TY - JOUR
T1 - Epidemiology and characterisation of carbapenem-non-susceptible Pseudomonas aeruginosa in a large intensive care unit in Jakarta, Indonesia
AU - Saharman, Yulia Rosa
AU - Pelegrin, Andreu Coello
AU - Karuniawati, Anis
AU - Sedono, Rudyanto
AU - Aditianingsih, Dita
AU - Goessens, Wil H.F.
AU - Klaassen, Corné H.W.
AU - van Belkum, Alex
AU - Mirande, Caroline
AU - Verbrugh, Henri A.
AU - Severin, Juliëtte A.
N1 - Funding Information:
Funding: YRS is an awardee of the DIKTI-NESO Scholarship by The Directorate General of Higher Education of the Indonesia Ministry of Research, Technology and Higher Education of the Republic of Indonesia. ACP received funding from the European Union's Horizon 2020 research and innovation programme (ND4ID) under the Marie Skłodowska-Curie grant agreement no. 675412.
Publisher Copyright:
© 2019 The Authors
PY - 2019/11
Y1 - 2019/11
N2 - The aim of this study was to describe the epidemiology and clinical impact of carbapenem-non-susceptible Pseudomonas aeruginosa (CNPA) in intensive care units (ICUs) of the national referral hospital of Indonesia. Adult patients admitted to ICUs were prospectively included. Pseudomonas aeruginosa were from clinical cultures and systematic screening. Environmental niches and healthcare workers (HCWs) were also screened. Susceptibility was determined phenotypically and the presence of carbapenemase genes was determined by PCR. Multiple loci variable-number tandem repeat analysis (MLVA) and multilocus sequence typing (MLST) were used for genotyping. Of the patients included in the study, 17/412 (4.1%) carried CNPA on admission and 34/395 (8.6%) became positive during their ICU stay. The acquisition rate was 18/1000 patient-days at risk. Of 16 environmental isolates, 12 (75.0%) were CNPA. HCWs screened negative. Acquisition of CNPA was associated with longer ICU stay (adjusted hazard ratio = 1.89, 99% confidence interval 1.12–3.13). Mortality was >40% among patients with CNPA versus <30% among those without CNPA (P = 0.019). Moreover, 83/119 (69.7%) CNPA carried either blaVIM (n = 36), blaIMP (n = 23) or blaGES-5 (n = 24). Four sequence types (STs) dominated (ST235, ST823, ST446 and ST357). Five major MLVA clusters were distinguished, two belonging to ST235 and the other three to ST823, ST446 and ST357. CNPA are introduced into these ICUs and some strains expand clonally among patients and the environment, creating endemic CNPA. VIM-, IMP- and GES-5 genes are prevalent. CNPA acquisition was associated with prolonged ICU stay and may affect ICU survival.
AB - The aim of this study was to describe the epidemiology and clinical impact of carbapenem-non-susceptible Pseudomonas aeruginosa (CNPA) in intensive care units (ICUs) of the national referral hospital of Indonesia. Adult patients admitted to ICUs were prospectively included. Pseudomonas aeruginosa were from clinical cultures and systematic screening. Environmental niches and healthcare workers (HCWs) were also screened. Susceptibility was determined phenotypically and the presence of carbapenemase genes was determined by PCR. Multiple loci variable-number tandem repeat analysis (MLVA) and multilocus sequence typing (MLST) were used for genotyping. Of the patients included in the study, 17/412 (4.1%) carried CNPA on admission and 34/395 (8.6%) became positive during their ICU stay. The acquisition rate was 18/1000 patient-days at risk. Of 16 environmental isolates, 12 (75.0%) were CNPA. HCWs screened negative. Acquisition of CNPA was associated with longer ICU stay (adjusted hazard ratio = 1.89, 99% confidence interval 1.12–3.13). Mortality was >40% among patients with CNPA versus <30% among those without CNPA (P = 0.019). Moreover, 83/119 (69.7%) CNPA carried either blaVIM (n = 36), blaIMP (n = 23) or blaGES-5 (n = 24). Four sequence types (STs) dominated (ST235, ST823, ST446 and ST357). Five major MLVA clusters were distinguished, two belonging to ST235 and the other three to ST823, ST446 and ST357. CNPA are introduced into these ICUs and some strains expand clonally among patients and the environment, creating endemic CNPA. VIM-, IMP- and GES-5 genes are prevalent. CNPA acquisition was associated with prolonged ICU stay and may affect ICU survival.
KW - Carbapenemase
KW - Indonesia
KW - Intensive care unit
KW - Metallo-β-lactamase
KW - Microbial drug resistance
KW - Pseudomonas aeruginosa
UR - http://www.scopus.com/inward/record.url?scp=85073151503&partnerID=8YFLogxK
U2 - 10.1016/j.ijantimicag.2019.08.003
DO - 10.1016/j.ijantimicag.2019.08.003
M3 - Article
C2 - 31398483
AN - SCOPUS:85073151503
SN - 0924-8579
VL - 54
SP - 655
EP - 660
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 5
ER -