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Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

Published online by Cambridge University Press:  21 June 2016

Ebbing Lautenbach ,
Mark G. Weiner ,
Irving Nachamkin ,
Warren B. Bilker ,
Angela Sheridan  and
Neil O. Fishman
Ebbing Lautenbach*
Affiliation:
Divisions of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistic, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mark G. Weiner
Affiliation:
General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistic, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Angela Sheridan
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Divisions of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104–6021, (elautenb@cceb.med.upenn.edu)
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Abstract

Objectives.

To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.

Designs.

An ecologic study, a case-control study, and a retrospective cohort study.

Setting.

A 625-bed tertiary care medical center.

Patients.

All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.

Results.

From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.

Conclusions.

The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 893 - 900
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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