Hospital Pharmacology (Jan 2020)

Risk factors for healthcare-associated infections caused by cefepime-resistant Pseudomonas aeruginosa

  • Folić Marko M.,
  • Đorđević Zorana M.,
  • Milovanović Dragan R.,
  • Ružić-Zečević Dejana T.,
  • Rosić Nikola V.,
  • Janković Slobodan M.

Journal volume & issue
Vol. 7, no. 2
pp. 923 – 933

Abstract

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Introduction: The increasing resistance of Pseudomonas aeruginosa against cefepime requires a better understanding of hospital epidemiology in order to retain this drug as a therapeutic option. Aim: The aim of this study was to identify risk factors associated with healthcare associated infections (HAIs) caused by cefepime-resistant P. aeruginosa (CRPA), both in all patients with HAIs and in the subgroups of patients who died or who acquired infection with carbapenem-resistant P. aeruginosa. Methods: The academic study was designed as a combination of three nested case/ control studies within the cohort of patients with HAIs caused by P. aeruginosa regardless of localization, prospectively followed from January 2009 to December 2017 in a tertiary care hospital. The influence of risk factors on specific outcomes was estimated by adjusted odds ratios calculated from multivariate logistic regressions. Results: Our study showed that there are independent risk factors for CRPA infections: the existence of another HAI (p=0.001), hospitalization in ICU longer than one month (p=0.007), a longer stay in hospital prior to infection (p=0.004), longer use of mechanical ventilation (p=0.036), administration of antibiotics before infection (p<0.001) and previous use of fluoroquinolones (p=0.030), while traumatic injury (p=0.020), the existence of another HAI (p=0.001) and long-term use of antibiotics before HAI (p=0.034) were related to mortality. Further, independent risk factors for HAIs caused by carbapenem-resistant CRPA are the existence of another HAI (p=0.011), transfer from another facility (p=0.023), more days spent in hospital (p=0.006) and ICU (p=0.004), and administration of antibiotics before infection (p<0.001). Conclusion: Risk factors for HAIs with CRPA are primarily linked to pre-infection use of systemic antibiotics, which is a common pathway for selection of multi, extensive or pan-resistant strains of P. aeruginosa that invade tissues and cause infection.

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