Lin Kuan-Yin, Lauderdale Tsai-Ling, Wang Jann-Tay, Chang Shan-Chwen
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
J Microbiol Immunol Infect. 2016 Feb;49(1):52-9. doi: 10.1016/j.jmii.2014.01.005. Epub 2014 Mar 21.
The prevalence and clinical impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) is unclear in Taiwan. We aim to clarify these clinical issues by using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program.
Patients from five hospitals with their P. aeruginosa isolates collected by TSAR II-VII (2000-2010) program were considered as the potential study population. All patients with CRPA were enrolled as case patients. Patients with carbapenem-susceptible P. aeruginosa were randomly selected in a 1:1 ratio to case patients as control patients. CRPA isolates were tested for the presence of carbapenemase-producing genes. The clinical data were collected to identify risk factors for CRPA carriage and mortality of P. aeruginosa infection.
The overall prevalence of CRPA was 10.2% (349/3408), which increased significantly by the TSAR period (p = 0.007). Among the 164 enrolled patients, the risk factor for carrying CRPA was previous fluoroquinolone exposure (p = 0.004). The risk factors for mortality among 80 patients with infection by P. aeruginosa included: intensive care unit (ICU) setting, receipt of antifungal therapy, and presence of invasive devices (p = 0.001, 0.010, and 0.017; respectively). Carbapenem resistance did not play a role. Among the 82 CRPA isolates enrolled in this study, 15 isolates were found to carry carbapenemase-producing genes.
In Taiwan, the prevalence of CRPA and carriage of carbapenemase-producing genes was high. However, carbapenem resistance did not play a role in the mortality of patients with P. aeruginosa infections.
在台湾，耐碳青霉烯类铜绿假单胞菌（CRPA）的患病率及其对死亡率的临床影响尚不清楚。我们旨在通过使用台湾抗菌药物耐药性监测（TSAR）项目的数据来阐明这些临床问题。
将TSAR II - VII（2000 - 2010年）项目收集的来自五家医院的铜绿假单胞菌分离株患者视为潜在研究人群。所有CRPA患者被纳入病例组。对碳青霉烯类敏感的铜绿假单胞菌患者以1:1的比例随机选择作为对照组。检测CRPA分离株中是否存在产碳青霉烯酶基因。收集临床数据以确定CRPA携带和铜绿假单胞菌感染死亡率的危险因素。
CRPA的总体患病率为10.2%（349/3408），在TSAR期间显著增加（p = 0.007）。在164名纳入的患者中，携带CRPA的危险因素是既往氟喹诺酮类药物暴露（p = 0.004）。80例铜绿假单胞菌感染患者的死亡危险因素包括：重症监护病房（ICU）环境、接受抗真菌治疗和存在侵入性装置（分别为p = 0.001、0.010和0.017）。碳青霉烯类耐药性不起作用。在本研究纳入的82株CRPA分离株中，发现15株携带产碳青霉烯酶基因。
在台湾，CRPA的患病率和产碳青霉烯酶基因的携带率很高。然而，碳青霉烯类耐药性在铜绿假单胞菌感染患者的死亡率中不起作用。
