Carbapenem Resistant Pseudomonas aeruginosa Infections in Elderly Patients: Antimicrobial Resistance Profiles, Risk Factors and Impact on Clinical Outcomes

Jie Qin; Chengyun Zou; Jianmin Tao; Tian Wei; Li Yan; Yufei Zhang; Haiying Wang

doi:10.2147/IDR.S358778

Carbapenem Resistant Pseudomonas aeruginosa Infections in Elderly Patients: Antimicrobial Resistance Profiles, Risk Factors and Impact on Clinical Outcomes

Infect Drug Resist. 2022 Apr 29:15:2301-2314. doi: 10.2147/IDR.S358778. eCollection 2022.

Authors

Jie Qin^{1

2}, Chengyun Zou², Jianmin Tao¹, Tian Wei¹, Li Yan¹, Yufei Zhang², Haiying Wang¹

Affiliations

¹ Department of Clinical Laboratory, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
² Department of Medical Technology, Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.

Abstract

Objective: The prevalence and clinical impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection are unclear in elderly patients. Here, we aimed to clarify the prevalence, the clinical manifestations, antimicrobial resistance, risk factors and outcomes of elderly inpatients with CRPA infection.

Methods: A retrospective study of 600 elderly inpatients infected with P. aeruginosa was conducted at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine from January 1st 2018 to December 31st 2020. All 155 patients with CRPA infection were designated as a case group. Patients with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) were randomly selected from remaining 445 cases in a 1:1 ratio to case group as a control group.

Results: Of 600 P. aeruginosa isolates, the overall rates of CRPA, MDR PA (multidrug-resistance Pseudomonas aeruginosa) were 25.8% (155), 22.3% (134), respectively. The rankings of the top five resistant rates of CRPA to tested antimicrobial drugs were imipenem (87.7%), meropenem (70.3%), ciprofloxacin (51.0%), levofloxacin (48.4%), cefoperazone (43.2%). Independent risk factors for patients with CRPA infection were cerebrovascular disease (OR = 3.517, P < 0.001), foley catheter (OR = 2.073, P = 0.018), length of hospital stay ≥ 14 days (OR = 1.980, P = 0.013), albumin < 35 g/L (OR = 2.049, P = 0.020), previous antibiotic exposure to carbapenems (OR = 7.022, P = 0.004), previous antibiotic exposure to third- or fourth-generation cephalosporins (OR = 12.649, P = 0.002). Of 155 patients with CRPA infection, the mortality rate was 16.8% (26/155). Independent risk factors for mortality were receiving mechanical ventilation (OR = 3.671, P = 0.007) and neutrophil percentage ≥ 80% (OR = 2.908, P = 0.024).

Conclusion: The study revealed high rates of CRPA, MDR PA among the hospitalized elderly patient with P. aeruginosa infection. The analysis of antimicrobial susceptibility emphasizes the necessity for antimicrobial stewardship and infection control in hospitals. These findings of risk factors are practical significant to identify patients at high risk for CRPA infection and mortality that may benefit from alternate empiric treatment.

Keywords: Pseudomonas aeruginosa; carbapenem-resistant; infection; mortality; risk factors.

Grants and funding

This study was supported by Foundation of Shanghai Municipal Health Commission for Distinguished Young Scholar project (grant number: 20204Y0147); Chinese medicine scientific research project of Shanghai Municipal Health Commission (grant number: 2020 JZ001).