Abstract
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. 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. 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. 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.
Highlights
The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units
The data from this study are the first from Northern Brazil that describe the clinical, epidemiologic, and molecular characteristics of infections caused by MBL-producing P. aeruginosa that was harboring the blaSPM-1-like gene, a variant that is widespread among Brazilian hospitals
An analysis of the distribution of the hospital-acquired infection (HAI) and the infection sites determined a higher prevalence of lower respiratory tract infections (RTI) that were associated with pulmonary diseases within the adult population, which highlights mechanical ventilation as a risk factor
Summary
The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. 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. The impact of P. aeruginosa resistance on health systems is a major concern in hospitals in Brazil and worldwide, and it is mainly caused by strains that produce metallo-β-lactamases (MBLs). This resistance mechanism has spread across hospitals because of the frequent use of carbapenems, which were. The widespread dissemination of MBL-producing multidrug-resistant strains across Brazilian hospitals highlights the need for national data, from northern Brazil where investigations into the patients’ clinical characteristics and the microbiological features of the infections remain scarce. We aimed to analyze the clinical, epidemiologic, and molecular characteristics of P. aeruginosa infections in patients who were hospitalized in intensive care units (ICUs) in a teaching hospital in Belém, Pará, Brazil
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