Implementing antimicrobial management to improve susceptibility of Pseudomonas aeruginosa to carbapenems

Abstract:

ObjectiveTo analyze susceptibility of clinically isolated Pseudomonas aeruginosa (PA) to carbapenems, and observe the effect of classified management of antimicrobial agents on carbapenem susceptibility.MethodsPA isolated from Peking University Cancer Hospital between October 2012 and March 2014 were collected, univariate analysis and multivariate logistic regression analysis were adopted to study the risk factors for nonsusceptibility to carbapenems, susceptibility of PA to carbapenems before and after the implementation of classified management of antimicrobial agents was analyzed. ResultsA total of 125 strains of PA were isolated, mainly from patients with esophageal cancer (n=30, 24.0%) and colorectal cancer (n=29, 23.2%); the main specimens were drainage fluid and wound secretion (n=62, 49.6%); the main source departments were surgical wards (n=86, 68.8%). Univariate analysis showed that nonsusceptibility of PA to carbapenems was related to strains from surgical wards, hospitalization within 3 months, carbapenem exposure, and length of hospital stay>4 weeks. Logistic regression analysis showed that 3 independent risk factors were: strains from surgical wards, exposure to carbapenems, and length of hospital stay>4 weeks. Susceptibility of PA to carbapenems after implementation of antimicrobial management was 74.6%, which was higher than 53.4% before management (P=0.015). ConclusionStrains from surgical wards, carbapenem exposure, and length of hospital stay>4 weeks are independent risk factors for nosusceptibility of PA to carbapenems; susceptibility of PA to carbapenems is increased after strict implementation of antimicrobial classified management system.