Imipenem-resistant Pseudomonas aeruginosa is a leading cause of hospital-acquired pneumonia. Aiming to determine the risk factors associated for hospital-acquired pneumonia due to imipenem-resistant Pseudomonas aeruginosa, we undertook a retrospective case-case-control study. Patients admitted to a 14-bed medical-surgical intensive care unit from a university-affiliated hospital with hospital-acquired pneumonia caused by imipenem-resistant Pseudomonas aeruginosa strains and by imipenem-susceptible Pseudomonas aeruginosa strains were matched to control patients by time under risk and comorbidities. A total of 58 resistant cases, 47 susceptible cases and 237 controls were evaluated. The risk factors independently associated to hospital-acquired pneumonia caused by imipenem-resistant Pseudomonas aeruginosa were: duration of hospitalisation, Acute Physiological and Chronic Health Evaluation II score, male gender, receipt of haemodialysis, receipt of piperacillin-tazobactam and receipt of third-generation cephalosporins.
ParamythiotouE., LucetJ-C, TimsitJ-F, VanjakD., Paugam-BurtzC., TrouilletJ-LAcquisition of multidrug-resistant Pseudomonas aeruginosa in patients in intensive care units: role of antibiotics with antipseudomonal activity.Clin Infect Dis2004; 38: 670–677.
2.
GalesA.C., JonesR.N., TurnidgeJ., RennieR., RamphalR.Characterization of Pseudomonas aeruginosa isolates: occurrence rates, antimicrobial susceptibility patterns, and molecular typing in the global SENTRY Antimicrobial Surveillance Program, 1997-1999.Clin Infect Dis2001; 32: S146–155.
3.
HarrisA.D., SmithD., JohnsonJ.A., BradhamD.D., RoghmannM-CRisk factors for imipenem-resistant Pseudomonas aeruginosa among hospitalized patients.Clin Infect Dis2002; 34: 340–345.
4.
El AmariE.B., ChamotE., AuckenthalerR., PechereJ.C., Van DeldenC.Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates.Clin Infect Dis2001; 33: 1859–1864.
5.
National Nosocomial Infections Surveillance (NNIS)System Report, data summary from January 1992 through June 2004, issued October 2004.Am J Infect Control2004; 32: 470–85.
6.
FurtadoG.H.C., MartinsS.T., MachadoA.M.O., WeyS.B., MedeirosE.A.S.Clinical culture surveillance of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species in a teaching hospital in Sao Paulo, Brazil: a 7-year study.Infect Control Hosp Epidemiol2006; 27: 1270–1273.
7.
HarrisA.D., KarchmerT.B., CarmeliY., SamoreM.H.Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review.Clin Infect Dis2001; 32: 1055–1061.
8.
KayeK.S., HarrisA.D., SamoreM., CarmeliY.The case-case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance.Infect Control Hosp Epidemiol2005; 26: 346–351.
McCabeW.R., JacksonG.G.Treatment of pyelonephritis: bacterial, drug and host factors in success or failure among 252 patients.N Engl J Med1965; 272: 137–144.
11.
Clinical and Laboratory Standards Institute (CLSI).Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; Approved Standard, 7th ed. Wayne, PA 2006. M7–A7.
ZavasckiA.P., CruzR.P., GoldaniL.Z.Risk factors for imipenem-resistant Pseudomonas aeruginosa: a comparative analysis of two case-control studies in hospitalized patients.J Hosp Infect2005; 59: 96–101.
14.
OzkurtZ., ErtekM., ErolS., AltoparlakU., AkcayM.N.The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit.Burns2005; 31: 870–873.
15.
FortalezaC.M., FreireM.P., Filho DdeC., de Carvalho RamosM.Risk factors for recovery of imipenem- or ceftazidime-resistant Pseudomonas aeruginosa among patients admitted to a teaching hospital in Brazil.Infect Control Hosp Epidemiol2006; 27: 901–906.
16.
FalagasM.E., KoletsiP.K., KopteridesP., MichalopoulosA.Risk factors for isolation of strains susceptible only to polymyxin among patients with Pseudomonas aeruginosa bacteremia.Antimicrob Agents Chemother2006; 50: 2541–2543.
17.
TamV.H., ChangK-T, LaRoccoM.T., SchillingA.N., McCauleyS.K., PooleK.Prevalence, mechanisms, and risk factors of carbapenem resistance in bloodstream isolates of Pseudomonas aeruginosa.Diagn Microbiol Infect Dis2007; 58: 309–314.
18.
PenaC., GuzmanA., SuarezC., DominguezM.A., TubauF., PujolM.Effects of carbapenem exposure on the risk for digestive tract carriage of intensive care unit-endemic carbapenem-resistant Pseudomonas aeruginosa strains in critically ill patients.Antimicrob Agents Chemother2007; 51: 1967–1971.
LautenbachE., WeinerM.G., NachamkinI., BilkerW.B., SheridanA., FishmanN.O.Imipenem resistance among Pseudomonas aeruginosa isolates: risk factors for infection and impact of resistance on clinical and economic outcomes.Infect Control Hosp Epidemiol2006; 27: 893–900.
CaoB., WangH., SunH., ZhuY., ChenM.Risk factors and clinical outcomes of nosocomial multi-drug resistant Pseudomonas aeruginosa infections.J Hosp Infect2004; 57: 112–118.
23.
LeroyO., d'EscrivanT., DevosP., DubreuilL., KipnisE., GeorgesH.Hospital-acquired pneumonia in critically ill patients: factors associated with episodes due to imipenem-resistant organisms.Infection2005; 33: 129–135.
24.
MentzelopoulosS.D., PratikakiM., PlatsoukaE., KraniotakiH., ZervakisD., KoutsoukouA.Prolonged use of carbapenems and colistin predisposes to ventilator-associated pneumonia by pandrug-resistant Pseudomonas aeruginosa.Intensive Care Med2007; 33: 1524–1532.
25.
LodiseT.P.Jr., MillerC., PatelN., GravesJ., McNuttL-AIdentification of patients with Pseudomonas aeruginosa respiratory tract infections at greatest risk of infection with carbapenem-resistant isolates.Infect Control Hosp Epidemiol2007; 28: 959–965.
26.
SatakeS., YoneyamaH., NakaeT.Role of OmpD2 and chromosomal beta-lactamase in carbapenem resistance in clinical isolates of Pseudomonas aeruginosa.J Antimicrob Chemother1991; 28: 199–207.
27.
NeuH.C.Resistance of Pseudomonas aeruginosa to imipenem.Infect Control Hosp Epidemiol1992; 13: 7–9.
28.
SprungC.L., AnnaneD., KehD., MorenoR., SingerM., FreivogelK.Hydrocortisone therapy for patients with septic shock.N Engl J Med2008; 358: 111–124.
29.
SprungC.L., CaralisP.V., MarcialE.H., PierceM., GelbardM.A., LongW.M.The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study.N Engl J Med1984; 311: 1137–1143.
30.
CroninL., CookD.J., CarletJ., HeylandD.K., KingD., LansangM.A.Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature.Crit Care Med1995; 23: 1430–1439.
31.
KubeD., SontichU., FletcherD., DavisP.B.Proinflammatory cytokine responses to P. aeruginosa infection in human airway epithelial cell lines.Am J Physiol Lung Cell Mol Physiol2001; 280: L493–502.
32.
FukushimaK., AndoM., SugaM., ArakiS.Impaired function of polymorphonuclear leukocytes exuded into bronchoalveolar spaces infected with Pseudomonas aeruginosa in steroid-treated rabbits.Exp Lung Res1987; 13: 141–155.
33.
SayerH.G., LongtonG., BowdenR., PepeM., StorbR.Increased risk of infection in marrow transplant patients receiving methylprednisolone for graft-versus-host disease prevention.Blood1994; 84: 1328–1332.
34.
PifarreR., FalgueraM., Vicente-de-VeraC., NoguesA.Characteristics of community-acquired pneumonia in patients with chronic obstructive pulmonary disease.Respir Med2007; 101: 2139–2144.
35.
SaderH.S., ReisA.O., SilbertS., GalesA.C.IMPs, VIMs and SPMs: the diversity of metallo-beta-lactamases produced by carbapenem-resistant Pseudomonas aeruginosa in a Brazilian hospital.Clin Microbiol Infect2005; 11: 73–76.
