Intensive Care Medicine

, Volume 35, Issue 3, pp 439–447

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

  • José A. Martínez
  • Esther Delgado
  • Sara Martí
  • Francesc Marco
  • Jordi Vila
  • Josep Mensa
  • Antoni Torres
  • Carles Codina
  • Antoni Trilla
  • Alex Soriano
  • Aitor Alquezar
  • Pedro Castro
  • José M. Nicolás
Original

Abstract

Objective

To assess the role of antipseudomonal agents on Pseudomonasaeruginosa colonization and acquisition of resistance.

Design

Prospective cohort study.

Setting

Two medical intensive care units.

Patients and participants

346 patients admitted for ≥ 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 ≥ 3 days (OR 2.6, 95% CI 1.09–6.27) and use of amikacin for ≥ 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.

Keywords

Intensive care unit Pseudomonas aeruginosa Antipseudomonal agents Antimicrobial resistance Emergence of resistance Nosocomial infection 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • José A. Martínez
    • 1
  • Esther Delgado
    • 2
  • Sara Martí
    • 3
  • Francesc Marco
    • 3
  • Jordi Vila
    • 3
  • Josep Mensa
    • 1
  • Antoni Torres
    • 4
  • Carles Codina
    • 5
  • Antoni Trilla
    • 6
  • Alex Soriano
    • 1
  • Aitor Alquezar
    • 2
  • Pedro Castro
    • 2
  • José M. Nicolás
    • 2
  1. 1.Department of Infectious DiseasesHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain
  2. 2.Medical Intensive Care UnitHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain
  3. 3.Microbiology LaboratoryHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain
  4. 4.Respiratory Intensive Care Unit-ICPTCHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain
  5. 5.Department of PharmacyHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain
  6. 6.Unit for Evaluation, Supporting and PreventionHospital Clínic, IDIBAPS, University of BarcelonaBarcelonaSpain

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