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Risk Factors for and Impact of Infection or Colonization With Aztreonam-Resistant Pseudomonas aeruginosa

Published online by Cambridge University Press:  02 January 2015

Leanne B. Gasink ,
Neil O. Fishman ,
Irving Nachamkin ,
Warren B. Bilker  and
Ebbing Lautenbach
Leanne B. Gasink*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
*
Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 Silverstein Pavilion, Suite E, Philadelphia, PA 19104 (leanne.gasink@uphs.upenn.edu)
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Abstract

Objective.

To identify risk factors for infection or colonization with aztreonam-resistant Pseudomonas aeruginosa and examine the impact of this organism on mortality.

Design.

A case-control study was performed to identify risk factors for infection or colonization with aztreonam-resistant P. aeruginosa. A cohort study was subsequently performed to examine the impact of aztreonam resistance on outcomes.

Setting.

A tertiary referral center in southeastern Pennsylvania.

Participants.

Inpatients with a clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.

Results.

Of 720 P. aeruginosa, isolates, 183 (25.4%) were aztreonam-resistant and 537 (74.6%) were aztreonam susceptible. In a multivariable model, prior fluoroquinolone use (adjusted odds ratio [aOR], 1.81 [95% confidence interval {CI}, 1.17-2.80]), prior use of an antianaerobic agent (aOR, 1.56 [95% CI, 1.06-2.29]), and renal insufficiency (aOR, 1.59 [95% CI, 1.10-2.29]) were associated with infection or colonization with aztreonam-resistant P. aeruginosa, while older age (aOR, 0.98 [95% CI, 0.97-0.99] per year of age) was negatively associated with infection or colonization with this organism. In-hospital mortality was higher among subjects infected or colonized with aztreonam-resistant P. aeruginosa, compared with those who were infected or colonized with aztreonam-susceptible P. aeruginos (25.7% vs 16.8%;P = .009), but in multivariable analysis, no significant association was found between infection or colonization with aztreonam-resistant P. aeruginosa and mortality.

Conclusions.

Curbing the use of fluoroquinolones and antimicrobials with antianaerobic activity may be an effective strategy to limit the emergence of aztreonam-resistant P. aeruginosa.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1175 - 1180
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

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