title: Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center.
abstract: This research report assessed the differences in resistance rates and antimicrobial usage-versus-susceptibility relationships ofPseudomonas aeruginosafound in various hospital patient care areas. A simplified case control study was also performed to identify patient-specific risk factors associated with cefepime-resistantP. aeruginosaisolates. Last, we determined the consequence of combining mucoid and non-mucoid derived antimicrobial susceptibilities ofP.aeruginosainto hospital antibiograms. Overall, susceptibility rates remained lower in the intensive care units (ICUs) compared to the non-ICU patient care areas, except for cefepime over the last time period. Cefepime utilization and antimicrobial-resistance rates amongP. aeruginosaisolates had a significant relationship. Decreased meropenem exposure was associated with lower resistance rates relative to cefepime. Risk factors independently associated with cefepime-resistantP. aeruginosawere structural lung disease, ICU admission, recent third generation cephalosporin use, frequent hospital admission and non-urine isolates. Large and statistically significant differences were observed between non-mucoid and combined percent susceptibility data for aminoglycosides. To control antimicrobial resistance and optimize initial empiric antimicrobial therapy, antimicrobial susceptibility and utilization patterns in specific patient care areas should be monitored and risk factors for antimicrobial resistance should be assessed. Mucoid strains ofP. aeruginosashould not be included into antimicrobial susceptibility data as this may underestimate activity of most antipseudomonal agents.
authors.affiliation: Clinical Pharmacy, San Francisco School of Pharmacy, University of California, 521 Parnassus Avenue UCSF Box 0622, Room C-152 San Francisco, CA 94143, USA. heintzb@pharmacy.ucsf.edu.|Department of Pharmaceutical Services, University of California Davis Health System, Sacramento, CA 95817, USA. heintzb@pharmacy.ucsf.edu.
authors.forename: Brett H
authors.initials: BH
authors.lastname: Heintz
authors.affiliation: Department of Pharmaceutical Services, University of California Davis Health System, Sacramento, CA 95817, USA. jhalilovic@pacific.edu.|Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, 3601 Pacific Avenue, Stockton, CA 95211, USA. jhalilovic@pacific.edu.
authors.forename: Jenana
authors.initials: J
authors.lastname: Halilovic
keywords: Pseudomonas aeruginosa; antibiogram; antibiotics; antimicrobial stewardship; antimicrobials; bacterial resistance; cefepime