Intensive Care Medicine

, Volume 33, Issue 9, pp 1524–1532

Prolonged use of carbapenems and colistin predisposes to ventilator-associated pneumonia by pandrug-resistant Pseudomonas aeruginosa

Authors

    • First Department of Critical CareUniversity of Athens Medical School
  • Maria Pratikaki
    • Department of MicrobiologyEvaggelismos General Hospital
  • Evangelia Platsouka
    • Department of MicrobiologyEvaggelismos General Hospital
  • Helen Kraniotaki
    • Department of MicrobiologyEvaggelismos General Hospital
  • Dimitris Zervakis
    • First Department of Critical CareUniversity of Athens Medical School
  • Antonia Koutsoukou
    • First Department of Critical CareUniversity of Athens Medical School
  • Serafim Nanas
    • First Department of Critical CareUniversity of Athens Medical School
  • Olga Paniara
    • Department of MicrobiologyEvaggelismos General Hospital
  • Charis Roussos
    • First Department of Critical CareUniversity of Athens Medical School
  • Evangelos Giamarellos-Bourboulis
    • First Department of Critical CareUniversity of Athens Medical School
  • Christina Routsi
    • First Department of Critical CareUniversity of Athens Medical School
  • Spyros G. Zakynthinos
    • First Department of Critical CareUniversity of Athens Medical School
Original

DOI: 10.1007/s00134-007-0683-2

Cite this article as:
Mentzelopoulos, S.D., Pratikaki, M., Platsouka, E. et al. Intensive Care Med (2007) 33: 1524. doi:10.1007/s00134-007-0683-2

Abstract

Objective

We present our experience with five cases of pandrug-resistant Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) and analysis of risk factors.

Design and setting

Case-control study in a 15-bed intensive care unit (ICU).

Patients and participants

The study included 5 cases and 20 controls. Each case patient was matched to four contemporary controls according to gender, prior hospital admissions, hospitalization duration, ICU admission cause, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Function Assessment (SOFA) scores on ICU admission, and length of ICU stay, and mechanical ventilation duration until first VAP episode by a multidrug-resistant bacterium.

Measurements and results

Recorded variables included age, gender, daily APACHE II and SOFA scores, patient medication, treatment interventions, positive cultures and corresponding antibiograms, occurrence of infection, sepsis, and septic shock, other ICU-associated morbidity, length of ICU stay and mechanical ventilation, and patient outcome. Healthcare worker and environmental cultures, and a hand-disinfection survey were performed. Pandrug-resistant P. aeruginosa isolates belonged to the same genotype and were blaVIM–1-like gene positive. The outbreak resolved following reinforcement of infection-control measures (September 27). The sole independent predictor for pandrug-resistant P. aeruginosa VAP was combined use of carbapenem for more than 20 days and colistin use for and more than 13 days (odds ratio 76.0; 95% confidence interval 3.7–1487.6). An additional risk factor was more than 78 open suctioning procedures during 6–26 September (odds ratio 16.0; 95% confidence interval 1.4–185.4).

Conclusions

Prolonged carbapenem-colistin use predisposes to VAP by pandrug-resistant P. aeruginosa. Cross-transmission may be facilitated by open suctioning.

Keywords

Disease outbreaksPseudomonas aeruginosaCarbapenemsβ-LactamasesColistin

Supplementary material

134_2007_683_MOESM1_ESM.doc (394 kb)
Electronic Supplementary Material (DOC 395K)

Copyright information

© Springer-Verlag 2007