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Acquisition of extensive drug-resistant Pseudomonas aeruginosa among hospitalized patients: risk factors and resistance mechanisms to carbapenems

Authors
 Y.S. Park  ;  H. Lee  ;  B.S. Chin  ;  S.H. Han  ;  S.G. Hong  ;  S.K. Hong  ;  H.Y. Kim  ;  Y. Uh  ;  H.B. Shin  ;  E.J. Choo  ;  S.-H. Han  ;  W. Song  ;  S.H. Jeong  ;  K. Lee  ;  J.M. Kim 
Citation
 JOURNAL OF HOSPITAL INFECTION, Vol.79(1) : 54-58, 2011 
Journal Title
 JOURNAL OF HOSPITAL INFECTION 
ISSN
 0195-6701 
Issue Date
2011
MeSH
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Carbapenems/pharmacology* ; Case-Control Studies ; Drug Resistance, Multiple, Bacterial* ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Pseudomonas Infections/epidemiology* ; Pseudomonas Infections/microbiology* ; Pseudomonas aeruginosa/enzymology* ; Pseudomonas aeruginosa/isolation & purification ; Republic of Korea/epidemiology ; Respiration, Artificial/adverse effects ; Risk Factors ; Severity of Illness Index ; beta-Lactamases/biosynthesis*
Keywords
Carbapenem resistance ; Extensive drug resistance ; Pseudomonas aeruginosa ; Risk factor
Abstract
Extensive drug-resistant Pseudomonas aeruginosa (XDRPA) strains, defined as resistant to all available antipseudomonal antibiotics, have been reported recently. This study aimed to investigate the risk factors for XDRPA acquisition by patients and the resistance mechanisms to carbapenems. From June to November 2007, XDRPA isolates were collected from patients in eight tertiary care hospitals. A case-control study was performed to determine factors associated with XDRPA acquisition. EDTA-imipenem disc synergy tests, and polymerase chain reaction amplification and sequencing were performed to detect the presence of metallo-β-lactamases (MBLs). Risk factor analysis was performed for 33 patients. Mechanical ventilation [odds ratio (OR) 8.2, 95% confidence interval (CI) 1.3-52.2; P = 0.026] and APACHE II score (OR 1.2, 95% CI 1.0-1.3; P = 0.007) were identified as independent risk factors for XDRPA acquisition. Pulsed-field gel electrophoresis of XDRPA identified clonal epidemic isolates co-existing with sporadic isolates. Eight of 43 (19%) XDRPA isolates were shown to produce MBLs; four produced VIM-2 and four produced IMP-6. This study suggests a major role for mechanical ventilation in XDRPA acquisition. Moreover, pulsed-field gel electrophoresis identified a clonal epidemic within hospitals. Taken together, these results suggest that patient-to-patient transmission contributes to XDRPA acquisition in Korea
Full Text
http://www.sciencedirect.com/science/article/pii/S0195670111002544
DOI
10.1016/j.jhin.2011.05.014
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, June Myung(김준명)
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Jeong, Seok Hoon(정석훈) ORCID logo https://orcid.org/0000-0001-9290-897X
Chin, Bum Sik(진범식)
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93512
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