title: Prolonged use of carbapenems and colistin predisposes to ventilator-associated pneumonia by pandrug-resistant Pseudomonas aeruginosa.
abstract: OBJECTIVE
  We present our experience with five cases of pandrug-resistant Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) and analysis of risk factors.
  
  
  METHODS
  Case-control study in a 15-bed intensive care unit (ICU).
  
  
  METHODS
  The study included 5 cases and 20 controls. Each case patient was matched to four contemporary controls according to gender, prior hospital admissions, hospitalization duration, ICU admission cause, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Function Assessment (SOFA) scores on ICU admission, and length of ICU stay, and mechanical ventilation duration until first VAP episode by a multidrug-resistant bacterium.
  
  
  RESULTS
  Recorded variables included age, gender, daily APACHE II and SOFA scores, patient medication, treatment interventions, positive cultures and corresponding antibiograms, occurrence of infection, sepsis, and septic shock, other ICU-associated morbidity, length of ICU stay and mechanical ventilation, and patient outcome. Healthcare worker and environmental cultures, and a hand-disinfection survey were performed. Pandrug-resistant P. aeruginosa isolates belonged to the same genotype and were bla (VIM-1)-like gene positive. The outbreak resolved following reinforcement of infection-control measures (September 27). The sole independent predictor for pandrug-resistant P. aeruginosa VAP was combined use of carbapenem for more than 20 days and colistin use for and more than 13 days (odds ratio 76.0; 95% confidence interval 3.7-1487.6). An additional risk factor was more than 78 open suctioning procedures during 6-26 September (odds ratio 16.0; 95% confidence interval 1.4-185.4).
  
  
  CONCLUSIONS
  Prolonged carbapenem-colistin use predisposes to VAP by pandrug-resistant P. aeruginosa. Cross-transmission may be facilitated by open suctioning.
authors.affiliation: University of Athens Medical School, First Department of Critical Care, 45-47 Ipsilandou Street, GR-10675 Athens, Greece. sdm@hol.gr
authors.forename: Spyros D
authors.initials: SD
authors.lastname: Mentzelopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Pratikaki
authors.forename: Evangelia
authors.initials: E
authors.lastname: Platsouka
authors.forename: Helen
authors.initials: H
authors.lastname: Kraniotaki
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zervakis
authors.forename: Antonia
authors.initials: A
authors.lastname: Koutsoukou
authors.forename: Serafim
authors.initials: S
authors.lastname: Nanas
authors.forename: Olga
authors.initials: O
authors.lastname: Paniara
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giamarellos-Bourboulis
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Spyros G
authors.initials: SG
authors.lastname: Zakynthinos
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015780:Carbapenems / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects*; D003428:Cross Infection / Q000382:microbiology; D004196:Disease Outbreaks; D004198:Disease Susceptibility; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012307:Risk Factors; D013396:Suction / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D003091:Colistin