Abstract
Background:Carbapenems, fluoroquinolones (FQs), and aminoglycosides (AGs) are key drugs for treating Pseudomonas aeruginosa infections, and accumulation of drug resistances make antibiotic therapy difficult.Methods:We evaluated 169 patients with imipenem (IPM)-resistant P. aeruginosa and compared patient background and microbiological characteristics between groups with or without FQ resistance. Similar analyses were performed for AG.Results:Of the 169 IPM-resistant strains, 39.1% showed resistance to FQs and 7.1% to AGs. The frequency of exposure to FQs within 90 days previously was higher in the group with FQ resistance (45.5%) than in the group without FQ resistance (13.6%). Similarly, 33.3% of patients in the group with AG resistance had been previously administered AGs, higher than the 7.6% of patients without AG resistance. Frequencies of metallo-β-lactamase (MBL) production were higher in the group with FQ or AG resistance (16.7% or 33.3%) than in the group without FQ or AG resistance (2.9% or 6.4%). Multivariate analyses showed exposures to FQs or AGs were related to the respective resistances. MBL production was a common factor for resistance to FQs or AGs, in addition to IPM-resistant P. aeruginosa.Conclusion: As well as promoting appropriate use of antibiotics, MBL production should be detected as a target of intervention for infection control.
Highlights
Pseudomonas aeruginosa is an important pathogen for nosocomial infections
Frequencies of metallo-β-lactamase (MBL) production were higher in the group with FQ or AG resistance (16.7% or 33.3%) than in the group without FQ or AG resistance (2.9% or 6.4%)
As well as promoting appropriate use of antibiotics, MBL production should be detected as a target of intervention for infection control
Summary
Pseudomonas aeruginosa is an important pathogen for nosocomial infections. P. aeruginosa displays 1874-2858/17 2017 Bentham OpenRisk Factors for Acquisition of FluoroquinoloneThe Open Microbiology Journal, 2017, Volume 11 93 intrinsic resistance, and the ability to acquire resistance during antibiotic therapy [1]. Pseudomonas aeruginosa is an important pathogen for nosocomial infections. The acquisition of drug-resistant pathogens by an individual patient involves numerous factors, such as microbial selection by antibiotic pressures and in-hospital transmission from other patients or medical environments. Carbapenems, fluoroquinolones (FQs), and aminoglycosides (AGs) are key drugs for treating P. aeruginosa infections, and accumulation of drug resistances make antibiotic therapy difficult. The Japan Nosocomial Infections Surveillance (JANIS), a program of the Ministry of Health Labour and Welfare, reported in 2013 that 78.3% and 84.0% of P. aeruginosa strains were susceptible to imipenem (IPM) and meropenem, 84.0% and 94.8% to gentamicin and amikacin, and 78.6% to levofloxacin, respectively [2] These susceptibility rates have been gradually improving in recent years in Japan, but drug-resistant P. aeruginosa remains an important issue from the perspective of patient outcomes and infection control [3, 4]. Carbapenems, fluoroquinolones (FQs), and aminoglycosides (AGs) are key drugs for treating Pseudomonas aeruginosa infections, and accumulation of drug resistances make antibiotic therapy difficult
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