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Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients.

Abstract：

OBJECTIVE:To assess the role of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance. DESIGN:Prospective cohort study. SETTING:Two medical intensive care units. PATIENTS AND PARTICIPANTS:346 patients admitted for >or= 48 h. INTERVENTION:Analysis of data from an 8-month study comparing a mixing versus a cycling strategy of antibiotic use. MEASUREMENTS AND RESULTS:Surveillance cultures from nares, pharynx, rectum, and respiratory secretions were obtained thrice weekly. Acquisition of resistance was defined as the isolation, after 48 h of ICU stay, of an isolate resistant to a given antibiotic if culture of admission samples were either negative or positive for a susceptible isolate. Emergence of resistance refers to the conversion of a defined pulsotype from susceptible to non-susceptible. Forty-four (13%) patients acquired 52 strains of P. aeruginosa. Administration of piperacillin-tazobactam for >or= 3 days (OR 2.6, 95% CI 1.09-6.27) and use of amikacin for >or= 3 days (OR 2.6, 95% CI 1.04-6.7) were positively associated with acquisition of P. aeruginosa, whereas use of quinolones (OR 0.27, 95% CI 0.1-0.7) and antipseudomonal cephalosporins (OR 0.27, 95% CI 0.08-0.9) was protective. Exposure to quinolones and cephalosporins was not associated with the acquisition of resistance, whereas it was linked with usage of all other agents. Neither quinolones nor cephalosporins were a major determinant on the emergence of resistance to themselves, as resistance to these antibiotics developed at a similar frequency in non-exposed patients. CONCLUSIONS:In critically ill patients, quinolones and antipseudomonal cephalosporins may prevent the acquisition of P. aeruginosa and may have a negligible influence on the acquisition and emergence of resistance.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Martínez JA,Delgado E,Martí S,Marco F,Vila J,Mensa J,Torres A,Codina C,Trilla A,Soriano A,Alquezar A,Castro P,Nicolás JM

doi

10.1007/s00134-008-1326-y

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

439-47

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

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Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients.