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JAC Advance Access originally published online on August 8, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):882-885; doi:10.1093/jac/dkl327
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-ß-lactamase in two tertiary-care teaching hospitals

Alexandre Prehn Zavascki1,2,*, Afonso Luís Barth2,3, Patrick Barcelos Gaspareto3, Ana Lúcia Saraiva Gonçalves3, Ana Lúcia Didonet Moro4, Juliana Fernandez Fernandes5 and Luciano Zubaran Goldani2,6

1 Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre, Brazil 2 Medicine: Medical Sciences Postgraduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre Brazil 3 Microbiology Unit, Clinical Pathology Service, Hospital de Clínicas de Porto Alegre Porto Alegre, Brazil 4 Medical School, Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre, Brazil 5 Medical School, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil 6 Division of Infectious Diseases, Hospital de Clínicas de Porto Alegre Porto Alegre, Brazil

Received 13 May 2006; returned 12 June 2006; revised 6 July 2006; accepted 15 July 2006

*Correspondence address. Serviço de Infectologia, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, 6690 Ipiranga Avenue, 90610-000, Porto Alegre, Brazil. Tel/Fax: +55-51-33621850; E-mail: apzavascki{at}terra.com.br

Objectives: To assess risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-ß-lactamase (MBL-PA) in two teaching hospitals where horizontal dissemination has been demonstrated.

Methods: A case–control study was performed in both hospitals (assigned as hospital 1 and 2). Cases were patients with MBL-PA infections and controls were those with non-MBL-PA infections. Multivariate analysis was performed to identify independent risk factors.

Results: A total of 86 cases and 212 controls were included in the study. A logistic regression model showed that exposure to ß-lactams [odds ratio (OR) 3.21; 95% confidence interval (CI) 1.74–5.93] or fluoroquinolones (OR 3.50; 95% CI 1.46–8.37) was associated with MBL-PA infections. Other independent risk factors were neurological disease (OR 3.00; 95% CI 1.61–5.58), urinary tract infection (OR 2.48; 95% CI 1.21–5.09) and renal failure (OR 2.29; 95% CI 1.13–4.65). Admission to hospital 1 (OR 5.97; 95% CI 3.45–14.09) and intensive care unit stay (OR 2.07; 95% CI 1.46–3.96) were also associated with increased risk for MBL-PA infections.

Conclusions: ß-Lactam exposure is an important risk factor for MBL-PA infections even in a setting where patient-to-patient transmission plays a major role in the spread of the isolates. Other risk factors deserve further investigation, particularly exposure to fluoroquinolones.

Keywords: bacterial drug resistance , multiple bacterial drug resistance , fluoroquinolones , SPM-1 ß-lactamase , P. aeruginosa , ß-lactamases , case–control studies


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