A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit
Abstract Background Pseudomonas aeruginosa (PA) surveillance may improve empiric antimicrobial therapy, since colonizing strains frequently cause infections. This colonization may be ‘endogenous’ or ‘exogenous’, and the source determines infection control measures. We prospectively investigated the...
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| Format: | Article |
| Language: | English |
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BMC
2017-01-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-016-0167-7 |
| _version_ | 1819237404126478336 |
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| author | Regev Cohen Frida Babushkin Shoshana Cohen Marina Afraimov Maurice Shapiro Martina Uda Efrat Khabra Amos Adler Ronen Ben Ami Svetlana Paikin |
| author_facet | Regev Cohen Frida Babushkin Shoshana Cohen Marina Afraimov Maurice Shapiro Martina Uda Efrat Khabra Amos Adler Ronen Ben Ami Svetlana Paikin |
| author_sort | Regev Cohen |
| collection | DOAJ |
| description | Abstract Background Pseudomonas aeruginosa (PA) surveillance may improve empiric antimicrobial therapy, since colonizing strains frequently cause infections. This colonization may be ‘endogenous’ or ‘exogenous’, and the source determines infection control measures. We prospectively investigated the sources of PA, the clinical impact of PA colonization upon admission and the dynamics of colonization at different body sites throughout the intensive care unit stay. Methods Intensive care patients were screened on admission and weekly from the pharynx, endotracheal aspirate, rectum and urine. Molecular typing was performed using Enterobacterial Repetitive Intergenic Consensus Polymerase Chain reaction (ERIC-PCR). Results Between November 2014 and January 2015, 34 patients were included. Thirteen (38%) were colonized on admission, and were at a higher risk for PA-related clinical infection (Hazard Ratio = 14.6, p = 0.0002). Strains were often patient-specific, site-specific and site-persistent. Sixteen out of 17 (94%) clinical isolates were identical to strains found concurrently or previously on screening cultures from the same patient, and none were unique. Ventilator associated pneumonia-related strains were identical to endotracheal aspirates and pharynx screening (87–75% of cases). No clinical case was found among patients with repeated negative screening. Conclusion PA origin in this non-outbreak setting was mainly ‘endogenous’ and PA-strains were generally patient- and site-specific, especially in the gastrointestinal tract. While prediction of ventilator associated pneumonia-related PA-strain by screening was fair, the negative predictive value of screening was very high. |
| first_indexed | 2024-12-23T13:19:47Z |
| format | Article |
| id | doaj.art-55eec1e381df4213bb3f22033a9214c2 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-23T13:19:47Z |
| publishDate | 2017-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-55eec1e381df4213bb3f22033a9214c22022-12-21T17:45:30ZengBMCAntimicrobial Resistance and Infection Control2047-29942017-01-01611910.1186/s13756-016-0167-7A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unitRegev Cohen0Frida Babushkin1Shoshana Cohen2Marina Afraimov3Maurice Shapiro4Martina Uda5Efrat Khabra6Amos Adler7Ronen Ben Ami8Svetlana Paikin9Head of Infectious diseases unit, Sanz Medical Center, Laniado hospitalInfectious diseases unit, Sanz Medical Center, Laniado hospitalInfectious diseases unit, Sanz Medical Center, Laniado hospitalInfectious diseases unit, Sanz Medical Center, Laniado hospitalMedical and Surgical intensive care unit, Sanz Medical Center, Laniado hospitalMedical and Surgical intensive care unit, Sanz Medical Center, Laniado hospitalNational Center of Infection Control, Ministry of HealthNational Center of Infection Control, Ministry of HealthSackler Faculty of Medicine, Tel Aviv UniversityMicrobiology Laboratory, Sanz Medical Center, Laniado hospitalAbstract Background Pseudomonas aeruginosa (PA) surveillance may improve empiric antimicrobial therapy, since colonizing strains frequently cause infections. This colonization may be ‘endogenous’ or ‘exogenous’, and the source determines infection control measures. We prospectively investigated the sources of PA, the clinical impact of PA colonization upon admission and the dynamics of colonization at different body sites throughout the intensive care unit stay. Methods Intensive care patients were screened on admission and weekly from the pharynx, endotracheal aspirate, rectum and urine. Molecular typing was performed using Enterobacterial Repetitive Intergenic Consensus Polymerase Chain reaction (ERIC-PCR). Results Between November 2014 and January 2015, 34 patients were included. Thirteen (38%) were colonized on admission, and were at a higher risk for PA-related clinical infection (Hazard Ratio = 14.6, p = 0.0002). Strains were often patient-specific, site-specific and site-persistent. Sixteen out of 17 (94%) clinical isolates were identical to strains found concurrently or previously on screening cultures from the same patient, and none were unique. Ventilator associated pneumonia-related strains were identical to endotracheal aspirates and pharynx screening (87–75% of cases). No clinical case was found among patients with repeated negative screening. Conclusion PA origin in this non-outbreak setting was mainly ‘endogenous’ and PA-strains were generally patient- and site-specific, especially in the gastrointestinal tract. While prediction of ventilator associated pneumonia-related PA-strain by screening was fair, the negative predictive value of screening was very high.http://link.springer.com/article/10.1186/s13756-016-0167-7Pseudomonas aeruginosaEndogenousIntensive Care unitSurveillanceERIC-PCRInfection control |
| spellingShingle | Regev Cohen Frida Babushkin Shoshana Cohen Marina Afraimov Maurice Shapiro Martina Uda Efrat Khabra Amos Adler Ronen Ben Ami Svetlana Paikin A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit Antimicrobial Resistance and Infection Control Pseudomonas aeruginosa Endogenous Intensive Care unit Surveillance ERIC-PCR Infection control |
| title | A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit |
| title_full | A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit |
| title_fullStr | A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit |
| title_full_unstemmed | A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit |
| title_short | A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit |
| title_sort | prospective survey of pseudomonas aeruginosa colonization and infection in the intensive care unit |
| topic | Pseudomonas aeruginosa Endogenous Intensive Care unit Surveillance ERIC-PCR Infection control |
| url | http://link.springer.com/article/10.1186/s13756-016-0167-7 |
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