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Emergence of Resistance in Pseudomonas aeruginosa and Acinetobacter Species After the Use of Antimicrobials for Burned Patients

Published online by Cambridge University Press:  02 January 2015

Andrea C. B. Ferreira ,
Satiko Gobara ,
Silvia F. Costa ,
Nairn Sauaia ,
Elsa M. Mamizuka ,
Inneke M. Van der Heijden ,
Robson E. Soares ,
Gisele D. Almeida ,
Carlos Fontana  and
Anna S. Levin
Andrea C. B. Ferreira
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Satiko Gobara
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Silvia F. Costa
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Nairn Sauaia
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Elsa M. Mamizuka
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Inneke M. Van der Heijden
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Robson E. Soares
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Gisele D. Almeida
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Carlos Fontana
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
Anna S. Levin*
Affiliation:
Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
*
Rua Harmonia, 564/52, São Paulo-SP 05435-000, Brazil
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Abstract

Objectives:

To evaluate the emergence of resistance of Pseudomonas aeruginosa and Acinetobacter species to imipenem, ciprofloxacin, or both after the use of these drugs and to compare resistant with susceptible isolates by molecular typing.

Design:

Cohort study.

Setting:

Burn intensive care unit (ICU) with 4 beds in a tertiary-care university hospital.

Methods:

During 16 months, surveillance cultures were performed for all patients admitted to the ICU. Demographic information was obtained for each patient. Molecular typing was done by pulsed-field gel electrophoresis using restriction enzymes for 71 isolates of P. aeruginosa and Acinetobacter species.

Results:

Thirty-four patients were admitted and 22 were colonized by susceptible P. aeruginosa or Acinetobacter species before they used the antimicrobials. Nine (41%) of these patients had a resistant isolate after antimicrobial use: 5 had used imipenem alone, 1 had used ciprofloxacin, and 3 had used both drugs. The interval between isolation of the susceptible and resistant isolates ranged from 4 to 25 days, but was 10 or more days for 6 patients. Molecular typing revealed that susceptible and resistant isolates from each patient were different and that although there were no predominant clones among susceptible isolates, there was a predominant clone among resistant isolates of P. aeruginosa and of Acinetobacter.

Conclusions:

Resistance was not due to the acquisition of resistance mechanisms by a previously susceptible strain, but rather to cross-transmission. Although various measures involving antimicrobial use have received great attention, it would seem that practices to prevent cross-transmission are more important in controlling resistance.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 868 - 872
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

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