title: Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions.
abstract: BACKGROUND
  Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting.
  
  
  OBJECTIVE
  Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates.
  
  
  RESULTS
  Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n = 10) or HTLV-1 infections (n = 5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical.
  
  
  CONCLUSIONS
  Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.
authors.affiliation: Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, RJ, Brazil. marisargomes@ioc.fiocruz.br
authors.forename: Marisa Zenaide Ribeiro
authors.initials: MZ
authors.lastname: Gomes
authors.forename: Carolina Romero
authors.initials: CR
authors.lastname: Machado
authors.forename: Magda de Souza
authors.initials: Mde S
authors.lastname: da Conceição
authors.forename: Jois Alves
authors.initials: JA
authors.lastname: Ortega
authors.forename: Sonia Maria Ferraz M
authors.initials: SM
authors.lastname: Neves
authors.forename: Maria Cristina da Silva
authors.initials: MC
authors.lastname: Lourenço
authors.forename: Marise Dutra
authors.initials: MD
authors.lastname: Asensi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology* / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology* / Q000401:mortality; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D011552:Pseudomonas Infections / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents