Endemic multidrug-resistant Pseudomonas aeruginosa in critically ill patients.
OBJECTIVE
To describe the epidemiology of endemic multidrug-resistant Pseudomonas aeruginosa colonizations and infections in critically ill patients.


METHODS
Prospective study on bacterial strain typing and retrospective cohort study of charts of patients in the intensive care unit (ICU).


METHODS
Fifty-three patients with P. aeruginosa isolated from clinical cultures in 2001 were selected, divided into those with P. aeruginosa in vitro resistant to at least two classes of antibiotics (multidrug-resistant, n = 18) and those susceptible to all or resistant to only one antibiotic (susceptible, n = 35).


RESULTS
Risk factors for multidrug-resistant P. aeruginosa included maxillary sinusitis, long-dwelling central venous catheters, prolonged use of certain antibiotics, a high lung injury score, and prolonged mechanical ventilation and duration of stay. The frequency of colonization (approximately 50%) versus infection (ie, ventilator-associated pneumonia) did not differ between the groups. On amplified fragment-length polymorphism analysis, 64% of the multidrug-resistant strains had been potentially transmitted via cross-colonization and 36% had probably originated endogenously. ICU mortality was 22% in the multidrug-resistant group and 23% in the susceptible group, although the duration of mechanical ventilation was longer in the former.


CONCLUSIONS
Patients with sinusitis who stayed in the ICU longer, were ventilated longer because of acute lung injury, received antibiotics for longer durations, and had long-dwelling central venous catheters ran an elevated risk of acquiring multidrug-resistant P. aeruginosa. These patients did not have a higher mortality than patients with susceptible P. aeruginosa. Prevention of the emergence of multidrug-resistant strains requires changes in infection control measures and antibiotic policies in our ICU.
Ortega
Bryan
B
Intensive Care Unit, Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, The Netherlands.
Groeneveld
A B Johan
AB
Schultsz
Constance
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D015373:Bacterial Typing Techniques; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015331:Cohort Studies; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000635:transmission; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications
D000900:Anti-Bacterial Agents