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Volume 49, Number 1, February 2016

Carbapenem-resistant Pseudomonas aeruginosa in Taiwan: Prevalence, risk factors, and impact on outcome of infections 


Kuan-Yin Lin, Tsai-Ling Lauderdale, Jann-Tay Wang, Shan-Chwen Chang


 

Corresponding author:

Jann-Tay Wang
Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. 



 

Background and purpose: 

The prevalence and clinical impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) is unclear in Taiwan. We aim to clarify these clinical issues by using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. 



 

Methods:

Patients from five hospitals with their P. aeruginosa isolates collected by TSAR II-VII (2000–2010) program were considered as the potential study population. All patients with CRPA were enrolled as case patients. Patients with carbapenem-susceptible P. aeruginosa were randomly selected in a 1:1 ratio to case patients as control patients. CRPA isolates were tested for the presence of carbapenemase-producing genes. The clinical data were collected to identify risk factors for CRPA carriage and mortality of P. aeruginosa infection. 



 

Results:

The overall prevalence of CRPA was 10.2% (349/3408), which increased significantly by the TSAR period (p = 0.007). Among the 164 enrolled patients, the risk factor for carrying CRPA was previous fluoroquinolone exposure (p = 0.004). The risk factors for mortality among 80 patients with infection by P. aeruginosa included: intensive care unit (ICU) setting, receipt of antifungal therapy, and presence of invasive devices (p = 0.001, 0.010, and 0.017; respectively). Carbapenem resistance did not play a role. Among the 82 CRPA isolates enrolled in this study, 15 isolates were found to carry carbapenemase-producing genes. 



 

Conclusion:

In Taiwan, the prevalence of CRPA and carriage of carbapenemase-producing genes was high. However, carbapenem resistance did not play a role in the mortality of patients with P. aeruginosa infections. 



 

Key words:

Carbapenem resistant, Mortality, Pseudomonas aeruginosa, Surveillance, Taiwan Surveillance of Antimicrobial Resistance (TSAR)