The influence of metallo-β-lactamase production on mortality in nosocomial Pseudomonas aeruginosa infections

被引:87
作者
Zavascki, Alexandre Prehn
Barth, Afonso Luis
Saraiva Goncalves, Ana Lucia
Didonet Moro, Ana Lucia
Fernandes, Juliana Fernandez
Martins, Andreza Francisco
Ramos, Fabiano
Goldani, Luciano Zubaran
机构
[1] Pontificia Univ Catolica Rio Grande do Sul, Hosp Sao Lucas, Infect Dis Serv, BR-90610000 Porto Alegre, RS, Brazil
[2] Univ Fed Rio Grande do Sul, Med Med Sci Postgrad Program, BR-90046900 Porto Alegre, RS, Brazil
[3] Hosp Clin Porto Alegre, Clin Pathol Serv, Microbiol Unit, Porto Alegre, RS, Brazil
[4] Pontificia Univ Catolica Rio Grande do Sul, Sch Med, BR-90610000 Porto Alegre, RS, Brazil
[5] Univ Fed Rio Grande do Sul, Sch Med, BR-90046900 Porto Alegre, RS, Brazil
[6] Hosp Clin Porto Alegre, Div Infect Dis, Porto Alegre, RS, Brazil
关键词
P; aeruginosa; resistance; beta-lactamases; nosocomial infections;
D O I
10.1093/jac/dkl239
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: To assess the effect of metallo-beta-lactamase (MBL) production on Pseudomonas aeruginosa nosocomial infection mortality and to identify the determinants of such effect. Methods: A cohort study of patients with A aeruginosa nosocomial infections was conducted at two teaching hospitals. MBL was detected by ceftazidime/2-mercaptopropionic disc approximation test and selected isolates were submitted to PCR using bla(SPM1) primer. Molecular typing was performed by DNA macrorestriction. To evaluate the influence of MBL on mortality a Cox proportional hazards model was performed using a hierarchized framework of the variables. Results: A total of 298 patients with A aeruginosa infections were included. Infections by MBL-carrying Pseudomonas aeruginosa (MBL-PA) resulted in higher in-hospital mortality than those by non-MBL-PA (51.2% versus 32.1%, respectively; relative risk 1.60, 95% CI 1.20-2.12) and higher mortality rates [17.3 per 1000 versus 11.8 per 1000 patient-days, respectively; hazard ratio (HR) 1.55, 95% CI 1.06-2.27]. In the final multivariate model, severe sepsis or septic shock [adjusted HR (AHR) 3.62, 95% CI 2.41-5.43], age (AHR 1.02, 95% CI 1.01-1.03) and use of appropriate therapy: 72 h (AHR 0.49, 95% CI 0.32-0.76) were significantly associated with mortality. Fourteen MBL-PA tested carried the bla(SPM-1) gene. Clonal dissemination was documented in both hospitals. Conclusions: MBL-PA infections resulted in higher mortality rates most likely related to the severity of these infections and less frequent early institution of appropriate antimicrobial therapy. Empirical treatments should be reviewed at institutions with high prevalence of MBL.
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收藏
页码:387 / 392
页数:6
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