Alessio Strazzulla, Vladimir Adrien, Segla Robert Houngnandan, Sandra Devatine, Ouerdia Bahmed, Sarra Abroug, Sarra Hamrouni, Mehran Monchi, Sylvain Diamantis
{"title":"抗菌药物管理计划启动前(2007-2010 年)和启动后(2011-2014 年)重症监护病房铜绿假单胞菌感染的特征。","authors":"Alessio Strazzulla, Vladimir Adrien, Segla Robert Houngnandan, Sandra Devatine, Ouerdia Bahmed, Sarra Abroug, Sarra Hamrouni, Mehran Monchi, Sylvain Diamantis","doi":"10.1017/ash.2024.53","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the factors associated with <i>Pseudomonas aeruginosa</i> isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.</p><p><strong>Materials: </strong>Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of <i>P. aeruginosa</i> patients were compared to overall ICU population. Clinical and microbiological characteristics of <i>P. aeruginosa</i> patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.</p><p><strong>Results: </strong>Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a <i>P. aeruginosa</i> isolate during their staying. In 2011-2014, the percentage <i>P. aeruginosa</i> isolates reduced (7% vs 4%, <i>P</i> ≤ .0001). Patients with <i>P. aeruginosa</i> had higher rates of in-hospital death (43% <i>vs</i> 20%, <i>P</i> < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% <i>vs</i> 2%, <i>P</i> = .0020), fluoroquinolone-resistant (35% vs 12%, <i>P</i> < .0001), and ceftazidime-resistant (23% vs 8%, <i>P</i> = .0009) <i>P. aeruginosa</i> reduced. Treatments by fluoroquinolones (36% vs 4%, <i>P</i> ≤ .0001), carbapenems (27% vs 9%, <i>P</i> = .0002), and third-generation cephalosporins (49% vs 12<i>%</i>, <i>P</i> ≤ .0001) before <i>P. aeruginosa</i> isolation reduced while piperacillin (0% vs 13%, <i>P</i> < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, <i>P</i> = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, <i>P</i> < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, <i>P</i> = .0197). Previous treatment by fluoroquinolones (OR = 2.94, <i>P</i> = .0020) and study period (2007-2010) (OR = 2.07, <i>P</i> = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.</p><p><strong>Conclusions: </strong>Antibiotic susceptibility in <i>P. aeruginosa</i> isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062793/pdf/","citationCount":"0","resultStr":"{\"title\":\"Characteristics of <i>Pseudomonas aeruginosa</i> infection in intensive care unit before (2007-2010) and after (2011-2014) the beginning of an antimicrobial stewardship program.\",\"authors\":\"Alessio Strazzulla, Vladimir Adrien, Segla Robert Houngnandan, Sandra Devatine, Ouerdia Bahmed, Sarra Abroug, Sarra Hamrouni, Mehran Monchi, Sylvain Diamantis\",\"doi\":\"10.1017/ash.2024.53\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate the factors associated with <i>Pseudomonas aeruginosa</i> isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.</p><p><strong>Materials: </strong>Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of <i>P. aeruginosa</i> patients were compared to overall ICU population. Clinical and microbiological characteristics of <i>P. aeruginosa</i> patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.</p><p><strong>Results: </strong>Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a <i>P. aeruginosa</i> isolate during their staying. In 2011-2014, the percentage <i>P. aeruginosa</i> isolates reduced (7% vs 4%, <i>P</i> ≤ .0001). Patients with <i>P. aeruginosa</i> had higher rates of in-hospital death (43% <i>vs</i> 20%, <i>P</i> < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% <i>vs</i> 2%, <i>P</i> = .0020), fluoroquinolone-resistant (35% vs 12%, <i>P</i> < .0001), and ceftazidime-resistant (23% vs 8%, <i>P</i> = .0009) <i>P. aeruginosa</i> reduced. Treatments by fluoroquinolones (36% vs 4%, <i>P</i> ≤ .0001), carbapenems (27% vs 9%, <i>P</i> = .0002), and third-generation cephalosporins (49% vs 12<i>%</i>, <i>P</i> ≤ .0001) before <i>P. aeruginosa</i> isolation reduced while piperacillin (0% vs 13%, <i>P</i> < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, <i>P</i> = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, <i>P</i> < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, <i>P</i> = .0197). Previous treatment by fluoroquinolones (OR = 2.94, <i>P</i> = .0020) and study period (2007-2010) (OR = 2.07, <i>P</i> = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.</p><p><strong>Conclusions: </strong>Antibiotic susceptibility in <i>P. aeruginosa</i> isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.</p>\",\"PeriodicalId\":72246,\"journal\":{\"name\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-04-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062793/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1017/ash.2024.53\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial stewardship & healthcare epidemiology : ASHE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1017/ash.2024.53","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:研究重症监护病房铜绿假单胞菌分离的相关因素:研究重症监护病房(ICU)在实施抗菌药物管理计划前后铜绿假单胞菌分离的相关因素:单中心回顾性队列研究。材料:单中心回顾性队列研究。将铜绿假单胞菌患者的特征与重症监护病房的总体情况进行比较。比较了 AMP 启用前(2007-2010 年)和启用后(2011-2014 年)铜绿假单胞菌患者的临床和微生物学特征:结果:共有5263名患者入住重症监护室,其中274人/5263人(5%)在住院期间分离到铜绿假单胞菌。2011-2014年,铜绿假单胞菌分离率有所下降(7% vs 4%,P ≤ .0001)。铜绿假单胞菌患者的院内死亡率(43% vs 20%,P < .0001)高于重症监护病房的总体死亡率。2011-2014年,耐多药(11% vs 2%,P = .0020)、耐氟喹诺酮(35% vs 12%,P < .0001)和耐头孢唑肟(23% vs 8%,P = .0009)铜绿假单胞菌的发病率有所下降。铜绿假单胞菌分离前使用氟喹诺酮类(36% vs 4%,P ≤ .0001)、碳青霉烯类(27% vs 9%,P = .0002)和第三代头孢菌素类(49% vs 12%,P ≤ .0001)治疗的情况减少,而使用哌拉西林(0% vs 13%,P < .0001)和三甲双胍-磺胺甲噁唑(8% vs 26%,P = .0023)治疗的情况增加。2011-2014年,气管插管率有所下降(61% vs 35%,P < .0001)。接受气管插管治疗的患者对氟喹诺酮类药物的耐药性更高(29% vs 17%,P = .0197)。曾接受氟喹诺酮类药物治疗(OR = 2.94,P = .0020)和研究时间(2007-2010年)(OR = 2.07,P = .0462)是多变量分析中与氟喹诺酮耐药相关的因素:结论:在减少气管插管、氟喹诺酮类、碳青霉烯类和第三代头孢菌素以及增加使用哌拉西林和三甲双氨-磺胺甲噁唑等生态足迹小的分子后,铜绿假单胞菌分离株的抗生素敏感性得到恢复。
Characteristics of Pseudomonas aeruginosa infection in intensive care unit before (2007-2010) and after (2011-2014) the beginning of an antimicrobial stewardship program.
Objectives: To investigate the factors associated with Pseudomonas aeruginosa isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.
Materials: Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of P. aeruginosa patients were compared to overall ICU population. Clinical and microbiological characteristics of P. aeruginosa patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.
Results: Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a P. aeruginosa isolate during their staying. In 2011-2014, the percentage P. aeruginosa isolates reduced (7% vs 4%, P ≤ .0001). Patients with P. aeruginosa had higher rates of in-hospital death (43% vs 20%, P < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% vs 2%, P = .0020), fluoroquinolone-resistant (35% vs 12%, P < .0001), and ceftazidime-resistant (23% vs 8%, P = .0009) P. aeruginosa reduced. Treatments by fluoroquinolones (36% vs 4%, P ≤ .0001), carbapenems (27% vs 9%, P = .0002), and third-generation cephalosporins (49% vs 12%, P ≤ .0001) before P. aeruginosa isolation reduced while piperacillin (0% vs 13%, P < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, P = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, P < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, P = .0197). Previous treatment by fluoroquinolones (OR = 2.94, P = .0020) and study period (2007-2010) (OR = 2.07, P = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.
Conclusions: Antibiotic susceptibility in P. aeruginosa isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.