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Emergence of Antibiotic Resistance in Pseudomonas aeruginosa

The resistance of Pseudomonas aeruginosa to antibiotics is an increasing problem in hospitalized patients. Boston researchers studied the consequences of resistance in 489 inpatients (mean age, 63 years) with P. aeruginosa infection. Patients had high levels of comorbidity (i.e., 49 percent had diabetes mellitus) and severity of illness (28 percent were undergoing a major surgical procedure; 20 percent were transferred from another institution; 19 percent were admitted to an ICU). Resistance to four antibiotics was studied: piperacillin, ceftazidime, ciprofloxacin, and imipenem.

At admission, 144 patients (30 percent) had resistance, whereas resistance emerged in 30 (6 percent). The mortality rate was 27 percent for patients in whom resistance emerged, compared with 6 percent for the remaining 459 patients. The median length of stay following identification of the initial P. aeruginosa isolate was 7 days for patients with baseline resistance, but 24 days for those in whom resistance emerged. After multivariate adjustment to control for confounding factors, emergence of resistance remained associated with a 6-day increase in length of stay.

Comment: In this study inpatient emergence of resistance predicted higher mortality and longer length of stay than baseline resistance or continued susceptibility of the organism, even after controlling for severity of illness. It remains to be seen whether close surveillance and early detection of emergent antibiotic resistance of pseudomonas will improve outcomes.

— TL Schwenk

Published in Journal Watch General Medicine June 11, 1999

Citation(s):

Carmeli Y et al. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999 May 24 159 1127-1132.

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