Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia
Shuang Li,1,* Xiaojiong Jia,1,* Congya Li,1 Hua Zou,1 Hang Liu,1 Yuanbiao Guo,2 Liping Zhang1 1Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 2Medical Research Center, The Second Chengdu Hospital Affiliated to Chongqing Medical Uni...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-08-01
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| Series: | Infection and Drug Resistance |
| Subjects: | |
| Online Access: | https://www.dovepress.com/carbapenem-resistant-and-cephalosporin-susceptible-pseudomonas-aerugin-peer-reviewed-article-IDR |
| _version_ | 1811207964474736640 |
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| author | Li S Jia X Li C Zou H Liu H Guo Y Zhang L |
| author_facet | Li S Jia X Li C Zou H Liu H Guo Y Zhang L |
| author_sort | Li S |
| collection | DOAJ |
| description | Shuang Li,1,* Xiaojiong Jia,1,* Congya Li,1 Hua Zou,1 Hang Liu,1 Yuanbiao Guo,2 Liping Zhang1 1Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 2Medical Research Center, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China *These authors contributed equally to this work Purpose: Pseudomonas aeruginosa is recognized as a major cause of severe and potentially life-threatening infection. However, P. aeruginosa isolates with the phenotype of being carbapenem resistant and cephalosporin susceptible (Carb-R/Ceph-S) have not been thoroughly characterized to date. The aim of this study was to assess the mechanisms, risk factors, and clinical impact of Carb-R/Ceph-S P. aeruginosa bacteremia on mortality.Patients and methods: We conducted a retrospective case–case–control study of the risk factors and clinical outcomes of hospitalized patients with Carb-R/Ceph-S P. aeruginosa bacteremia from 2011 to 2017 in Chongqing, China. Case patients infected with Carb-R/Ceph-S P. aeruginosa, carbapenem-susceptible and cephalosporin-susceptible (Carb-S/Ceph-S) P. aeruginosa, and controls with no P. aeruginosa bacteremia were compared at a ratio of 1:1:2. Real-time reverse transcription polymerase chain reaction was performed to assess resistance mechanisms. A multivariate logistic regression model was performed to investigate several potential predictors for mortality.Results: We collected 63 Carb-R/Ceph-S P. aeruginosa isolates during the study period. None of these isolates possessed carbapenemase or extended-spectrum β-lactamase-encoding genes. The overall 30-day mortality rate was 27.0%. Real-time reverse transcription polymerase chain reaction analysis showed that an overexpression of efflux systems and decreased expression of OprD were associated with Carb-R/Ceph-S P. aeruginosa. Multivariate analysis indicated that 30-day readmission, central venous catheters, and exposure to carbapenems were unique independent predictors for acquiring Carb-R/Ceph-S P. aeruginosa bacteremia. Additionally, hematologic malignancy was a peculiar predictor for Carb-S/Ceph-S P. aeruginosa bacteremia. Notably, total parenteral nutrition was the only common factor of both Carb-R/Ceph-S and Carb-S/Ceph-S groups compared to controls. In a multivariate analysis for the outcome, intensive care unit admission and septic shock were identified as the independent predictors for mortality.Conclusion: Our findings can potentially improve the ability of physicians to identify the high-risk patients, and carbapenems were noted to potentially increase the risk of Carb-R/Ceph-S P. aeruginosa. Additionally, cephalosporin should be considered a valuable therapeutic option for such cases of bacteremia. Keywords: Pseudomonas aeruginosa, carbapenem resistance, bacteremia, risk factor |
| first_indexed | 2024-04-12T04:14:05Z |
| format | Article |
| id | doaj.art-1376656882f7434e97d54eb63fca1b73 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-04-12T04:14:05Z |
| publishDate | 2018-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-1376656882f7434e97d54eb63fca1b732022-12-22T03:48:27ZengDove Medical PressInfection and Drug Resistance1178-69732018-08-01Volume 111225123539956Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremiaLi SJia XLi CZou HLiu HGuo YZhang LShuang Li,1,* Xiaojiong Jia,1,* Congya Li,1 Hua Zou,1 Hang Liu,1 Yuanbiao Guo,2 Liping Zhang1 1Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 2Medical Research Center, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China *These authors contributed equally to this work Purpose: Pseudomonas aeruginosa is recognized as a major cause of severe and potentially life-threatening infection. However, P. aeruginosa isolates with the phenotype of being carbapenem resistant and cephalosporin susceptible (Carb-R/Ceph-S) have not been thoroughly characterized to date. The aim of this study was to assess the mechanisms, risk factors, and clinical impact of Carb-R/Ceph-S P. aeruginosa bacteremia on mortality.Patients and methods: We conducted a retrospective case–case–control study of the risk factors and clinical outcomes of hospitalized patients with Carb-R/Ceph-S P. aeruginosa bacteremia from 2011 to 2017 in Chongqing, China. Case patients infected with Carb-R/Ceph-S P. aeruginosa, carbapenem-susceptible and cephalosporin-susceptible (Carb-S/Ceph-S) P. aeruginosa, and controls with no P. aeruginosa bacteremia were compared at a ratio of 1:1:2. Real-time reverse transcription polymerase chain reaction was performed to assess resistance mechanisms. A multivariate logistic regression model was performed to investigate several potential predictors for mortality.Results: We collected 63 Carb-R/Ceph-S P. aeruginosa isolates during the study period. None of these isolates possessed carbapenemase or extended-spectrum β-lactamase-encoding genes. The overall 30-day mortality rate was 27.0%. Real-time reverse transcription polymerase chain reaction analysis showed that an overexpression of efflux systems and decreased expression of OprD were associated with Carb-R/Ceph-S P. aeruginosa. Multivariate analysis indicated that 30-day readmission, central venous catheters, and exposure to carbapenems were unique independent predictors for acquiring Carb-R/Ceph-S P. aeruginosa bacteremia. Additionally, hematologic malignancy was a peculiar predictor for Carb-S/Ceph-S P. aeruginosa bacteremia. Notably, total parenteral nutrition was the only common factor of both Carb-R/Ceph-S and Carb-S/Ceph-S groups compared to controls. In a multivariate analysis for the outcome, intensive care unit admission and septic shock were identified as the independent predictors for mortality.Conclusion: Our findings can potentially improve the ability of physicians to identify the high-risk patients, and carbapenems were noted to potentially increase the risk of Carb-R/Ceph-S P. aeruginosa. Additionally, cephalosporin should be considered a valuable therapeutic option for such cases of bacteremia. Keywords: Pseudomonas aeruginosa, carbapenem resistance, bacteremia, risk factorhttps://www.dovepress.com/carbapenem-resistant-and-cephalosporin-susceptible-pseudomonas-aerugin-peer-reviewed-article-IDRPseudomonas aeruginosacarbapenem resistancebacteremiarisk factor. |
| spellingShingle | Li S Jia X Li C Zou H Liu H Guo Y Zhang L Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia Infection and Drug Resistance Pseudomonas aeruginosa carbapenem resistance bacteremia risk factor. |
| title | Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia |
| title_full | Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia |
| title_fullStr | Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia |
| title_full_unstemmed | Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia |
| title_short | Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: a notable phenotype in patients with bacteremia |
| title_sort | carbapenem resistant and cephalosporin susceptible pseudomonas aeruginosa a notable phenotype in patients with bacteremia |
| topic | Pseudomonas aeruginosa carbapenem resistance bacteremia risk factor. |
| url | https://www.dovepress.com/carbapenem-resistant-and-cephalosporin-susceptible-pseudomonas-aerugin-peer-reviewed-article-IDR |
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