Background
Author (Year) | Country | Setting | Rates of resistance | Ref. |
---|---|---|---|---|
NNIS (2004) | USA | ICU | Imipenem resistance = 15% | [18] |
Quinolone resistance = 9% | ||||
3rd-generation cephalosporin resistance = 20% | ||||
Obritsch et al. (2004) | USA | ICU | MDR P. aeruginosa (defined as resistance to at least three of the following four drugs: imipenem, ceftazidime, ciprofloxacin, and tobramycin) increased from 4% in 1993 to 14% in 2002 | [19] |
Morrow et al. (2013) | USA | Tertiary | Doripenem resistance = 11.4% | [20] |
Imipenem resistance = 21.9% | ||||
Meropenem resistance = 15.4% | ||||
Levofloxacin resistance = 26.0% | ||||
Ceftazidime resistance = 15.2% | ||||
Tobramycin resistance = 10.1% | ||||
Piperacillin / tazobactam resistance = 14.7% | ||||
Souli et al. (2008), European Center for Disease Prevention and Control (2013) | Europe | Tertiary | Carbapenem resistance = > 25% | |
De Francesco et al. (2013) | Italy | Tertiary | MDR P. aeruginosa (defined as resistance to 5 commonly prescribed antibiotics) increased from 2.1% in 2007 to 4.1% in 2010 | [23] |
Joo et al. (2011) | Korea | Tertiary | Ceftazidime resistance = 37% | [24] |
Piperacillin resistance = 22% | ||||
Imipenem resistance = 23% | ||||
Fluoroquinolone resistance = 24% | ||||
Aminoglycoside resistance = 18% | ||||
Gales et al. (2001) | South America | Tertiary | MDR resistance = 8.2% | [25] |
Raja et al. (2001) | Malaysia | Tertiary | MDR resistance = 6.9% | [26] |
Methods
Study (Year) | Study Design | Setting/ location | Source of Infection | Definition of Resistance / Controls | Study Population | Patients (n) | Ref. |
---|---|---|---|---|---|---|---|
Akhabue et al. (2011) | Retrospective Observational | Tertiary; USA | Genitourinary, respiratory wound, blood, tissue | Culture positive results for cefepime susceptible or resistant P. aeruginosa | Cefepime resistant P. aeruginosa | 213 | [61] |
Susceptible P. aeruginosa | 2316 | ||||||
Brooklyn Antibiotic Resistance Task Force (2002) | Retrospective Observational | Tertiary; USA | Genitourinary, respiratory, wound | Culture positive results for carbapenem susceptible or resistant P. aeruginosa | Susceptible P. aeruginosa | 10 | [60] |
Resistant P. aeruginosa | 10 | ||||||
Cao et al. (2004) | Retrospective Observational | Tertiary; China | Genitourinary, respiratory wound, blood, tissue | Culture positive results for susceptible or MDR P. aeruginosa (when the absence of susceptibility to three or more antibiotics: ceftazidime, cefepime, piperacillin, ciprofloxacin, gentamicin, and imipenem or meropenem) | MDR P. aeruginosa | 44 | [57] |
Susceptible P. aeruginosa | 68 | ||||||
Eagye et al. (2009) | Retrospective Observational | Tertiary; USA | Genitourinary, respiratory, wound | Culture positive results for meropenem susceptible or resistant P. aeruginosa; control patients were located in the same unit and on the same day as cases and without 105 DRG codes related to infection | Meropenem resistant P. aeruginosa | 58 | [53] |
Susceptible P. aeruginosa | 125 | ||||||
Control | 57 | ||||||
Evans et al. (2007) | Retrospective Observational | Tertiary; USA | Genitourinary, respiratory, wound | Culture positive results for susceptible or resistant P. aeruginosa; resistance defined as resistance to all the drugs in one or more of the following antibiotic classes: aminoglycosides, cephalosporins, carbapenems, and fluoroquinolones. | Susceptible P. aeruginosa | 73 | [71] |
Resistant P. aeruginosa | 47 | ||||||
Furtado et al. (2009) | Retrospective Observational | ICU; Brazil | Genitourinary, respiratory, wound | Culture positive results for imipenem susceptible or resistant P. aeruginosa; control patients were hospitalized in the same ICU unit as the case participants and matched by time (within a 30-day interval), age (within a 10-year interval), and time at risk (control patients were imipenem susceptible) | Imipenem resistant P. aeruginosa | 63 | [62] |
Control | 182 | ||||||
Furtado et al. (2011) | Prospective Observational | Tertiary; Brazil | Respiratory | Culture positive results for imipenem susceptible or resistant P. aeruginosa; Isolates were screened for the presence of metallo-β-lactamases by using multiplex PCR. | São Paulo Metallo-β-lactamase (SPM-1) producing imipenem resistant P. aeruginosa | 5 | [68] |
Non-SPM-1-producing susceptible P. aeruginosa | 24 | ||||||
Gasink et al. (2006) | Retrospective Observational | Tertiary; USA | Respiratory, wound | Culture positive results for fluoroquinolone susceptible or resistant P. aeruginosa | Fluoroquinolone resistant P. aeruginosa | 320 | [64] |
Susceptible P. aeruginosa | 527 | ||||||
Hirakata et al. (2003) | Retrospective Observational | Tertiary; Japan | Genitourinary, respiratory, wound | Culture positive results for blaIMP-positive or negative P. aeruginosa; control subjects selected at random from among inpatients; control subjects samples were blaIMP-negative P. aeruginosa | blaIMP-positive P. aeruginosa | 69 | [69] |
blaIMP-negative P. aeruginosa | 247 | ||||||
Kaminski et al. (2011) | Nested case cohort | ICU; France | Respiratory | Culture positive results for Ureido/carboxypenicillin susceptible or resistant P. aeruginosa | Ureido/carboxypenicillin-resistant P. aeruginosa | 70 | [66] |
Susceptible P. aeruginosa | 153 | ||||||
Lambert et al. (2011) | Prospective Observational | ICU; EU | Respiratory | Susceptibility testing in different centers was done according to local policies | Ceftazidime resistant P. aeruginosa | 366 | [31] |
Susceptible P. aeruginosa | 1266 | ||||||
Lautenbach et al. (2010) | Retrospective Observational | Tertiary; USA | Genitourinary, respiratory wound, blood, tissue | Culture positive results for imipenem susceptible or resistant P. aeruginosa | Imipenem resistant P. aeruginosa | 253 | [63] |
Susceptible P. aeruginosa | 2289 | ||||||
Montero et al. (2009) | Retrospective Observational | Tertiary; Spain | Respiratory | Culture positive results for P. aeruginosa; MDR when the absence of susceptibility to three or more antibiotic families (betalactams, quinolones, carbapenems, and aminoglycosides); control patients also had nosocomial infection (20% with P. aeruginosa), but were not multidrug-resistant | MDR P. aeruginosa | 50 | [58] |
Control | 50 | ||||||
Morales et al. (2012) | Retrospective Observational | Tertiary; Spain | Genitourinary, respiratory, wound | Culture positive results for susceptible or resistant P. aeruginosa; MDR when strains were resistant to carbapenems, β-lactams, quinolones, tobramycin, and gentamicin | MDR P. aeruginosa | 134 | [49] |
Resistant P. aeruginosa | 119 | ||||||
Susceptible P. aeruginosa | 149 | ||||||
Paramythiotou et al. (2004) | Retrospective Observational (matched) | ICU; France | Genitourinary, respiratory, wound | Culture positive results for susceptible or resistant P. aeruginosa; MDR were resistant to piperacillin, ceftazidime, imipenem, and ciprofloxacin; control patient was hospitalized in the same ICU as the corresponding case participant during the study period but whose microbiological cultures for P. aeruginosa showed no growth at any time during their ICU stay. Controls matched to cases for length of ICU stay. | MDR P. aeruginosa | 37 | [54] |
Control | 34 | ||||||
Peña et al. (2013) | Retrospective Observational | Tertiary; Spain | Respiratory | MDR defined as strains non-susceptible to > = 1 agent in > = 3 anti-pseudomonal antimicrobial categories (carbapenems, β-lactams, quinolones, tobramycin, and gentamicin) | MDR P. aeruginosa | 27 | [56] |
Susceptible P. aeruginosa | 56 | ||||||
Scheetz et al. (2006) | Retrospective Observational | Tertiary; USA | Blood | Culture positive results for fluoroquinolone susceptible or resistant P. aeruginosa | Fluoroquinolone resistant P. aeruginosa | 79 | [65] |
Fluoroquinolone susceptible P. aeruginosa | 136 | ||||||
Söderström et al. (2009) | Retrospective Observational (matched) | Tertiary; Finland | Wound | Culture positive results for resistant P. aeruginosa to ciprofloxacin, tobramycin, and a combination of piperacillin and tazobactam; A control participant with negative MDR P. aeruginosa culture was matched to each study participant (a drug-sensitive strain of P. aeruginosa was cultured from 31 control participants (48%)) | MDR P. aeruginosa | 64 | [59] |
Control | 64 | ||||||
Tam et al. (2009) | Retrospective Observational | Tertiary; USA | Blood | Culture positive results for AmpC++ by ceftazidime susceptibility with and without clavulanic acid | AmpC++ P. aeruginosa | 21 | [72] |
Wild-type P. aeruginosa | 33 | ||||||
Tam et al. (2010) | Retrospective Observational | Tertiary; USA | Blood | MDR was defined as culture positive results for resistance to three or more of the following four classes of agents: antipseudomonal carbapenems, antipseudomonal β-lactams (penicillins and cephalosporins), aminoglycosides, and fluoroquinolones | MDR P. aeruginosa | 25 | [13] |
Susceptible P. aeruginosa | 84 | ||||||
Trouillet et al. (2002) | Prospective Observational | ICU; France | Respiratory | Culture positive results for piperacillin susceptible or resistant P. aeruginosa | Piperacillin resistant P. aeruginosa | 34 | [67] |
Piperacillin susceptible P. aeruginosa | 101 | ||||||
Tumbarello et al. (2013) | Retrospective Observational | ICU; Italy | Respiratory | Culture positive results for piperacillin susceptible or resistant P. aeruginosa; MDR if in vitro resistance to >1 antipseudomonal agent in 3 or more of the following categories: β-lactam/β-lactamase inhibitors, cephalosporins, carbapenems, quinolones and aminoglycosides | MDR P. aeruginosa | 42 | [55] |
Non-MDR P. aeruginosa | 68 | ||||||
Zavascki et al. (2006) | Prospective Observational | Tertiary; Brazil | Blood, genitourinary, respiratory, wound | Culture positive results for metallo-β-lactamase (MBL) –carrying versus non-MBL- carrying P. aeruginosa | MBL-carrying P. aeruginosa | 86 | [70] |
Non-MBL-carrying P. aeruginosa | 212 |
Results and discussion
Study characteristics
Mortality outcomes
Setting | Author | Study groups (n) | In-Hospital Mortality | Reported P-value | Ref |
---|---|---|---|---|---|
Tertiary care center | Akhabue et al. (2011) | Cefepime resistant P. aeruginosa (213) | 20% | 0.007 | [61] |
Susceptible P. aeruginosa (2316) | 13% | ||||
Brooklyn Antibiotic Resistance Task Force (2002) | Carbapenem resistant P. aeruginosa (10) | 20% | > 0.05 (NS) | [60] | |
Susceptible P. aeruginosa (10) | 10% | ||||
Cao et al. (2004) | MDR P. aeruginosad (44) | 55% | 0.05 | [57] | |
Susceptible P. aeruginosa (68) | 16% | ||||
Eagye et al. (2009) | Meropenem resistant P. aeruginosa (58) | 31% | 0.152a | [53] | |
Meropenem susceptible P. aeruginosa (125) | 15% | ||||
Meropenem resistant P. aeruginosa (58) | 31% | 0.01a | |||
Control (57) | 9% | ||||
Evans et al. (2007) | Resistant P. aeruginosae (47) | 15% | 0.43 | [71] | |
Susceptible P. aeruginosa (73) | 21% | ||||
Furtado et al. (2011) | SPM-1-producing imipenem resistant P. aeruginosa (5) | 60% | 0.59 | [68] | |
Non-SPM-1-producing susceptible P. aeruginosa (24) | 75% | ||||
Gasink et al. (2006) | Fluoroquinolone resistant P. aeruginosa (320) | 24% | 0.004 | [64] | |
Fluoroquinolone susceptible P. aeruginosa (527) | 16% | ||||
Hirakata et al. (2003) | blaIMP-positive P. aeruginosa (69) | 30.4% | 0.41 | [69] | |
blaIMP-negative P. aeruginosa (247) | 25.5% | ||||
Lautenbach et al. (2010) | Imipenem resistant P. aeruginosa (253) | 17% | 0.01 | [63] | |
Imipenem susceptible P. aeruginosa (2289) | 13% | ||||
Morales et al. (2012) | MDR P. aeruginosaf (134) | 25% | < 0.05 | [49] | |
Susceptible P. aeruginosa (149) | 13% | ||||
Resistant P. aeruginosa (119) | 22% | <0.05 | |||
Susceptible P. aeruginosa (149) | 13% | ||||
Peña et al. (2013) | Non-MDR P. aeruginosa (27) | 55% | 0.33 | [56] | |
MDR P. aeruginosag (56) | 50% | ||||
Scheetz et al. (2006) | Fluoroquinolone resistant P. aeruginosa (79) | 32% | 0.731 | [65] | |
Fluoroquinolone susceptible P. aeruginosa (136) | 29% | ||||
Tam et al. (2010) | MDR P. aeruginosah (25) | 56% | 0.001 | [13] | |
Susceptible P. aeruginosa (84) | 17% | ||||
Zavascki et al. (2006) | MBL-carrying P. aeruginosa (86) | 51.2% | 0.003 | [70] | |
Non-MBL-carrying P. aeruginosa (212) | 32.1% | ||||
ICU | Lambert et al. (2011) | Ceftazidime resistant P. aeruginosa (362)b | 43% | NR | [31] |
Susceptible P. aeruginosa (1251)b | 37% | ||||
Ceftazidime resistant P. aeruginosa (82)c | 41% | ||||
Susceptible P. aeruginosa (280)c | 39% | ||||
Furtado et al. (2009) | Imipenem resistant P. aeruginosa (63) | 49% | 0.02 | [62] | |
Control (182) | 34% | ||||
Kaminski et al. (2011) | Ureido/carboxypenicillin resistant P. aeruginosa (70) | 43% | 0.56 | [66] | |
Ureido/carboxypenicillin susceptible P. aeruginosa (153) | 44% | ||||
Paramythiotou et al. (2004) | MDR P. aeruginosai (34) | 47% | 0.8 | [54] | |
Control (34) | 50% | ||||
Trouillet et al. (2002) | Piperacillin resistant P. aeruginosa (34) | 59% | > 0.05 (NS) | [67] | |
Piperacillin susceptible P. aeruginosa (101) | 50% | ||||
Tumbarello et al. 2013 | MDR P. aeruginosaj (42) | 60% | 0.01 | [55] | |
Susceptible P. aeruginosa (68) | 35% |
Setting | Author | Study groups (n) | Infection-related In-Hospital Mortality | P-value | Ref |
---|---|---|---|---|---|
Tertiary Care Center | Cao et al | MDR P. aeruginosaa (44) | 45.5% | <0.05 | [57] |
Susceptible P. aeruginosa (68) | 7.4% | ||||
Hirakata et al | blaIMP-positive P. aeruginosa (69) | 5.8% | 0.02 | [69] | |
blaIMP-negative P. aeruginosa (247) | 1.2% | ||||
Tam et al | MDR P. aeruginosab (25) | 52% | <0.001 | [13] | |
Susceptible P. aeruginosa (84) | 9.5% |
Economic outcomes
Author | Study groups (n) | Median (mean) Hospital Length of Stay (days) | Reported Significance (p-value or 95% CI) | Ref |
---|---|---|---|---|
Main findings | ||||
Brooklyn Antibiotic Resistance Task Force (2002)* | Carbapenem susceptible P. aeruginosa (10) | 20 (17) | 0.002 (0.001) | [60] |
Carbapenem resistant P. aeruginosa (10) | 33.5 (36) | |||
Eagye et al. (2009)* | Meropenem resistant P. aeruginosa (58) | 30 | <0.001 | [53] |
Meropenem susceptible P. aeruginosa (125) | 16 | |||
Meropenem resistant P. aeruginosa (58) | 30 | <0.001 | ||
Control (57) | 10 | |||
Evans et al. (2007)‡ | Susceptible P. aeruginosa (73) | 20 | 0.03 | [71] |
Resistant P. aeruginosae (47) | 26 | |||
Furtado et al. (2009)‡ | Imipenem resistant P. aeruginosa (63) | 25 | 0.006 | [62] |
Control (182) | 15 | |||
Gasink et al. (2006)* | Fluoroquinolone resistant P. aeruginosa (320) | 10 | 0.13 | [64] |
Fluoroquinolone susceptible P. aeruginosa (527) | 9 | |||
Kaminski et al. (2011)† | Ureido/carboxypenicillin resistant P. aeruginosa (70) | 50 | 0.24 | [66] |
Ureido/carboxypenicillin susceptible P. aeruginosa (153) | 47.5 | |||
Lautenbach et al. (2010)† | Imipenem resistant P. aeruginosa (253) | 16 | <0.001 | [63] |
Imipenem susceptible P. aeruginosa (2289) | 9 | |||
Morales et al. (2012)‡ | MDR P. aeruginosaf (134) | 39 (45.7) | <0.001a | [49] |
Susceptible P. aeruginosa (149) | 20 (25.1) | |||
Resistant P. aeruginosa (119) | 30 (39.0) | <0.001a | ||
Susceptible P. aeruginosa (149) | 20 (25.1) | |||
Paramythiotou et al. (2004)† | MDR P. aeruginosag (34) | 44.5 (57.0)b,d/11.1c,d | 0.28/0.81 | [54] |
Control (34) | 43.5 (46.9)b,d/5.8c,d | |||
Tam et al. (2010)† | MDR P. aeruginosah (25) | 26.4c | 0.12 | [13] |
Susceptible P. aeruginosa (84) | 16.5c |
Author | Study groups (n) | Median ICU Length of Stay (days) | Reported Significance (p-value or 95% CI) | Ref |
---|---|---|---|---|
Main findings | ||||
Evans et al. (2007) | Susceptible P. aeruginosa (73) | 6 | 0.02 | [71] |
Resistant P. aeruginosac (47) | 13 | |||
Kaminski et al. (2011) | Ureido/carboxypenicillin resistant P. aeruginosa (70) | 29 | 0.37 | [66] |
Ureido/carboxypenicillin susceptible P. aeruginosa (153) | 28.5 | |||
Paramythiotou et al. (2004) | MDR P. aeruginosad (34) | 44.5 (57.0)a,b | 0.55 | [54] |
Control (34) | 43.5 (46.9)a,b |
Author | Study groups (n) | Description of cost | Hospital Inpatient Care Costs or Charges | Reported P-value | Ref |
---|---|---|---|---|---|
Main findings | |||||
Eagye et al. (2009) | Meropenem resistant P. aeruginosa (58) | Median total cost (IQR) | $100,704 ($27,710 – $183,125) | < 0.001 | [53] |
Meropenem susceptible P. aeruginosa (125) | $32,594 ($13,112 – $100,702) | ||||
Meropenem resistant P. aeruginosa (58) | $100,704 ($27,710 – $183,125) | < 0.001 | |||
Control (57) | $25,744 ($17,456 – $40,616) | ||||
Evans et al. (2007) | Susceptible P. aeruginosa (73) | Median total cost (IQR) | $99,672 ($43,714 – $187,260 | 0.015 | [71] |
Resistant P. aeruginosaa (47) | $69,502 ($24,853 – $113,933) | ||||
Gasink et al. (2006) | Fluoroquinolone resistant P. aeruginosa (320) | Median total charges (IQR)* | $62,325 ($22,129 - $188,979) | 0.008 | [64] |
Fluoroquinolone susceptible P. aeruginosa (527) | $48,733 ($18,760 - $124,820) | ||||
Lautenbach et al. (2010) | Imipenem resistant P. aeruginosa (253) | Mean hospital cost after culture sampling (95% CI) | $286,417 ($234,326 – $338,510) | < 0.001 | [63] |
Imipenem susceptible P. aeruginosa (2289) | $189,274 ($172,428 – $206,121) | ||||
Morales et al. (2012) | MDR P. aeruginosab (134) | Mean hospital cost after culture sampling (median) | $13,178 ($5,745) | < 0.001† | [49] |
Susceptible P. aeruginosa (149) | $4,258 ($2,420) | ||||
Resistant P. aeruginosa (119) | $10,662 ($5,248) | < 0.001† | |||
Susceptible P. aeruginosa (149) | $4,258 ($2,420) |