title: Cefepime-resistant Pseudomonas aeruginosa.
abstract: Resistance to extended-spectrum cephalosporins complicates treatment of Pseudomonas aeruginosa infections. To elucidate risk factors for cefepime-resistant P. aeruginosa and determine its association with patient death, we conducted a case-control study in Philadelphia, Pennsylvania. Among 2,529 patients hospitalized during 2001-2006, a total of 213 (8.4%) had cefepime-resistant P. aeruginosa infection. Independent risk factors were prior use of an extended-spectrum cephalosphorin (p<0.001), prior use of an extended-spectrum penicillin (p = 0.005), prior use of a quinolone (p<0.001), and transfer from an outside facility (p = 0.01). Among those hospitalized at least 30 days, mortality rates were higher for those with cefepime-resistant than with cefepime-susceptible P. aeruginosa infection (20.2% vs. 13.2%, p = 0.007). Cefepime-resistant P. aeruginosa was an independent risk factor for death only for patients for whom it could be isolated from blood (p = 0.001). Strategies to counter its emergence should focus on optimizing use of antipseudomonal drugs.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Ehimare
authors.initials: E
authors.lastname: Akhabue
authors.forename: Marie
authors.initials: M
authors.lastname: Synnestvedt
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime