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JAC Advance Access published online on August 8, 2006
Journal of Antimicrobial Chemotherapy, 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
Received May 13, 2006
Revised July 6, 2006
Accepted July 15, 2006

Brief report

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

Alexandre Prehn Zavascki 1 *, Afonso Luís Barth 2, Patrick Barcelos Gaspareto 3, Ana Lúcia Saraiva Gonçalves 3, Ana Lúcia Didonet Moro 4, Juliana Fernandez Fernandes 5, and Luciano Zubaran Goldani 6

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

* To whom correspondence should be addressed.
Alexandre Prehn Zavascki, E-mail: apzavascki{at}terra.com.br


  Abstract

Objectives: To assess risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-{beta}-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 {beta}-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: {beta}-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 {beta}-lactamase; P. aeruginosa; {beta}-lactamases; case-control studies.
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