Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

• Published in: The Brazilian journal of infectious diseases Vol. 15; no. 4; pp. 312 - 322
• Main Authors: Gomes, Marisa Zenaide Ribeiro, Machado, Carolina Romero, de Souza da Conceição, Magda, Ortega, Jois Alves, Neves, Sonia Maria Ferraz M, da Silva Lourenço, Maria Cristina, Asensi, Marise Dutra
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01.07.2011; Contexto; Elsevier
• Subjects: acquired immunodeficiency syndrome; AIDS (Disease); AIDS-Related Opportunistic Infections - microbiology; AIDS-Related Opportunistic Infections - mortality; Anti-Bacterial Agents - pharmacology; Brazil; Cross infection; Cross Infection - microbiology; Cross Infection - mortality; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Health aspects; Humans; Infection control; molecular epidemiology; Mortality; Nosocomial infections; Pharmaceutical industry; Pseudomonas aeruginosa; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - mortality; United States; Brazil; United States; molecular epidemiology; Pseudomonas aeruginosa; disease outbreaks; infection control; acquired immunodeficiency syndrome
• ISSN: 1413-8670; 1678-4391
• DOI: 10.1016/S1413-8670(11)70198-2

Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting. Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates. Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n=10) or HTLV-1 infections (n=5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical. Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.