The Role of Patient-to-Patient Transmission in the Acquisition of Imipenem-Resistant Pseudomonas aeruginosa Colonization in the Intensive Care Unit

Johnson Kristie, Gwen Smith, Mary S. Lee, Richard A. Venezia, O. Colin Stine, James P. Nataro, William Hsiao, Anthony D. Harris

Research output: Contribution to journalArticle

Abstract

Background. Imipenem-resistant Pseudomonas aeruginosa (IRPA) is an emerging problem. The causal role of antibiotic selective pressure versus patient-to-patient transmission has not been assessed using a large cohort. Methods. Patients who were admitted to the medical and surgical intensive care units (ICUs) at the University of Maryland Medical Center from 2001 through 2006 had multiple perianal culture samples collected. Using pulsed-field gel electrophoresis (PFGE), the number of patients who acquired IRPA as a result of patient-to-patient transmission was determined. We also analyzed a subset of patients who had a previous surveillance culture that grew an imipenem-susceptible P. aeruginosa (ISPA) and a subsequent culture that grew IRPA. Results. Our cohort consisted of 7071 patients. Three hundred patients were colonized with IRPA. 151 patients had positive culture findings at ICU admission, and 149 patients acquired an IRPA. Among the patients who acquired IRPA, 46 (31%) had a PFGE pattern similar to that for another isolate, and 38 (26%) were found to be colonized with an ISPA on the basis of earlier culture results. Of the 38-patient subset, 28 (74%) had identical PFGE patterns. Conclusions. Our data showed that, of those cases of IRPA acquisition, 46 (31%) were defined as cases of patient-to-patient transmission, and 28 (19%) were cases of acquisition by the patients' endogenous flora.

Original languageEnglish (US)
Pages (from-to)900-905
Number of pages6
JournalJournal of Infectious Diseases
Volume200
Issue number6
DOIs
StatePublished - Sep 15 2009
Externally publishedYes

Fingerprint

Imipenem
Pseudomonas aeruginosa
Intensive Care Units
Pulsed Field Gel Electrophoresis
Patient Admission
Critical Care

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

Cite this

The Role of Patient-to-Patient Transmission in the Acquisition of Imipenem-Resistant Pseudomonas aeruginosa Colonization in the Intensive Care Unit. / Kristie, Johnson; Smith, Gwen; Lee, Mary S.; Venezia, Richard A.; Colin Stine, O.; Nataro, James P.; Hsiao, William; Harris, Anthony D.

In: Journal of Infectious Diseases, Vol. 200, No. 6, 15.09.2009, p. 900-905.

Research output: Contribution to journalArticle

Kristie, Johnson ; Smith, Gwen ; Lee, Mary S. ; Venezia, Richard A. ; Colin Stine, O. ; Nataro, James P. ; Hsiao, William ; Harris, Anthony D. / The Role of Patient-to-Patient Transmission in the Acquisition of Imipenem-Resistant Pseudomonas aeruginosa Colonization in the Intensive Care Unit. In: Journal of Infectious Diseases. 2009 ; Vol. 200, No. 6. pp. 900-905.
@article{97624f4b723c42648fa387fb9f706d96,
title = "The Role of Patient-to-Patient Transmission in the Acquisition of Imipenem-Resistant Pseudomonas aeruginosa Colonization in the Intensive Care Unit",
abstract = "Background. Imipenem-resistant Pseudomonas aeruginosa (IRPA) is an emerging problem. The causal role of antibiotic selective pressure versus patient-to-patient transmission has not been assessed using a large cohort. Methods. Patients who were admitted to the medical and surgical intensive care units (ICUs) at the University of Maryland Medical Center from 2001 through 2006 had multiple perianal culture samples collected. Using pulsed-field gel electrophoresis (PFGE), the number of patients who acquired IRPA as a result of patient-to-patient transmission was determined. We also analyzed a subset of patients who had a previous surveillance culture that grew an imipenem-susceptible P. aeruginosa (ISPA) and a subsequent culture that grew IRPA. Results. Our cohort consisted of 7071 patients. Three hundred patients were colonized with IRPA. 151 patients had positive culture findings at ICU admission, and 149 patients acquired an IRPA. Among the patients who acquired IRPA, 46 (31{\%}) had a PFGE pattern similar to that for another isolate, and 38 (26{\%}) were found to be colonized with an ISPA on the basis of earlier culture results. Of the 38-patient subset, 28 (74{\%}) had identical PFGE patterns. Conclusions. Our data showed that, of those cases of IRPA acquisition, 46 (31{\%}) were defined as cases of patient-to-patient transmission, and 28 (19{\%}) were cases of acquisition by the patients' endogenous flora.",
author = "Johnson Kristie and Gwen Smith and Lee, {Mary S.} and Venezia, {Richard A.} and {Colin Stine}, O. and Nataro, {James P.} and William Hsiao and Harris, {Anthony D.}",
year = "2009",
month = "9",
day = "15",
doi = "10.1086/605408",
language = "English (US)",
volume = "200",
pages = "900--905",
journal = "Journal of Infectious Diseases",
issn = "0022-1899",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - The Role of Patient-to-Patient Transmission in the Acquisition of Imipenem-Resistant Pseudomonas aeruginosa Colonization in the Intensive Care Unit

AU - Kristie, Johnson

AU - Smith, Gwen

AU - Lee, Mary S.

AU - Venezia, Richard A.

AU - Colin Stine, O.

AU - Nataro, James P.

AU - Hsiao, William

AU - Harris, Anthony D.

PY - 2009/9/15

Y1 - 2009/9/15

N2 - Background. Imipenem-resistant Pseudomonas aeruginosa (IRPA) is an emerging problem. The causal role of antibiotic selective pressure versus patient-to-patient transmission has not been assessed using a large cohort. Methods. Patients who were admitted to the medical and surgical intensive care units (ICUs) at the University of Maryland Medical Center from 2001 through 2006 had multiple perianal culture samples collected. Using pulsed-field gel electrophoresis (PFGE), the number of patients who acquired IRPA as a result of patient-to-patient transmission was determined. We also analyzed a subset of patients who had a previous surveillance culture that grew an imipenem-susceptible P. aeruginosa (ISPA) and a subsequent culture that grew IRPA. Results. Our cohort consisted of 7071 patients. Three hundred patients were colonized with IRPA. 151 patients had positive culture findings at ICU admission, and 149 patients acquired an IRPA. Among the patients who acquired IRPA, 46 (31%) had a PFGE pattern similar to that for another isolate, and 38 (26%) were found to be colonized with an ISPA on the basis of earlier culture results. Of the 38-patient subset, 28 (74%) had identical PFGE patterns. Conclusions. Our data showed that, of those cases of IRPA acquisition, 46 (31%) were defined as cases of patient-to-patient transmission, and 28 (19%) were cases of acquisition by the patients' endogenous flora.

AB - Background. Imipenem-resistant Pseudomonas aeruginosa (IRPA) is an emerging problem. The causal role of antibiotic selective pressure versus patient-to-patient transmission has not been assessed using a large cohort. Methods. Patients who were admitted to the medical and surgical intensive care units (ICUs) at the University of Maryland Medical Center from 2001 through 2006 had multiple perianal culture samples collected. Using pulsed-field gel electrophoresis (PFGE), the number of patients who acquired IRPA as a result of patient-to-patient transmission was determined. We also analyzed a subset of patients who had a previous surveillance culture that grew an imipenem-susceptible P. aeruginosa (ISPA) and a subsequent culture that grew IRPA. Results. Our cohort consisted of 7071 patients. Three hundred patients were colonized with IRPA. 151 patients had positive culture findings at ICU admission, and 149 patients acquired an IRPA. Among the patients who acquired IRPA, 46 (31%) had a PFGE pattern similar to that for another isolate, and 38 (26%) were found to be colonized with an ISPA on the basis of earlier culture results. Of the 38-patient subset, 28 (74%) had identical PFGE patterns. Conclusions. Our data showed that, of those cases of IRPA acquisition, 46 (31%) were defined as cases of patient-to-patient transmission, and 28 (19%) were cases of acquisition by the patients' endogenous flora.

UR - http://www.scopus.com/inward/record.url?scp=70349413152&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349413152&partnerID=8YFLogxK

U2 - 10.1086/605408

DO - 10.1086/605408

M3 - Article

C2 - 19673646

AN - SCOPUS:70349413152

VL - 200

SP - 900

EP - 905

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 6

ER -