Abstract
Pseudomonas aeruginosa (P.aeruginosa) remains a prominent nosocomial pathogen responsible for high morbi-mortality in intensive care units (ICUs). P.aeruginosa transmission is known to be partly endogenous and exogenous. Main factors have been highlighted but the precise role of environment in regard to antibiotics use remained unclear.ObjectiveTo assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection.Study design and settingA French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples. Hydric environment was also sampled each week. Data on patient clinical features, environmental and device exposures, and antibiotics supports were regularly collected. Multivariate analysis was performed with a multistate model.ResultsThe overall prevalence of P. aeruginosa carriage was 15.3% (201/1314). Risk factors associated with patient colonization were: use of inactive antibiotics against P. aeruginosa (HR = 1.60 [1.15–2.21] p<0.01), tap water contamination at the entry in the room (HR = 1.66 [1.01–2.27] p<0.05) and mechanical invasive ventilation (HR = 4.70 [2.66–8.31] p<0.0001). Active antibiotics prevented from colonization (HR = 0.67 [0.48–0.93] p = 0.02) and from infection (HR = 0.64 [0.41–1.01] p = 0.05). Interaction between hydric environment antibiotics support was not statistically associated with patient colonization.ConclusionHydric contamination and antibiotics pressure seem to remain key independent risk factors in P. aeruginosa colonization. These results advocate the need to carry on preventive and targeted interventions toward healthcare associated infections.
Highlights
Risk factors associated with patient colonization were: use of inactive antibiotics against P. aeruginosa (HR = 1.60 [1.15–2.21] p
Active antibiotics prevented from colonization (HR = 0.67 [0.48–0.93] p = 0.02) and from infection
Despite persistent and constant efforts made in Healthcare associated infections prevention, cross infections remain an issue especially in intensive care units (ICU)
Summary
Despite persistent and constant efforts made in Healthcare associated infections prevention, cross infections remain an issue especially in intensive care units (ICU). Cross infections are associated with high mortality rates and higher costs by complicating patients’ cares and lengthening hospital stay [2,3,4,5] Pathogens responsible for those infections are often multi-drug resistant (MDR) bacteria. Among those pathogens, Pseudomonas aeruginosa is often encountered [6] and is responsible for severe infections, difficult to manage, such as ventilator associated pneumonia, bacteremia or skin infections, mainly in immunocompromised patients [7] with already a poor baseline prognosis. When focusing on the bacteria strains it seems that P.aeruginosa related infections are more likely to occur to P.aeruginosa colonized patients, which highlights the link between the two conditions [8,9]
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