Risk factors for imipenem-resistant Pseudomonas aeruginosa: a comparative analysis of two case-control studies in hospitalized patients.
Risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa by hospitalized patients were assessed at a tertiary care hospital. Two case-control studies with different control groups were used. In Study 1, patients with imipenem-resistant P. aeruginosa (IRPA) (case group) were compared with patients selected at random from the same unit. In Study 2, the case group was compared with patients with imipenem-susceptible P. aeruginosa (ISPA). Ninety-three patients with IRPA and 93 control patients were included in Study 1, and 93 IRPA patients and 65 patients with ISPA were included in Study 2. Carbapenem treatment [odds ratio (OR) 5.82], mechanical ventilation (OR 3.22) and hospital admission in the previous year (OR 2.59) were associated with IRPA in Study 1. An interaction between carbapenem and vancomycin was found to be a significant risk factor for IRPA (OR for carbapenem in patients with vancomycin use 43.71). In Study 2, carbapenem exposure (OR 12.82) and renal failure (OR 5.00) were associated with IRPA. Our study confirmed that carbapenem exposure is the main risk factor for IRPA, and found that the use of both carbapenem and vancomycin can increase this effect.
Zavascki
A P
AP
Infectious Diseases Unit, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. apzavascki@terra.com.br
Cruz
R P
RP
Goldani
L Z
LZ
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D015378:Imipenem