J Korean Med Sci.  2021 Nov;36(43):e273. 10.3346/jkms.2021.36.e273.

Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance in Pseudomonas aeruginosa Bacteremia: 12-Year Experience in a Tertiary Hospital in Korea

• Kang JS
• Moon C
• Mun SJ
• Lee JE
• Lee SO
• Lee S
• Lee SH

• KMID: 2522286
• DOI: http://doi.org/10.3346/jkms.2021.36.e273

Abstract

Background
Infections caused by multidrug-resistant Pseudomonas aeruginosa (MDRPA) have been on the rise worldwide, and delayed active antimicrobial therapy is associated with high mortality. However, few studies have evaluated increases in P. aeruginosa infections with antimicrobial resistance and risk factors for such antimicrobial resistance in Korea. Here, we analyzed changes in antimicrobial susceptibility associated with P. aeruginosa bacteremia and identified risk factors of antimicrobial resistance.
Methods
The medical records of patients with P. aeruginosa bacteremia who were admitted to a tertiary hospital between January 2009 and October 2020 were retrospectively reviewed. Antibiotic resistance rates were compared among the time periods of 2009–2012, 2013–2016, and 2017–2020 and between the intensive care unit (ICU) and non-ICU setting. Empirical antimicrobial therapy was considered concordant, if the organism was susceptible to antibiotics in vitro, and discordant, if resistant.
Results
During the study period, 295 patients with P. aeruginosa bacteremia were identified. The hepatobiliary tract (26.8%) was the most common primary site of infection. The rates of carbapenem-resistant P. aeruginosa (CRPA), MDRPA, and extensively drug-resistant P. aeruginosa (XDRPA) were 24.7%, 35.9%, and 15.9%, respectively. XDRPA showed an increasing trend, and CRPA, MDRPA, and XDRPA were also gradually increasing in non-ICU setting. Previous exposure to fluoroquinolones and glycopeptides and urinary tract infection were independent risk factors associated with CRPA, MDRPA, and XDRPA. Previous exposure to carbapenems was an independent risk factor of CRPA. CRPA, MDRPA, and XDRPA were associated with discordant empirical antimicrobial therapy.
Conclusion
The identification of risk factors for antimicrobial resistance and analysis of antimicrobial susceptibility might be important for concordant empirical antimicrobial therapy in patients with P. aeruginosa bacteremia.

Keyword

Pseudomonas aeruginosa; Bacteremia; Multidrug Resistance; Risk Factors

Figure

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  Fig. 1 Annual antimicrobial susceptibility trends in P. aeruginosa bacteremia.

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  Fig. 2 Results of antimicrobial susceptibility in P. aeruginosa bacteremia for 2009–2012, 2013–2016, and 2017–2020. The P value was a comparison between susceptible and non-susceptible.NA = not applicable, S = susceptible, I = intermediate, R = resistant.

• 

  Fig. 3 Antimicrobial resistance trends in P. aeruginosa bacteremia. (A) Antimicrobial resistance rates in P. aeruginosa bacteremia. (B) Comparison of antibiotic resistance rates of the ICUs vs. the non-ICUs setting.CRPA = carbapenem-resistant P. aeruginosa, MDRPA = multidrug-resistant P. aeruginosa, XDRPA = extensively drug-resistant P. aeruginosa, ICU = intensive care unit.*Comparison between 2009–2013 and 2017–2020; **Comparison of the three groups.

• 

  Fig. 4 Survival curve according to antibiotic resistance in patientsa with P. aeruginosa bacteremia.CRPA = carbapenem-resistant P. aeruginosa, MDRPA = multidrug-resistant P. aeruginosa, XDRPA = extensively drug-resistant P. aeruginosa.aPatients who did not show polymicrobial bacteremia, received active antimicrobial therapy during their hospital stay, and were hospitalized for more than 5 days after the onset of bacteremia.

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