Zou Yamin, Lian Jiangping, Di Ying, You Haisheng, Yao Hongping, Liu Junhui, Dong Yalin
Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Pharmacy, Xi'an Jiaotong University Hospital, Xi'an, China.
Int J Clin Pharm. 2018 Feb;40(1):175-182. doi: 10.1007/s11096-017-0524-5. Epub 2017 Nov 14.
Background Patients colonized with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) strains upon admission to the intensive care unit (ICU) tend to be quickly followed by detected carbapenem-resistant P. aeruginosa strains after admission. Objective To assess the risk factors associated with the quick loss of carbapenem susceptibility and to identify time threshold of prior antimicrobial exposure for the loss during ICU stay. Setting A tertiary-care teaching hospital with 2560 beds located in the northwest region of China. Method A retrospective observational study was conducted between January 2013 and April 2016 at ICUs. Logistic regression analysis was used to assess risk factors, and receiver operating characteristic (ROC) analyses were constructed to identify the time threshold. Main outcome measure The time threshold and risk factors for the quick loss of carbapenem susceptibility. Results Among the 84 patients with CSPA initially, 32 (38.1%) patients were observed to have a loss of carbapenem susceptibility during ICU stay. Logistic regression analyses showed that previous carbapenem exposure was only independently associated with the loss of carbapenem susceptibility (odds ratio 13.16; 95% CI 3.13-55.24; p < 0.001). The optimal cut-off was 3.5 days on ROC curve, indicating the high risk for loss of susceptibility. Conclusion In order to alleviate selective pressure caused by antipseudomonal carbapenems exposure, continued research is needed to determine the most appropriate carbapenems treatment strategies.
入住重症监护病房（ICU）时被碳青霉烯敏感铜绿假单胞菌（CSPA）菌株定植的患者，在入院后往往很快就会检测到碳青霉烯耐药铜绿假单胞菌菌株。目的：评估与碳青霉烯敏感性快速丧失相关的危险因素，并确定ICU住院期间敏感性丧失的先前抗菌药物暴露时间阈值。地点：位于中国西北地区的一家拥有2560张床位的三级教学医院。方法：2013年1月至2016年4月在ICU进行了一项回顾性观察研究。采用逻辑回归分析评估危险因素，并构建受试者工作特征（ROC）分析以确定时间阈值。主要结局指标：碳青霉烯敏感性快速丧失的时间阈值和危险因素。结果：最初的84例CSPA患者中，32例（38.1%）患者在ICU住院期间出现碳青霉烯敏感性丧失。逻辑回归分析表明，先前使用碳青霉烯仅与碳青霉烯敏感性丧失独立相关（比值比13.16；95%CI 3.13 - 55.24；p < 0.001）。ROC曲线上的最佳截断值为3.5天，表明敏感性丧失风险高。结论：为减轻抗假单胞菌碳青霉烯类药物暴露引起的选择压力，需要继续研究以确定最合适的碳青霉烯类药物治疗策略。
