J Korean Med Sci.  2008 Dec;23(6):982-987. 10.3346/jkms.2008.23.6.982.

Imipenem-Resistant Pseudomonas aeruginosa : Risk Factors for Nosocomial Infections

• Onguru P
• Erbay A
• Bodur H
• Baran G
• Akinci E
• Balaban N
• Cevik MA

• KMID: 1107521
• DOI: http://doi.org/10.3346/jkms.2008.23.6.982

Abstract

The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p= 0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p= 0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252- 10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration.

Keyword

Pseudomonas; Cross Infection; Risk Factors; Imipenem Resistance

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/*pharmacology/therapeutic use
Case-Control Studies
Cross Infection/drug therapy/epidemiology/*microbiology
Drug Resistance, Multiple, Bacterial
Female
Humans
Imipenem/*pharmacology/therapeutic use
Length of Stay
Male
Microbial Sensitivity Tests
Middle Aged
Multivariate Analysis
Penicillanic Acid/analogs & derivatives/pharmacology/therapeutic use
Piperacillin/pharmacology/therapeutic use
Prospective Studies
Pseudomonas Infections/drug therapy/epidemiology/*microbiology
Pseudomonas aeruginosa/drug effects/*isolation & purification
Risk Factors
Vancomycin/pharmacology/therapeutic use