900:Anti-Bacterial Agents