<i>Pseudomonas aeruginosa</i> in the ICU: prevalence, resistance profile, and antimicrobial consumption

Ribeiro, Ághata Cardoso da Silva; Crozatti, Márcia Terezinha Lonardoni; Silva, Adilson Aderito da; Macedo, Rodrigo Spineli; Machado, Antonia Maria de Oliveira; Silva, Antonio Távora de Albuquerque

doi:10.1590/0037-8682-0498-2018

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 53 • 2020 • https://doi.org/10.1590/0037-8682-0498-2018 copy

Pseudomonas aeruginosa in the ICU: prevalence, resistance profile, and antimicrobial consumption

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance.

METHODS:

Data were obtained from ICUs between 2010 and 2013.

RESULTS:

P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B.

CONCLUSIONS:

Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.

Keywords:
Pseudomonas aeruginosa; Antimicrobial agents; Drug resistance

Class / Antimicrobial agent	Total isolates	Total resistant		Resistant isolates
	(S+I+R)	isolates
				2010		2011		2012		2013
	n	N	%	n	%	N	%	n	%	n	%
Aminoglycosides
Amikacin	925	263	28.4	98	37.3	67	25.5	63	24.0	35	13.3
Streptomycin	11	6	54.6	1	16.7	0	0.0	4	66.7	1	16.7
Gentamicin	938	434	46.3	146	33.6	92	21.2	87	20.0	109	25.1
Tobramycin	53	34	64.2	0	0.0	4	11.8	25	73.5	5	14.7
Carbapenems
Ertapenem	23	10	43.5	0	0.0	0	0.0	1	10.0	9	90.0
Imipenem	931	477	51.2	127	26.6	116	24.3	108	22.6	126	26.4
Meropenem	930	473	50.9	129	27.3	112	23.7	103	21.8	129	27.3
Cephalosporins
Cefepime	928	410	44.2	132	32.2	92	22.4	81	19.8	105	25.6
Cefotaxime	26	26	100.0	8	30.8	6	23.1	4	15.4	8	30.8
Cefoxitin	1	1	100.0	0	0.0	0	0.0	0	0.0	1	100.0
Ceftazidime	920	366	39.8	124	33.9	73	19.9	67	18.3	102	27.9
Ceftriaxone	35	32	91.4	2	6.3	1	3.1	5	15.6	24	75.0
Fluoroquinolones
Ciprofloxacin	928	459	49.5	155	33.8	103	22.4	85	18.5	116	25.3
Levofloxacin	3	3	100.0	2	66.7	0	0.0	0	0.0	1	33.3
Moxifloxacin	2	0	0.0	0	0.0	0	0.0	0	0.0	0	0.0
Norfloxacin	90	49	54.4	27	55.1	12	24.5	7	14.3	3	6.1
Monobactams
Aztreonam	924	377	40.8	101	26.8	87	23.1	83	22.0	106	28.1
Polymyxins
Polymyxin B	766	7	0.9	0	0.0	1	14.3	0	0.0	6	85.7
Penicillins
Amoxicillin	31	28	90.3	1	3.6	1	3.6	3	10.7	23	82.1
Ampicillin	15	12	80.0	2	16.7	1	8.3	6	50.0	3	25.0
Oxacillin	2	2	100.0	2	100.0	0	0.0	0	0.0	0	0.0
Penicillin	9	7	77.8	0	0.0	1	14.3	4	57.1	2	28.6
Piperacillin/Tazobactam	929	334	36.0	130	38.9	83	24.9	58	17.4	63	18.9
Macrolides
Erythromycin	2	2	100.0	2	100.0	0	0.0	0	0.0	0	0.0
Lincosamides
Clindamycin	2	2	100.0	2	100.0	0	0.0	0	0.0	0	0.0
Oxazolidinones
Linezolid	11	0	0.0	0	0.0	0	0.0	0	0.0	0	0.0
Sulfonamides
Sulfamethoxazole/ Trimethoprim	7	6	85.7	2	33.3	0	0.0	2	33.3	2	33.3
Glycopeptides
Teicoplanin	10	5	50.0	0	0.0	0	0.0	2	40.0	3	60.0
Vancomycin	11	8	72.7	0	0.0	1	12.5	3	37.5	4	50.0
Tetracyclines
Tigecycline	17	2	11.8	1	50.0	0	0.0	0	0.0	1	50.0
Others
Ethambutol	2	0	0.0	0	0.0	0	0.0	0	0.0	0	0.0
Isoniazid	2	0	0.0	2	0.0	0	0.0	0	0.0	0	0.0
Nitrofurantoin	2	1	50.0	0	0.0	0	0.0	0	0.0	1	100.0
Pyrazinamide	2	0	0.0	0	0.0	0	0.0	0	0.0	0	0.0
Rifampicin	4	1	25.0	1	100.0	0	0.0	0	0.0	0	0.0

Antimicrobial agent	*Trend in the prevalence of P. aeruginosa* resistance**				Trend in antimicrobial agent consumption
	β	p	Trend	KS significance	β	p	Trend	KS significance
Amikacin	-0.345	0.016	decreasing	0.974	0.793	0.000	increasing	0.445
Gentamicin	0.037	0.802	increasing	0.769	0.746	0.000	increasing	0.845
Ciprofloxacin	0.040	0.786	increasing	0.966	0.188	0.200	increasing	0.341
Imipenem	0.419	0.003	increasing	0.927	-0.875	0.000	decreasing	0.904
Meropenem	0.485	0.000	increasing	0.754	0.571	0.000	increasing	0.301
Cefepime	0.163	0.269	increasing	0.470	-0.825	0.000	decreasing	0.575
Ceftazidime	0.217	0.138	increasing	0.967	0,336	0.020	increasing	0.016
Piperacillin/ Tazobactam	-0.301	0.038	decreasing	0.673	0.245	0.094	increasing	0.889
Polymyxin B	0.401	0.005	increasing	0.010	0.625	0.000	increasing	0.210

Antimicrobial agent	β	p	Impact	KS significance
Amikacin	-0.361	0.012	Negative	0.774
Gentamicin	0.082	0.579	Positive	0.858
Ciprofloxacin	-0.002	0.992	Negative	0.881
Imipenem	-0.316	0.029	Negative	0.350
Meropenem	0.327	0.023	Positive	0.534
Cefepime	-0.239	0.102	Negative	0.399
Ceftazidime	-0.199	0.176	Negative	0.982
Piperacillin/Tazobactam	-0.062	0.675	Negative	0.953
Polymyxin B	0.351	0.014	Positive	0.001

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[1] Corresponding author: Ághata Cardoso da Silva Ribeiro. e-mail:aghata.cardoso@unifesp.br