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Genodiversity of Resistant Pseudomonas aeruginosa Isolates in Relation to Antimicrobial Usage Density and Resistance Rates in Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Daniel Jonas ,
Elisabeth Meyer ,
Frank Schwab  and
Hajo Grundmann
Daniel Jonas*
Affiliation:
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany
Elisabeth Meyer
Affiliation:
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany
Frank Schwab
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Hospital and National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
Hajo Grundmann
Affiliation:
Rijksinstituut voor Volksgezondheid en Mileu, European Antimicrobial Resistance Surveillance System, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
*
Department of Environmental Health Sciences, University Medical Center Freiburg, Breisacher Straße 115b, 79106 Freiburg, Germany ([email protected])
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Abstract

Objective.

To evaluate the assumption that resistance rates in intensive care units (ICUs) are markedly influenced by cross-transmission events in addition to high rates of antimicrobial usage.

Methods.

This was a prospective ICU- and laboratory-based surveillance study involving 35 German ICUs from 1999 through 2004. A total of 585 ciprofloxacin- or imipenem-resistant isolates of Pseudomonas aeruginosa were investigated together with resistance rate and unit-based antimicrobial usage density. Antimicrobial use was reported in terms of defined daily doses per 1,000 patient-days. All the strains were assigned to ICU-based genotypes. Genodiversity was calculated as the numbers of indistinguishable ICU-based genotypes found per isolates tested. Reduced ICU-based genodiversity was taken as an indirect measure of frequently occurring cross-transmission events.

Results.

The genodiversity of ciprofloxacin- and imipenem-resistant P. aeruginosa isolates was significantly lower (P ≤ .05, by Fisher exact test) in ICUs with high resistance rate and low antimicrobial usage density (genodiversity, 0.50 and 0.50, respectively) than in ICUs that featured low resistance rate in the presence of high antimicrobial usage density (genodiversity, 0.90 and 0.95, respectively). In ICUs with low genodiversity, there was a greater rise in resistance rate with increasing antimicrobial usage density, compared with that in ICUs with high diversity.

Conclusions.

This study on resistant P. aeruginosa isolates supports the assumption that high resistance rate in the presence of low antimicrobial usage density results from more-frequent cross-transmission events. A greater rise in resistance rate with increasing antimicrobial usage density in ICUs with low genodiversity indicates that resistance rate in ICUs might be markedly determined by cross-transmission events other than antimicrobial usage.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 4 , April 2008 , pp. 350 - 357
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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