Risk factors and the resistance mechanisms involved in Pseudomonas aeruginosa mutation in critically ill patients

Autor: Stéphanie Druge, Stéphanie Ruiz, Fanny Vardon-Bounes, Marion Grare, François Labaste, Thierry Seguin, Olivier Fourcade, Vincent Minville, Jean-Marie Conil, Bernard Georges
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Journal of Intensive Care, Vol 7, Iss 1, Pp 1-9 (2019)
Druh dokumentu: article
ISSN: 2052-0492
DOI: 10.1186/s40560-019-0390-4
Popis: Abstract Background The objective of this study was to determine the main risk factors of Pseudomonas aeruginosa mutation as well as the mechanisms of acquired resistance. Methods We conducted a 2-year prospective study in patients who were carriers of a Pseudomonas aeruginosa strain and who had been admitted to a medical/surgical ICU. Results Of the 153 patients who were included, 34 had a mutation in their strain. In a multivariate analysis, a duration of ventilation > 24 days was a risk factor for mutation (risk ratio 4.29; CI 95% 1.94–9.49) while initial resistance was a protective factor (RR 0.36; CI 95% 0.18–0.71). In a univariate analysis, exposure of P. aeruginosa to ceftazidime was associated with an over-production of AmpC cephalosporinase and exposure to meropenem was associated with impermeability. A segmentation method based on the duration of ventilation (> 24 days), initial resistance, and exposure of strains to ceftazidime made it possible to predict at 83% the occurrence of mutation. Conclusion The duration of ventilation and the presence of resistance as soon as P. aeruginosa is identified are predictive factors of mutation in ICU patients.
Databáze: Directory of Open Access Journals
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