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Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center†
Clinical Pharmacy, San Francisco School of Pharmacy, University of California, 521 Parnassus Avenue UCSF Box 0622, Room C-152 San Francisco, CA 94143, USA
Department of Pharmaceutical Services, University of California Davis Health System, Sacramento, CA 95817, USA
Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, 3601 Pacific Avenue, Stockton, CA 95211, USA
† This research report is dedicated to the late Jeff King, Pharm. D.
* Author to whom correspondence should be addressed.
Received: 17 December 2009; in revised form: 22 March 2010 / Accepted: 1 April 2010 / Published: 1 April 2010
(This article belongs to the Special Issue Antibiotics
Abstract: This research report assessed the differences in resistance rates and antimicrobial usage-versus-susceptibility relationships of Pseudomonas aeruginosa found in various hospital patient care areas. A simplified case control study was also performed to identify patient-specific risk factors associated with cefepime-resistant P. aeruginosa isolates. Last, we determined the consequence of combining mucoid and non-mucoid derived antimicrobial susceptibilities of P. aeruginosa into hospital antibiograms. Overall, susceptibility rates remained lower in the intensive care units (ICUs) compared to the non-ICU patient care areas, except for cefepime over the last time period. Cefepime utilization and antimicrobial-resistance rates among P. aeruginosa isolates had a significant relationship. Decreased meropenem exposure was associated with lower resistance rates relative to cefepime. Risk factors independently associated with cefepime-resistant P. aeruginosa were structural lung disease, ICU admission, recent third generation cephalosporin use, frequent hospital admission and non-urine isolates. Large and statistically significant differences were observed between non-mucoid and combined percent susceptibility data for aminoglycosides. To control antimicrobial resistance and optimize initial empiric antimicrobial therapy, antimicrobial susceptibility and utilization patterns in specific patient care areas should be monitored and risk factors for antimicrobial resistance should be assessed. Mucoid strains of P. aeruginosa should not be included into antimicrobial susceptibility data as this may underestimate activity of most antipseudomonal agents.
Keywords: Pseudomonas aeruginosa; antimicrobials; antibiotics; bacterial resistance; cefepime; antimicrobial stewardship; antibiogram
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MDPI and ACS Style
Heintz, B.H.; Halilovic, J. Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center. Pharmaceuticals 2010, 3, 1070-1083.
Heintz BH, Halilovic J. Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center. Pharmaceuticals. 2010; 3(4):1070-1083.
Heintz, Brett H.; Halilovic, Jenana. 2010. "Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center." Pharmaceuticals 3, no. 4: 1070-1083.