title: Infections in intensive care unit adult patients harboring multidrug-resistant Pseudomonas aeruginosa: implications for prevention and therapy.
abstract: The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC50to meropenem was 16 μg/mL and the MIC90was >32 μg/mL, with 60.4% of respiratory samples being MIC >32 μg/mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron, 119-129, 08035, Barcelona, Spain. bborgattab@gmail.com.|CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain. bborgattab@gmail.com.|Universitat Autònoma de Barcelona, Barcelona, Spain. bborgattab@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Borgatta
authors.affiliation: CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Anesthesiology Department, Institut Hypnos, Hospital General de Catalunya, Barcelona, Spain.
authors.forename: A T
authors.initials: AT
authors.lastname: Imbiscuso
authors.affiliation: Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: M N
authors.initials: MN
authors.lastname: Larrosa
authors.affiliation: Respiratory Medicine Department, Fundació Sanitària Parc Taulí, Sabadell, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lujàn
authors.affiliation: CRIPS, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERES, Madrid, Spain.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-0676-6210
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents