Population-based epidemiological study of infections caused by carbapenem-resistant Pseudomonas aeruginosa in the Calgary Health Region:: Importance of metallo-β-lactamase (MBL)-producing strains

被引:86
作者
Laupland, KB
Parkins, MD
Church, DL
Gregson, DB
Louie, TJ
Conly, JM
Elsayed, S
Pitout, JDD
机构
[1] Calgary Lab Serv, Div Microbiol, Calgary, AB T2L 2K8, Canada
[2] Univ Calgary, Dept Med, Calgary, AB, Canada
[3] Univ Calgary, Dept Pathol & Lab Med, Calgary, AB, Canada
[4] Univ Calgary, Dept Crit Care Med, Calgary, AB, Canada
[5] Univ Calgary, Dept Microbiol & Infect Dis, Calgary, AB, Canada
[6] Ctr Antimicrobial Resistance, Calgary, AB, Canada
[7] Calgary Hlth Reg, Calgary, AB, Canada
关键词
D O I
10.1086/444469
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. A study was conducted in the Calgary Health Region between May 2002 and April 2004 to define the population-based epidemiological characteristics of infections caused by imipenem-resistant Pseudomonas aeruginosa and to explore the clinical outcomes due to metallo-beta-lactamase (MBL) - producing and non - MBL-producing strains. Methods. Detailed clinical information was obtained by chart review, and phenotypic and molecular characterizations were performed using the MBL E-test, polymerase chain reaction with sequencing, and pulsed-field gel electrophoresis. Results. A total of 228 patients with infections caused by imipenem-resistant P. aeruginosa were identified ( annual incidence, 10.5 cases/100,000 population), with the highest incidence rate in those >= 75 years old. MBL-producing strains (98/228) were associated with higher rates of multidrug resistance and bacteremia. Ninety MBL-producing strains also produced VIM-2, 4 produced IMP-7, and 4 were unclassified. A cluster of VIM-2 - producing strains was responsible for a nosocomial outbreak during 2003. The case-fatality rate was significantly higher for infections caused by MBL-producing strains than for those caused by non - MBL-producing strains (25% vs. 13%; relative risk, 1.98 [95% confidence interval, 1.00 - 3.90]; P = .05). Conclusion. MBL-producing P. aeruginosa strains were associated with a higher case-fatality rate and invasive disease. Our study highlights the potential importance of molecular laboratory techniques in infection control and patient care.
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页码:1606 / 1612
页数:7
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