Abstract
BackgroundThe incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.MethodsWe retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014.ResultsOf the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08).ConclusionThe prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.
Highlights
Pseudomonas aeruginosa (PA) has become an important cause of healthcare-associated infections (HAIs) [1, 2]
Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock, admission to a medical department, receiving a central venous catheter, and XDR-PA infection
A previous Thai study which focused on patients in a surgical intensive care unit identified that the prevalence of ventilatorassociated pneumonia (VAP) caused by XDR-PA was only 1.7% [24]
Summary
Pseudomonas aeruginosa (PA) has become an important cause of healthcare-associated infections (HAIs) [1, 2]. Recent data from the National Antimicrobial Resistance Surveillance, Thailand (NARST), revealed an increasing trend of carbapenem-resistant P. aeruginosa (CRPA), from approximately 15% of infections in 2000–2005 to 30% in 2009–2013 [4, 5]. Previous studies of the prevalence and risk factors for XDR-PA infections or acquisition focused only on specific populations, such as patients with cancer [12], hematologic malignancies [13], solid organ transplant recipients [14] or patients with XDR-PA bacteremia [15,16,17]. This study aimed to determine the prevalence and factors associated with XDR-PA infections and their outcomes in general healthcare settings. The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality
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