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. 2019 Jul 19:7:36.
doi: 10.1186/s40560-019-0390-4. eCollection 2019.

Risk factors and the resistance mechanisms involved in Pseudomonas aeruginosa mutation in critically ill patients

Stéphanie Druge  1 , Stéphanie Ruiz  1 , Fanny Vardon-Bounes  1 , Marion Grare  2 , François Labaste  1 , Thierry Seguin  1 , Olivier Fourcade  1 , Vincent Minville  1 , Jean-Marie Conil  1 , Bernard Georges  1   3
Affiliations

Risk factors and the resistance mechanisms involved in Pseudomonas aeruginosa mutation in critically ill patients

Stéphanie Druge et al. J Intensive Care. .

Abstract

Background: The objective of this study was to determine the main risk factors of Pseudomonas aeruginosa mutation as well as the mechanisms of acquired resistance.

Methods: We conducted a 2-year prospective study in patients who were carriers of a Pseudomonas aeruginosa strain and who had been admitted to a medical/surgical ICU.

Results: Of the 153 patients who were included, 34 had a mutation in their strain. In a multivariate analysis, a duration of ventilation > 24 days was a risk factor for mutation (risk ratio 4.29; CI 95% 1.94-9.49) while initial resistance was a protective factor (RR 0.36; CI 95% 0.18-0.71). In a univariate analysis, exposure of P. aeruginosa to ceftazidime was associated with an over-production of AmpC cephalosporinase and exposure to meropenem was associated with impermeability. A segmentation method based on the duration of ventilation (> 24 days), initial resistance, and exposure of strains to ceftazidime made it possible to predict at 83% the occurrence of mutation.

Conclusion: The duration of ventilation and the presence of resistance as soon as P. aeruginosa is identified are predictive factors of mutation in ICU patients.

Keywords: Antibiotic; ICU (intensive care unit); Mutation; Pseudomonas aeruginosa; Resistance mechanism; Segmentation tree.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of the population according to the existence of mutation and the duration of ventilation (> or < 24 days), initial resistance, and the prescription of ceftazidime after identification of P. aeruginosa
See this image and copyright information in PMC

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