Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions (original) (raw)
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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 infection in human immunodeficiency virus infected patients
Journal of Infection, 1999
Infectio mmunodeficienc 'Sel-vim des Maladies InJectieuses el Tropicales and 'Service de Rnctdriologie-l7iI-ologie. H@ital Saint-Antoine. 75022 Paris, aid 31LNSERM U 444. Facdte' de M&cine Saint-Antoine, Paris, Frmce 017jectives: (1) To determine the incident e and outcome of ~se~1do~~7oi7~s ~er~,~~~~~os~ infection in HIV-infected patients. (2) To study the antimicrobial susceptibility of R aerlaginosa isojlates in this particular ~o~nIatio~. (3) To iden-tifJr risk factors for these infections. Patients and Methods: a retrospective case-control study performed in a 2%bed infectious-diseases unit in a 94Q-bed university hospital. AII cases were defined as IIIV-infected patients with severe infections due to E aenrginosa, including bacteriemia, lower or upper respiratory tract infections, infections related to a central venous catheter, and cutaneous/muscular infectioil. Each case was mate ed with au NIV-seropositive control not infected by El aer~@rosn an hospitalized ou the same dates as the cases. Resrd~~: one thousand and thirty-five HIV-infected patients were B-rospitalized during the study period. A. First severe E? creruginosn infection was documented in 41 patients , giving an overaIl annuai iucideuce note of 2.5 1 episodes per 100 admissions. Forty of the 41 case notes were available for analysis. They consisted of 17 cases of bacteraemia, four
Considerations on Bacterial Infections in Hiv Positive Patients
2013
It has been more than three decades since the first cases of acquired immune deficiency were reported, groups at risk were defined, routes of transmission of the disease determined and the causative agent, the human immunodeficiency virus (HIV) was identified. The discovery of antiretroviral therapy (ARV) was a key moment in the history of the pandemic, transforming HIV from a fatal clinical condition in any case, to a chronic disease receiving a long-term care and an almost normal life expectancy. Since the discovery of zidovudine, the first pharmacologically active molecule against HIV, antiretroviral therapy had rapid and significant changes. However, opportunistic or common infections are relatively common in persons infected with HIV (PIH), which is today an important cause of morbidity and mortality, and problems remain related to prevention and curative therapy. HIV-induced immunosuppression amplifies the risk of bacterial infections, tuberculosis and non-tuberculosis, often involving antibiotic-resistant strains, with severe and / or recurrent potential. Occurrence surrogate markers and bacterial infections spectrum are CD4 cell count and HIV-viral load. Clinical and biological manifestations are often atypical, and therefore requires a high index of suspicion for early diagnosis and medical management, prophylactic therapy or appropriate curative treatment. By studying bacterial infections in immunocompromised patients with HIV, I tried to help improving prevention and diagnosis strategies of these infections in context of achieving an appropriate antibiotic standard for a cost-benefit effective treatment and for improving individual prognosis.
BMC Infectious Diseases, 2011
Background: Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied. Methods: Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with crosstransmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented. Results: Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more.
European Journal of Clinical Microbiology & Infectious Diseases, 2017
The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC 50 to meropenem was 16 μg/mL and the MIC 90 was >32 μg/mL, with 60.4% of respiratory samples being MIC >32 μg/ mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.
Plos One, 2013
Objective: To describe an outbreak of multi-resistant Pseudomonas aeruginosa bloodstream infections (MRPA-BSI) that occurred in the haematology ward of a tertiary academic hospital in Cape Town, South Africa, and determine risk factors for acquisition of MRPA-BSI. Methods: The outbreak investigation included a search for additional cases, review of patient records, environmental and staff screening, molecular typing using pulsed-field gel electrophoresis (PFGE) and Multi-locus sequencing (MLST) and a retrospective case-control study. Results: Ten MRPA-BSI cases occurred in the haematology ward between January 2010 and January 2011. The case fatality rate was 80%. Staff screening specimens were negative for MRPA and an environmental source was not identified. PFGE showed that 9/10 isolates were related. MLST showed that 3 of these 9 isolates belonged to Sequence type (ST) 233 while the unrelated isolate belonged to ST260. Conclusion: We have described an outbreak of MRPA-BSI occurring over an extended period of time among neutropenic haematology patients. Molecular typing confirms that the outbreak was predominantly due to a single strain. The source of the outbreak was not identified, but the outbreak appears to have been controlled following intensive infection control measures.