Abstract
IntroductionThe purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa.MethodsAn open, prospective cohort study was carried out in a 16-bed medical ICU where P. aeruginosa was endemic. Over a six-month period, all patients without P. aeruginosa on admission and with a length of stay >72 h were included. Throat, nasal, rectal, sputum and urine samples were taken on admission and at weekly intervals and screened for P. aeruginosa. All antibiotic treatments were recorded daily. Environmental analysis included weekly tap water specimen culture and the presence of other patients colonized with P. aeruginosa.ResultsA total of 126 patients were included, comprising 1,345 patient-days. Antibiotics were given to 106 patients (antibiotic selective pressure for P. aeruginosa in 39). P. aeruginosa was acquired by 20 patients (16%) and was isolated from 164/536 environmental samples (31%). Two conditions were independently associated with P. aeruginosa acquisition by multivariate analysis: (i) patients receiving ≥3 days of antibiotic selective pressure together with at least one colonized patient on the same ward on the previous day (odds ratio (OR) = 10.3 ((% confidence interval (CI): 1.8 to 57.4); P = 0.01); and (ii) presence of an invasive device (OR = 7.7 (95% CI: 2.3 to 25.7); P = 0.001).ConclusionsSpecific interaction between both patient colonization pressure and selective antibiotic pressure is the most relevant factor for P. aeruginosa acquisition on an ICU. This suggests that combined efforts are needed against both factors to decrease colonization with P. aeruginosa.
Highlights
The purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa
The hypothesis of a complex mechanism involving antibiotic selective pressure and patient colonization pressure should be relevant for P. aeruginosa acquisition in an ICU with endemic context
In conclusion, this study adds further support for an interaction between the patient colonization pressure and antibiotic selective pressure in the process of P. aeruginosa acquisition in the ICU. These results should be confirmed in a larger study in order to generalize their potential implications
Summary
The purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa. Pseudomonas aeruginosa infections on the ICU are a constant concern [1] Colonization with this organism often precedes infection [2] and its prevention is, extremely important. Acquisition of a strain not isolated from the environment does not necessarily mean that it is part of the patient’s flora (the classical endogenous definition [17,18]). It could have been acquired through previous healthcare procedures from undiscovered environmental sources (misdiagnosed exogenous acquisition). The role of antibiotic selective pressure on P. aeruginosa colonization is an important issue
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