Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-30T20:14:20.673Z Has data issue: false hasContentIssue false
  • English
  • Français

Resistance to Imipenem Among Selected Gram-Negative Bacilli in the United States

Published online by Cambridge University Press:  21 June 2016

Robert P. Gaynes ,
David H. Culver  and
The National Nosocomial Infections Surveillance System
Robert P. Gaynes*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia Public Health Service, US Department of Health and Human Services, Washington, DC
David H. Culver
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia Public Health Service, US Department of Health and Human Services, Washington, DC
*
Hospital Infections Program, A-07, Building 3, Room B16A, Centers for Disease Control, 1600 Clifton Road NE, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Identification of imipenem resistance among selected gram-negative bacilli, especially Pseudomonas aeruginosa and Enterobacter species.

Methods:

We analyzed 1986-1990 National Nosocomial Infection Surveillance (NNIS) data from 3,316 P aeruginosa isolates and 1,825 Enterobacter species isolates for which susceptibility results to imipenem were reported.

Results:

For P aeruginosa, 11.1% of the isolates were resistant to imipenem; 16.1% were either intermediate-susceptible or resistant to the drug. A logistic regression model found that resistance was more common among P aeruginosa isolated from the respiratory tract, patients in intensive care units, and in teaching hospitals. Additionally, resistance to imipenem increased by 25% in teaching hospitals from 1986-1988 to 1989-1990. For Enterobacter species, 1.3% of the isolates were resistant to imipenem; 2.3% were either intermediate-susceptible or resistant to the drug. However, imipenem resistance for these isolates did not differ between the two periods and was not more common in patients in an intensive care unit or infections at any specific site.

Conclusions:

The frequency of resistance to imipenem is greater among P aeruginosa than among Enterobacter species. Resistance to imipenem among the P aeruginosa isolates is more common from strains isolated from patients with nosocomial infections in an intensive care unit, from the respiratory tract, and from teaching hospitals. Resistance appears to be increasing among nosocomial P aeruginosa isolated in teaching hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 1 , January 1992 , pp. 10 - 14
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Acar, JF Therapy for lower respiratory tract infections with imipenem/cilastatin: a review of worldwide experience. Rev Infect Dis. 1985:7(suppl 3):S513–S517.CrossRefGoogle ScholarPubMed
2. Eron, LJ. Imipenem/cilastatin therapy of bacteremia. JAMA. 1985;78(supp l6a):87–91.Google ScholarPubMed
3. Freimer, EH, Donabdian, H, Raeder, R, Ribner, B.S. Empirical use of imipenem as the sole antibiotic in the treatment of serious infections. JAntimicrob Chemother 1985;16:499–507.CrossRefGoogle ScholarPubMed
4. Quinn, JP: Dudek, EJ, DiVencenzo, CA, Lucks, DA, Lerner, SA. Emergence of resistance to imipenem during therapy for Pseudomonas aeruginosa infections. J Infect Dis. 1986;154:289–294.CrossRefGoogle ScholarPubMed
5. Pedersen, SS, Pressler, T: Hoiby, N, Bentzon, MW, Koch, C. Imipenem/cilastatin treatment of multiresistant Pseudomonas aeruginosa lung infections in cystic fibrosis. J Antimicrob Chemother. 1985;16:626–635.CrossRefGoogle ScholarPubMed
6. Salata, RA, Gebhart, RL, Palmer, DL, et al. Pneumonia treated with imipenem/cilastatin. JAMA. 1985;78(suppl 6a):96–102.Google ScholarPubMed
7. Trumbore, D, Pontzer, R, Levison, ME, et al. Multicenter study of the clinical efficacy of imipenem/cilastatin for treatment of serious infections. Rev Infect Dis. 1985;7(suppl 3):S476–S481.CrossRefGoogle ScholarPubMed
8. Kahan, FM, Drusano, GL, and the ISS Study Group. Resistance of gram-negative organisms isolated from intensive care unit patients in four cities to b-lactam antibiotics. Proceedings of Third International Conference on Nosocomial Infections. Atlanta, Ga: Centers for Disease Control; 1990; Abstract #66.Google Scholar
9. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance (NNIS) system: description of surveillance methodology. Am Infect Control. 1991;19:19–35.CrossRefGoogle Scholar
10. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.CrossRefGoogle ScholarPubMed
11. Snedecor, GW, Cochran, WG. Statistical Methods. 7th edition. Ames, Ia: Iowa State University Press; 1980.Google Scholar
12. Lee, EH, Nicolas, MH, Kitzis, MD, Pialoux, G, Collatz, E, Gutmann, L. Association of two resistance mechanisms in a clinical isolate of Enterobacter cloacae with high-level resistance to imipenem. Antimicrob Agents Chemother: 1991;35:1093–1098.CrossRefGoogle Scholar
13. Buscher, KH, Cullmann, W, Dick, W, Opferkuch, W. Imipenem resistance in Pseudomonas aeruginosa resulting from diminished expression of an outer membrane protein. Antimicrob Agents Chemother. 1987;31:703–708.CrossRefGoogle ScholarPubMed
14. Trias, JJ, Dufresne, R, Levesque, C, Nikaido, H. Decreased outer membrane permeability in imipenem-resistant mutants of Pseudomonas aeruginosa . Antimicrob Agents Chemother. 1989;33:1201–1206.CrossRefGoogle ScholarPubMed
15. Trias, J, Nikaido, H. Outer membrane protein D2 catalyzes facilitated diffusion of carbapenems and penems through the outer membrane of Pseudomonas aeruginosa . Antimicrob Agents Chemother 1990;34:52–57.CrossRefGoogle ScholarPubMed