Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission.

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES

Antimicrobial Resistance and Infection Control Pub Date : 2025-02-25 DOI:10.1186/s13756-025-01527-4

Romeo Reyle, Frank Schwab, Selin Saydan, Michael Behnke, Rasmus Leistner, Petra Gastmeier, Christine Geffers, Tobias Siegfried Kramer

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引用次数: 0

Abstract

Background/introduction: Antipseudomonal antibiotics are frequently used in patients admitted to hospitals. Many of these substances are classified as a reserve or watch status by the WHO. Inappropriate risk assessment of invasive detection of P. aeruginosa (PAE) can be a reason for overuse of antipseudomonal antibiotics. Therefore it is important to define relevant and specific risk factors for invasive PAE detection.

Objective: The objective of this study was to identify risk factors for invasive detection of PAE in patients upon hospital admission.

Methods: All patients 18 years of age and older with a detection of PAE and/or Enterobacterales in clinical samples taken within 48 h of admission to one of the hospitals of Charité Universitätsmedizin Berlin between 2015 and 2020 were included into this retrospective cohort study.

Results: Overall, we included a total of 27,710 patients. In 3,764 (13.6%) patients PAE was detected in clinical samples taken within 48 h after admission. The most frequently detected Enterobacterales was E. coli in 14.142 (51%) patients followed by Klebsiella spp. in 4.432 (16%) patients. Multivariable regression analysis identified that prior colonisation with a multi drug resistant PAE or detection of a PAE in clinical samples during a previous hospitalisation increased the risk for invasive detection of PAE (OR 39.41; 95% CI 28.54-54.39) and OR 7.87 (95% CI 6.60-9.38) respectively. Admission to a specialised ward for patients with cystic fibrosis was associated with an increased risk (OR 26.99; 95% CI 20.48-35.54). Presence of chronic pulmonary disease (OR 2.05; 95% CI 1.85-2.26), hemiplegia (OR 2.16; 95% CI 1.90-2.45) and male gender (OR 1.60; 95% CI 1.46-1.75) were associated with a modest increase in risk for presence of PAE.

Conclusion: Patients with a prior detection of P. aeruginosa or admission to a cystic fibrosis ward had the highest risk for invasive detection of P. aeruginosa. Adherence to specific risk scores based on local risk factors could help to optimize prescription of anti-pseudomonal antibiotics that categorized as reserve and watch.

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入院后临床标本中铜绿假单胞菌检测的危险因素。

背景/介绍：住院患者经常使用抗假单胞菌抗生素。这些物质中有许多被世界卫生组织列为储备或观察状态。对铜绿假单胞菌（PAE）侵袭性检测风险评估不当可能是过度使用抗假单胞菌抗生素的原因之一。因此，确定有创性PAE检测的相关和特定危险因素是很重要的。目的：本研究的目的是确定住院患者有创检测PAE的危险因素。方法：所有在2015年至2020年期间在柏林慈善医院Universitätsmedizin就诊的18岁及以上的患者，在入院48小时内的临床样本中检测到PAE和/或肠杆菌，均被纳入本回顾性队列研究。结果：总体而言，我们共纳入27710例患者。3764例（13.6%）患者在入院后48 h内的临床标本中检出PAE。检出最多的肠杆菌是大肠杆菌（14.142例，51%），其次是克雷伯菌（4.432例，16%）。多变量回归分析发现，先前有多药耐药PAE定植或先前住院期间临床样本中检测到PAE增加了PAE侵入性检测的风险(or 39.41；95% CI 28.54-54.39)和OR 7.87 （95% CI 6.60-9.38）。囊性纤维化患者入住专门病房与风险增加相关(OR 26.99；95% ci（20.48-35.54）。存在慢性肺部疾病(OR 2.05；95% CI 1.85-2.26)，偏瘫(OR 2.16；95% CI 1.90-2.45)和男性(OR 1.60；95% CI 1.46-1.75)与PAE存在的风险适度增加相关。结论：先前检测到铜绿假单胞菌或入住囊性纤维化病房的患者有最高的侵入性铜绿假单胞菌检测风险。坚持基于当地危险因素的特定风险评分有助于优化储备类和观察类抗假单胞菌抗生素的处方。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

9.70

自引率

3.60%

发文量

140

审稿时长

13 weeks

期刊介绍： Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.