Mortality in patients with carbapenem-resistant Pseudomonas aeruginosa with and without susceptibility to traditional antipseudomonal β-lactams.

• Type of Material: Article
• Authors: Jessica Howard-Anderson, Emory University; Chris W Bower, Georgia Emerging Infections Program; Gillian Smith, Georgia Emerging Infections Program, Atlanta, GA, USA.; Sarah W Satola, Emory University; Jesse Jacob, Emory University
• Language: English
• Date: 2021-12
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/jacamr/dlab187
• Title of Journal or Parent Work: JAC Antimicrob Resist
• Volume: 3
• Issue: 4
• Start Page: dlab187
• End Page: dlab187
• Grant/Funding Information: Surveillance of carbapenem-resistant P. aeruginosa was funded through the Centers for Disease Control and Prevention Emerging Infection Program (U50CK000485). J.H.-A. was supported by the Antibacterial Resistance Leadership Group fellowship (National Institute of Allergy and Infectious Diseases UM1AI104681). Funding agencies were not involved in the study design, data analysis, interpretation of results or drafting of the manuscript.
• Keywords: inpatients; surveillance; pseudomonas aeruginosa; ceftazidime; piperacillin/tazobactam; adult; urine; lactams; cefepime; medical; mortality; intensive care unit; emerging communicable diseases; arbapenem resistance
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates can frequently retain susceptibility to traditional antipseudomonal β-lactams including cefepime, ceftazidime and piperacillin/tazobactam. OBJECTIVES: This observational study aimed to determine the proportion of CRPA isolates that were susceptible to all tested other traditional antipseudomonal β-lactams (S-CRPA) and assess whether patients with S-CRPA had improved 30 day mortality compared with patients with NS-CRPA (non-susceptible to cefepime, ceftazidime or piperacillin/tazobactam). METHODS: Patients with CRPA isolated from normally sterile sites, urine, lower respiratory tracts and wounds were identified using active population- and laboratory-based surveillance through the Georgia Emerging Infections Program from August 2016 to July 2018 in Atlanta, GA, USA. Only unique patients who were hospitalized at the time of, or within 1 week of, culture were included. We excluded patients with cystic fibrosis. Multivariable logistic regression estimated the association between S-CRPA and 30 day mortality. RESULTS: Among 635 adults hospitalized with CRPA, 219 (34%) had S-CRPA. Patients with S-CRPA were more likely to be white (50% versus 38%, P = 0.01) and live in a private residence prior to culture (44% versus 28%, P < 0.01), and less likely to have required ICU care within the prior week (23% versus 36%, P < 0.01) compared with patients with NS-CRPA. Compared with those with NS-CRPA, patients with S-CRPA had an increased 30 day mortality (18% versus 15%, adjusted OR 1.9; 95% CI 1.2-3.1). CONCLUSIONS: S-CRPA was associated with higher 30 day mortality than NS-CRPA in hospitalized patients. The reason for this observed increase in mortality deserves further investigation.