title: Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units.
abstract: BACKGROUND
  The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa.
  
  
  METHODS
  Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-β-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction.
  
  
  RESULTS
  Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity.
  
  
  CONCLUSIONS
  This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.
authors.affiliation: Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brasil.
authors.forename: Eliseth Costa Oliveira de
authors.initials: EC
authors.lastname: Matos
authors.affiliation: Seção de Bacteriologia e Micologia, Instituto Evandro Chagas, Ministério da Saúde, Ananindeua, Pará, Brasil.
authors.forename: Haroldo José de
authors.initials: HJ
authors.lastname: Matos
authors.affiliation: Programa de Pós-Graduação em Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém, Pará, Brasil.
authors.forename: Marília Lima
authors.initials: ML
authors.lastname: Conceição
authors.affiliation: Programa de Pós-Graduação em Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém, Pará, Brasil.
authors.forename: Yan Corrêa
authors.initials: YC
authors.lastname: Rodrigues
authors.affiliation: Centro de Ciências Biológicas e Saúde, Universidade do Estado do Pará, Belém, Pará, Brasil.
authors.forename: Irna Carla do Rosário Souza
authors.initials: IC
authors.lastname: Carneiro
authors.affiliation: Seção de Bacteriologia e Micologia, Instituto Evandro Chagas, Ministério da Saúde, Ananindeua, Pará, Brasil.|Programa de Pós-Graduação em Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém, Pará, Brasil.
authors.forename: Karla Valéria Batista
authors.initials: KV
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology*; D018432:Drug Resistance, Multiple; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D012189:Retrospective Studies; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases