ArticleCritical care (London, England)2015
Acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill medical patients: role of colonization pressure and antibiotic exposure.
Article in Critical care (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Risk factors for hospitalized patients with resistant or multidrug-resistantAntimicrobial resistance and infection control · 2018Pooled it
- Pooled it
- Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization.JAMA network open · 2026Article
- Multidrug-resistant colonization in decompensated cirrhosis outside the ICU predicts infection and poor outcomes.JHEP reports : innovation in hepatology · 2026Article
- Using electronic health records to assess the relationship between colonization pressure and nosocomial pathogen acquisition.Nature communications · 2026Article
- Epidemiology and Outcomes of Bloodstream Infections in Patients in a Burns Intensive Care Unit: An 8-Year Retrospective Study.Open forum infectious diseases · 2025Article
- Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission.Antimicrobial resistance and infection control · 2025Article
- Antipseudomonal Versus Narrow-Spectrum Agents for the Treatment of Community-Onset Intra-abdominal Infections.Open forum infectious diseases · 2021Article
- Recommendations for antibiotic selection for severe nosocomial infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2021Article
- Emergence of non-susceptibility during persistentJAC-antimicrobial resistance · 2021Article
- Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-ResistantAntibiotics (Basel, Switzerland) · 2021Article
- Article
- Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2019Observational
- Direct Measurement of Performance: A New Era in Antimicrobial Stewardship.Antibiotics (Basel, Switzerland) · 2019Review
- Perioperative prophylaxis with ertapenem reduced infections caused by extended-spectrum betalactamase-producting Enterobacteriaceae after kidney transplantation.BMC nephrology · 2019Article
- Detection and Colonization of Multidrug Resistant Organisms in a Regional Teaching Hospital of Taiwan.International journal of environmental research and public health · 2019Article
- Investigation of the prevalence of genes conferring resistance to carbapenems inInfection and drug resistance · 2019Article
- Risk factors and the resistance mechanisms involved inJournal of intensive care · 2019Article
- Influence of antibiotic pressure on multi-drug resistantAntimicrobial resistance and infection control · 2019Observational
- Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case-case-control study.Infection · 2018Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe objective of this work was to investigate the risk factors for the acquisition of Pseudomonas aeruginosa and its resistance phenotypes in critically ill patients, taking into account colonization pressure.
methodsWe conducted a prospective cohort study in an 8-bed medical intensive care unit during a 35-month period. Nasopharyngeal and rectal swabs and respiratory secretions were obtained within 48 hours of admission and thrice weekly thereafter. During the study, a policy of consecutive mixing and cycling periods of three classes of antipseudomonal antibiotics was followed in the unit.
resultsOf 850 patients admitted for ≥ 3 days, 751 (88.3%) received an antibiotic, 562 of which (66.1%) were antipseudomonal antibiotics. A total of 68 patients (8%) carried P. aeruginosa upon admission, and among the remaining 782, 104 (13%) acquired at least one strain of P. aeruginosa during their stay. Multivariate analysis selected shock (odds ratio (OR) = 2.1; 95% confidence interval (CI), 1.2 to 3.7), intubation (OR = 3.6; 95% CI, 1.7 to 7.5), enteral nutrition (OR = 3.6; 95% CI, 1.8 to 7.6), parenteral nutrition (OR = 3.9; 95% CI, 1.6 to 9.6), tracheostomy (OR = 4.4; 95% CI, 2.3 to 8.3) and colonization pressure >0.43 (OR = 4; 95% CI, 1.2 to 5) as independently associated with the acquisition of P. aeruginosa, whereas exposure to fluoroquinolones for >3 days (OR = 0.4; 95% CI, 0.2 to 0.8) was protective. In the whole series, prior exposure to carbapenems was independently associated with carbapenem resistance, and prior amikacin use predicted piperacillin-tazobactam, fluoroquinolone and multiple-drug resistance.
conclusionsIn critical care settings with a high rate of antibiotic use, colonization pressure and non-antibiotic exposures may be the crucial factors for P. aeruginosa acquisition, whereas fluoroquinolones may actually decrease its likelihood. For the acquisition of strains resistant to piperacillin-tazobactam, fluoroquinolones and multiple drugs, exposure to amikacin may be more relevant than previously recognized.
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