Skip to main content Accessibility help
×
×
Home

Rapidly Rising Prevalence of Nosocomial Multidrug-Resistant, Gram-Negative Bacilli: A 9-Year Surveillance Study

  • Erika M. C. D'Agata (a1)

Abstract

Objective:

To examine and quantify the temporal trends of nosocomial multidrug-resistant, gram-negative bacilli.

Design:

A 9-year surveillance study was conducted. Multidrug resistance was defined as resistance to 3 or more antimicrobial classes.

Setting:

Tertiary-care institution.

Results:

From 1994 to 2002, multidrug-resistant, gram-negative bacilli increased from 1% to 16% for multidrug-resistant Pseudomonas aeruginosa, 4% to 13% for multidrug-resistant Enterobacter species, 0.5% to 17% for multidrug-resistant Klebsiella species, 0% to 9% for multidrug-resistant Proteus species, and 0.2% to 4% for multidrug-resistant Escherichia coli (P ≤ .05). The most common pattern of multidrug resistance was co-resistance to quinolones, third-generation cephalosporins, and aminoglycosides.

Conclusion:

The rapid rise of multidrug-resistant, gram-negative bacilli may warrant infection control programs to include these pathogens in strategies aimed at limiting the emergence and spread of antimicrobial-resistant pathogens.

Copyright

Corresponding author

Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 330 Brookline Ave., East Campus Mailstop SL-435G, Boston, MA 02215

References

Hide All
1.Jarvis, WR, Edwards, JR, Culver, DH, et al.Nosocomial infection rates in adult and pediatric intensive care units in the United States: National Nosocomial Infection Surveillance System. Am J Med 1991;91:185S191S.
2.Gales, AC, Jones, RN, Turnidge, JJ, Rennie, R, Ramphai, R. Characterization of Pseudomonas aeruginosa isolates: occurrence rates, antimicrobial susceptibility patterns, and molecular typing in the global SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32:S146S155.
3.Karlowsky, JA, Jones, ME, Thornsberry, C, Friedland, IR, Sahm, DETrends in antimicrobial susceptibilities among Enterobacteriaceae isolates from hospitalized patients in the United States from 1998 to 2001. Antimicrob Agents Chemother 2003;47:16721680.
4.Karlowsky, JA, Draghi, DC, Jones, ME, Thornsberry, C, Friedland, IR, Sahm, DESurveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrob Agents Chemother 2003;47:16811688.
5.Livermore, DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst night mare? Clin Infect Dis 2002;34:634640.
6.Bradford, PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933951.
7.Nikaido, H. Multidrug efflux pumps of gram-negative bacteria. J Bacteriol 1996;178:58535859.
8.Ziha-Zarifi, I, Lianes, C, Köhler, T, Pechere, J, Plesiat, P. In vivo emergence of multidrug-resistant mutants of Pseudomonas aeruginosa over-expressing the active efflux system MexA-MexB-OprM. Antimicrob Agents Chemother 1999;43:287291.
9.Leverstein-van Hall, MA, Blok, HEM, Donders, AR, et al.Multidrug resistance among Enterobacteriaceae is strongly associated with the presence of integrons and is independent of species or isolate origin. J Infect Dis 2003;187:251259.
10.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Villanova, PA: National Committee for Clinical Laboratory Standards; 1999.
11.D'Agata, E, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of acquisition of ceftazidime-resistant gram-negative strains in a non-outbreak setting. J Clin Microbiol 1997;35:26022605.
12.Vollaard, EJ, Clasener, HA. Colonization resistance. Antimicrob Agents Chemother 1994;38:409414.
13.Lidsky, K, Hoyen, C, Salvator, A, Rice, LB, Toltzis, P. Antibiotic-resistant gram-negative organisms in pediatric chronic-care facilities. Clin Infect Dis 2002;34:760766.
14.D'Agata, EM, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of ceftazidime-resistant gram-negative bacilli on inanimate surfaces and their role in cross-transmission during nonoutbreak periods. J Clin Microbiol 1999;37:30653067.
15.Ojeniyi, B, Frederiksen, B, Hoiby, N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol 2000;29:177181.
16.Verweij, PE, Bijl, D, Melchers, WJ, et al.Pseudo-outbreak of multiresis-tant Pseudomonas aeruginosa in a hematology unit. Infect Control Hosp Epidemiol 1997;18:128131.
17.Tacconelli, E, Tumbarello, M, Bertagnolio, S, et al.Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: analysis of trends in prevalence and epidemiology. Emerg Infect Dis 2002;8:220221.
18.Pirnay, JP, De Vos, D, Cochez, C, et al.Molecular epidemiology of Pseudomonas aeruginosa colonization in a burn unit: persistence of a multidrug-resistant clone and a silver sulfadiazine-resistant clone. J Clin Microbiol 2003;41:11921202.
19.D'Agata, E, Venkataraman, L, DeGirolami, P, Weigel, L, Samore, M, Tenover, F. The molecular epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a tertiary care hospital. J Infect 1998;36:279285.
20.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococci, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834844.
21.Arruda, EA, Marinho, IS, Boulos, M, et al.Nosocomial infections caused by multiresistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 1999;20:620623.
22.Eveillard, M, Schmit, JL, Eb, F. Antimicrobial use prior to the acquisition of multiresistant bacteria. Infect Control Hosp Epidemiol 2002;23:155158.
23.Paterson, DL, Ko, WC, Von Gottberg, A, et al.International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial infections. Ann Intern Med 2004;140:2632.
24.D'Agata, EM, Venkataraman, L, DeGirolami, P, et al.Colonization with broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units during a nonoutbreak period: prevalence, risk factors, and rate of infection. Crit Care Med 1999;27:10901095.
25.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362386.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed