Ann Lab Med.  2024 Jan;44(1):38-46. 10.3343/alm.2024.44.1.38.

Changing Genotypic Distribution, Antimicrobial Susceptibilities, and Risk Factors of Urinary Tract Infection Caused by Carbapenemase-Producing Pseudomonas aeruginosa

• Jeong S
• Jeon K
• Lee N
• Park MJ
• Song W

• KMID: 2550221
• DOI: http://doi.org/10.3343/alm.2024.44.1.38

Abstract

Background
Carbapenem-resistant Pseudomonas aeruginosa (CrPA) is a leading cause of healthcare-associated urinary tract infections (UTIs). Carbapenemase production is an important mechanism that significantly alters the efficacy of frequently used anti-pseudomonal agents. Reporting the current genotypic distribution of carbapenemase-producing P. aeruginosa (CPPA) isolates in relation to antimicrobial susceptibility, UTI risk factors, and mortality is necessary to increase the awareness and control of these strains.
Methods
In total, 1,652 non-duplicated P. aeruginosa strains were isolated from hospitalized patients between 2015 and 2020. Antimicrobial susceptibility, carbapenemase genotypes, risk factors for UTI, and associated mortality were analyzed.
Results
The prevalence of carbapenem-non-susceptible P. aeruginosa isolates showed a decreasing trend from 2015 to 2018 and then increased in the background of the emergence of New Delhi metallo-β-lactamase (NDM)-type isolates since 2019. The CPPA strains showed 100.0% non-susceptibility to all tested antibiotics, except aztreonam (94.5%) and colistin (5.9%). Carbapenems were identified as a risk and common predisposing factor for UTI (odds ratio [OR] = 1.943) and mortality (OR = 2.766). Intensive care unit (ICU) stay (OR = 2.677) and white blood cell (WBC) count (OR = 1.070) were independently associated with mortality.
Conclusions
The changing trend and genetic distribution of CPPA isolates emphasize the need for relentless monitoring to control further dissemination. The use of carbapenems, ICU stay, and WBC count should be considered risk factors, and aggressive antibiotic stewardship programs and monitoring may serve to prevent worse outcomes.

Keyword

Carbapenemase; Imipenemase; Metallo-β-lactamase; New Delhi metallo-β-lactamase; Pseudomonas aeruginosa; Urinary tract infection

Figure

• 

  Fig. 1 Distribution of carbapenem-non-susceptible and carbapenemase-producing Pseudomonas aeruginosa isolates detected between 2015 and 2020. Urine samples were predominant (84.9%); other samples included respiratory tract (7.0%) and wound (2.3%) samples. Abbreviations: GES, Guiana extended-spectrum β-lactamase; IMP, imipenase; NDM, New Delhi metallo-β-lactamase.

• 

  Fig. 2 Antimicrobial susceptibilities of 503 urinary Pseudomonas aeruginosa isolates from inpatients detected between 2015 and 2020. (A) Carbapenem-susceptible isolates (N=227); (B) carbapenem-non-susceptible and non-carbapenemase producers (N=57); and (C) carbapenem-non-susceptible and carbapenemase producers (N=219). The red, pink, and green bars represent the antimicrobial-resistant, -intermediate, and -susceptible isolates, respectively.

• 

  Fig. 3 Performance of combined variables (the use of carbapenems, intensive care unit stay, and white blood cell count) for predicting mortality in patients with urinary Pseudomonas aeruginosa isolates.

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