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Extensively drug-resistant Pseudomonas aeruginosa: risk of bloodstream infection in hospitalized patients

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Abstract

Several studies have suggested that resistance determinants usually reduce virulence. However, their contribution to decrease bloodstream infections is unclear. Our aim was to identify risk factors of extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) bacteremia and to assess the prevalence of XDR-PA bacteremia. A retrospective study of PA bloodstream infections in our patient population with at least one clinical sample isolate due to PA (2006–2007) was carried out. A total of 2,131 patients with PA clinical samples were detected. Among 1,657 patients with susceptible-PA isolates, 95 developed PA-susceptible bacteremia. Concomitantly, among 474 patients with multidrug-resistant (MDR)-PA isolates, 265 with XDR-PA, and 209 with non-XDR MDR-PA, 43 developed XDR-PA bacteremia and 13 non-XDR MDR-PA bacteremia, respectively. Pulsed-field gel electrophoresis (PFGE) revealed the clonal nature of the two predominant XDR-PA phenotypes and genetic heterogeneity in non-XDR MDR-PA phenotypes. The proportion of XDR-PA bacteremia was higher than the proportion of bacteremia in the susceptible-PA population (16 % vs. 6 %; p < 0.001). A logistic regression model identified prior exposure to fluoroquinolones [odds ratio (OR) 2.80; 95 % confidence interval (CI) 1.02 to 7.70] as the independent variable associated with XDR-PA bacteremia. Our study suggests that XDR-PA strains have a greater ability to develop bacteremia. It remains unclear as to whether this invasive capacity depends on clonal traits or on other virulence determinants.

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Acknowledgments

This work was supported by the National Health Service grant FIS 08/0276 from the Fondo de Investigación Sanitarias and supported by Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, co-financed by the European Regional Development Fund (ERDF) “A way to achieve Europe”, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008), and by the Ciber de Enfermedades Respiratorias (CB06/06/0037).

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Infectious Diseases Service, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain

    C. Peña, S. Gómez-Zorrilla, C. Suarez, O. Arch, M. Pujol & J. Ariza

  2. Microbiology Service, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain

    M. A. Dominguez & F. Tubau

  3. Microbiology Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain

    A. Oliver

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  1. C. Peña
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  2. S. Gómez-Zorrilla
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  4. M. A. Dominguez
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  6. O. Arch
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Correspondence to C. Peña.

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Peña, C., Gómez-Zorrilla, S., Suarez, C. et al. Extensively drug-resistant Pseudomonas aeruginosa: risk of bloodstream infection in hospitalized patients. Eur J Clin Microbiol Infect Dis 31, 2791–2797 (2012). https://doi.org/10.1007/s10096-012-1629-3

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  • DOI: https://doi.org/10.1007/s10096-012-1629-3

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