Pseudomonas aeruginosa infection in human immunodeficiency virus infected patients (original) (raw)
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Romanian Journal of Infectious Diseases, 2018
Background. Pseudomonas aeruginosa is a dangerous, hard to treat pathogen, due to an increasing frequency of resistance to multiple antibiotics. This susceptibility pattern is influenced by multiple factors and it frequently has a regional or local character, different for each hospital or intensive care unit. Methods. We analysed and compared the characteristics of 62 patients and their isolated P. aeruginosa strains, treated in the "Sfânta Parascheva" Infectious Diseases Hospital of Iasi City between January and December 2011 (Group 1-25c) and between January and December 2016 (Group 2-37c). The susceptibility was tested by disk diffusion test; CLSI standards were used. Results. The median age was higher in group 2 (63 years) vs group 1 (52 years, p=0.04), more men were affected in both groups (59.2 vs 57.5%). In group 2 the strains were isolated from urine (50%), sputum (17.5%), wound secretions (15%), blood cultures (10%) or central venous catheters (7.5%); more than half may be of nosocomial origin; the infection mainly occurred in patients with significant comorbidities, long-term hospitalization (median-15 days), ICU care or mechanical ventilation. We did not find a significant increase in the resistance rates in group 2 for the tested antibiotics; they remain high for almost every drug: 55 vs 60% for imipenem, 70 vs 62% for meropenem, 31 vs 41.7% for ceftazidime, 68 vs 75% for ciprofloxacin, 50 vs 42.8% for gentamicin, 63.6 vs 45.8% for amikacin, 46 vs 30% for piperacillin-tazobactam. All isolates were susceptible to colistin. The share of MDR isolates was slightly higher in group 2 (52 vs 61%, p=0.4). The treatment of these infections was difficult, with an average duration of 15 days; 20% of patients died. Conclusions. In our hospital, P. aeruginosa infections appeared predominantly in elderly patients, often in association with medical care, were associated with multidrug resistance to antibiotics and sometimes had a guarded prognosis. The antibiotic susceptibility rates did not vary significantly in the two time intervals that we analysed.
Risk factors and a clinical index for diagnosis of Pseudomonas aeruginosa bacteremia
Clinical Microbiology and Infection, 1995
Objective: To define risk factors significantly and independently associated with Pseudornonas aeruginosa bacteremia and to combine them in a diagnostic index which will define groups of septic patients at low or high risk of bloodstream infection caused by k? aeruginosa. Methods: Logistic regression analysis was used to identify risk factors associated with pseudomonal bacteremia among all patients with bacteremia at St Thomas' Hospital, London, from 1969 to1989. The coefficients of the final logistic model were used to compile a linear model for the diagnosis of pseudomonal bacteremia. The index was validated in another set of patients with bacteremia detected at Beilinson Medical Center, Petah Tiqva, Israel, from 1988 to 1991. Results: Seven factors were significantly and independently predictive of pseudornonal bacteremia:l) neutropenia; 2) previous or current treatment with antibiotics; 3) cytotoxic or corticosteroid treatment; 4) hospital acquisition of infection; 5) detection in the intensive care unit; 6) male gender; and 7) focus of infection. High-risk foci were the urinary tract with catheter or post-instrumentation, or unknown source. Low-risk foci were bone, joint, meninges, female genital tract and upper respiratory tract. The index score divided patients into three groups with increasing likelihood of F! aeruginosa bacteremia: I%, 7% and 19%, respectively (p = 0.0001). In the validation set, the percentage of F! aeruginosa bacteremia in the three respective groups defined by the index were 5%, 18% and 22% (p = 0.0001). Conclusions: The use of simple clinical and laboratory data known within hours of detection of an infectious episode can define patients at high and low risk for F! aeruginosa bacteremia.
American Journal of Infection Control, 2006
Background: Pseudomonas aeruginosa strains are generally resistant to many antibiotics, and nosocomial infections because of this species are one of the major problems in many hospitals. Molecular typing provides very useful information about origin and transmission of the strains. The aims of the present study were to investigate clinical and microbiologic characteristics of the nosocomial infections caused by P aeruginosa strains in a medical center and to bring up the cross-transmission level of this opportunistic pathogen in a university hospital by analyzing the clonal relationship among the isolates. Methods: A total of 105 P aeruginosa strains had been identified among the 80 inpatients in a 1-year period from August 2003 to August 2004. Demographic, clinical, and epidemiologic data of the patients were prospectively recorded. The standardized diskdiffusion method was used to determine resistance of the strains to imipenem, ceftazidime, aztreonam, amikacin, gentamicin, mezlocillin, cefepime, tobramycin, meropenem, ceftriaxone, and ciprofloxacin. Clonal relatedness of the strains was investigated by pulsed-field gel electrophoresis (PFGE). Results: Of the 105 P aeruginosa strains identified, 45 (43%) were isolated from the patients hospitalized in intensive care units. Thirteen patients had repeated pseudomonas infection (total 38 infections/13 patients); 26 of these repeated infections in 9 patients showed the same localization. Half of the patients had at least 1 underlying disease such as burn (48%), chronic illness (32%), and malignancy (20%). Fifty-seven patients (71%) had urinary and/or other catheterization. Urinary tract infection (35%) was the most frequent infection encountered, followed by respiratory tract infection (34%) and sepsis (13%). Resistance to the antibiotics tested was in the 12% to 88% range; amikacin was the most effective and ceftriaxone was the least effective antibiotic. The PFGE typing method showed that 28 of the 80 patients' isolates were clonally related, including 23 indistinguishable or closely related strains (29%), and 5 possibly related strains (6%). Epidemiologic data of the 16 patients (20% of the patients) confirmed a clonal relationship among the strains. Of the 26 isolates of the 9 patients having repeated infection in the same location, 18 (69%) were in the clonally related groups, whereas 11 of the 12 strains isolated from repeated infections on different body sites were clonally different. Conclusion: Our results indicated that P aeruginosa infections in our hospital mainly affected the patients hospitalized in intensive care units and those having catheterization, burn, and/or chronic illness. Amikacin was the best antibiotic as far as bacterial resistance was considered. Although lack of major PFGE type confirmed no P aeruginosa outbreak, typing results showed that cross transmission and treatment failure are the 2 main problems, which should be consider together to prevent this bacterial infection in medical centers.
Recurrent infections caused by Pseudomonas aeruginosa strains in a unique patient
American Journal of Infection Control, 2007
the footstool is stepped. We limit it to no more than twice in our department. Additionally, the footstool height should be as low as possible. Another contrivance is to eliminate the rounded portion of the draped field. As Fig 3 depicts, longitudinal bars should be set on both sides of the patient, at a slightly higher level than the body. By draping over the bars, the vertical side plane and the operative field can be demarcated clearly. Even in a setting in which the entire side plane is contaminated by stepping on and off a footstool frequently, this area can be recognized readily as a contaminated field, and, thus, virtually will never be touched. Because it is not clear that microorganisms are transmitted as effectively as is powder, our hypothesis and corrective actions should be ascertained by a further experiment using bacteria, as have been done previously. 1-3 We believe that operations can be conducted in more sanitary conditions by putting the above-mentioned points into practice.
Occurrence of Pseudomonas aeruginosa infections in a Tertiary care Hospital
IOSR Journals , 2019
Pseudomonas has been recognized as an important nosocomial, health care associated pathogen, selected out due to indiscriminate use of antibiotics. They are multidrug resistant, contributing to treatment problems. The present study was undertaken to determine the occurrence of Pseudomonas as a hospital pathogen from various clinical samples and to ascertain its sensitivity pattern along with a clinico-bacteriological correlation. Cultural analysis was undertaken on solid and liquid media. Antimicrobial susceptibility was done using CLSI Guidelines. The occurrence as a hospital pathogen was 3.1%. The male female ratio 1.2: 1. Patients belonged to age groups above 51 years (55.4%). Pus samples yielded the maximum isolates of Pseudomonas (40.2%), followed by endo tracheal tubes (24.5%).Patients with Pseudomonas infection were predominantly from ICU (31.8%), Surgical wards(23.8%) and Burns unit (16.4%). Clinically, patients presented with wound infections (41.2%) and Pneumonia (25.5%). Risk factors identified were patients on ventilator (25.1%), prolonged antibiotic use (16.8%) and urinary catheter (12.9%). Periodic surveillance with knowledge of Pseudomonas isolation rate and susceptibility pattern is essential to guide physicians to choose appropriate antibiotics. This will reduce mortality and morbidity associated with these infections.
Pseudomonas infections in patients with AIDS and AIDS-related complex
Journal of Internal Medicine, 1992
Abstract. We identified and reviewed retrospectively all the cases of infection by Pseudomonas and related genera in patients with AIDS and AIDS-related complex (ARC) who were hospitalized at our Institution over a 36-month period. We recorded 48 episodes of infection in 34 of 355 patients with AIDS, and in two of 73 patients with ARC: 25 pneumonias (9 community-acquired and 16 of nosocomial origin), 20 urinary tract infections, two soft tissue infections and one sepsis. In 14 of 16 patients with nosocomial pneumonia but in only one of nine patients with community-acquired pneumonia did we find coexisting opportunistic lung diseases. The following micro-organisms were isolated: P. aeruginosa in 41 cases. P. fluorescens in three cases. Xanthomonas maltophilia (P. maltophilia) in two cases, P. putida in one case, Comamonas testosteronis (P. testosteronis) and Comamonas acidovorans (P. acidovorans) in one case. Amikacin and ceftazidime, alone or in combination, appear to be the optimal choice of therapy for severe Pseudomonas infections in HIV-infected patients, although in our study six of 47 isolates were resistant in vitro to amikacin, and nine of 31 isolates were resistant to ceftazidime.
Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality
Medicina (Kaunas, Lithuania)
The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine. All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients' risk factors and mortality caused by P. aeruginosa bacteremia. A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P...
Antimicrobial Agents and Chemotherapy, 2013
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A B S T R A C TBA C K G R O U N D : Pseudomonas aerugi - n o s a bacteremia (PAB) is associated with high mortal- ity and morbidity rates, but the outcome for patients with PAB has not been recently well evaluated. METHODS : Between 1997 and 1999, all episodes of PAB at the Hôtel-Dieu de France University Hospital, Lebanon, were analyzed to evaluate the outcome for patients with PAB. RE S U L T S : Fifty-five episodes of PAB in 53 patients (26 episodes in men and 29 in women) were ana- lyzed. The mean age of the patients in the cohort was 60.7 years (range : 18-89 years). The mean time be- tween the onset of hospitalizati on and the first epi - sode of PAB was 21 days (range : 0-77 days). Most of the tested isolates showed favorable in vitro suscep - tibility to ceftazidime (85%), amikacin (77%) and imipenem (67%). The overall in-hospital cumulative survival was 89% at one week and 49% at 2 months. Among the variables analyzed, four were statistically associated with a higher mortal...