Cefepime-Resistant Pseudomonas aeruginosa | CDC EID || MEDSCAPE CME ACTIVITY

EID Journal Home > Volume 17, Number 6–June 2011

Volume 17, Number 6–June 2011
MEDSCAPE CME ACTIVITY
Cefepime-Resistant Pseudomonas aeruginosa
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.

Release date: May 24, 2011; Expiration date: May 24, 2012

Learning Objectives
Upon completion of this activity, participants will be able to:

•Distinguish the prevalence of cefepime-resistant P. aeruginosa
•Analyze risk factors for the development of cefepime-resistant P. aeruginosa
•Evaluate the effects of cefepime-resistant P. aeruginosa on the risk for mortality

Medscape CME Editor
P. Lynne Stockton, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: P. Lynne Stockton has disclosed no relevant financial relationships.

Medscape CME Author
Charles P. Vega, MD, Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

Authors
Disclosures: Ehimare Akhabue, BA, and Marie Synnestvedt, PhD, have disclosed no relevant financial relationships. Mark G. Weiner, MD, has disclosed the following relevant financial relationships: received grants for clinical research from Pfizer Inc. Warren B. Bilker, PhD, has disclosed the following relevant financial relationships: served as an advisor or consultant for Johnson & Johnson Pharmaceutical Research & Development, LLC, Hisamitsu Pharmaceuticals, and Avid Radiopharmaceuticals; received grants for clinical research from Novartis Pharmaceuticals Corporation, Takeda Pharmaceuticals North America, Inc., and Pfizer Inc. Ebbing Lautenbach, MD, MPH, has disclosed the following relevant financial relationships: received grants for clinical research from 3M Pharmaceuticals and AstraZeneca Pharmaceuticals LP.

Cefepime-Resistant Pseudomonas aeruginosa, CME Activity | CDC EID

EID Journal Home > Volume 17, Number 6–June 2011

Volume 17, Number 6–June 2011
Research
Cefepime-Resistant Pseudomonas aeruginosa
Ehimare Akhabue,1 Marie Synnestvedt, Mark G. Weiner, Warren B. Bilker, and Ebbing Lautenbach

Suggested citation for this article

Abstract
Resistance to extended-spectrum cephalosporins complicates treatment of Pseudomonas aeruginosa infections. To elucidate risk factors for cefepime-resistant P. aeruginosa and determine its association with patient death, we conducted a case–control study in Philadelphia, Pennsylvania. Among 2,529 patients hospitalized during 2001–2006, a total of 213 (8.4%) had cefepime-resistant P. aeruginosa infection. Independent risk factors were prior use of an extended-spectrum cephalosphorin (p< 0.001), prior use of an extended-spectrum penicillin (p = 0.005), prior use of a quinolone (p< 0.001), and transfer from an outside facility (p = 0.01). Among those hospitalized at least 30 days, mortality rates were higher for those with cefepime-resistant than with cefepime-susceptible P. aeruginosa infection (20.2% vs. 13.2%, p = 0.007). Cefepime-resistant P. aeruginosa was an independent risk factor for death only for patients for whom it could be isolated from blood (p = 0.001). Strategies to counter its emergence should focus on optimizing use of antipseudomonal drugs.


Pseudomonas aeruginosa is one of the most common gram-negative bacterial causes of health care–acquired infections (1–3). These infections result in high morbidity and mortality rates (4,5). When serious P. aeruginosa infections are suspected, early and appropriate antimicrobial drug therapy is crucial because inadequate drug selection has been associated with increased mortality rates (6,7). Complicating the empiric selection of adequate therapy is the increasing prevalence of antimicrobial drug resistance among P. aeruginosa (8–10). Even in initially susceptible strains, resistance can rapidly develop during treatment (11–13).

Cefepime, a fourth-generation cephalosphorin, is one of the few agents remaining that has reliable activity against P. aeruginosa. However, increased prevalence of resistance to cefepime among these organisms has been noted (14–18). As such, elucidating the epidemiology of cefepime-resistant P. aeruginosa is crucial to ensure that this agent remains a viable therapeutic option. Our goals were to identify risk factors for cefepime-resistant P. aeruginosa infections in the hospital setting and to describe the clinical effects of these infections.

Methods
The study was performed at the Hospital of the University of Pennsylvania (HUP), a 725-bed tertiary-care center, and Penn Presbyterian Medical Center (PPMC), a 344-bed urban community hospital. Each hospital is located in Philadelphia, Pennsylvania, USA, and is part of the University of Pennsylvania Health System. The study was reviewed and approved by the University of Pennsylvania Institutional Review Board.

Participants
To investigate risk factors for cefepime-resistant P. aeruginosa, we conducted a case–control study. We identified study participants through records obtained from the clinical microbiology laboratory at HUP, which performs bacterial cultures on all clinical specimens from HUP and PPMC. All adult patients with a positive P. aeruginosa culture result from January 1, 2001, through December 31, 2006, were eligible for inclusion. Each participant was included only one time; the first positive P. aeruginosa culture identified during the study period was used.

On the basis of our first study goal—identifying risk factors—we designated all participants with a cefepime-resistant P. aeruginosa–positive culture result as case-patients and all participants with a cefepime-susceptible P. aeruginosa culture result as controls. All eligible case-patients and controls were included according to the aforementioned eligibility criteria.

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Cefepime-Resistant Pseudomonas aeruginosa | CDC EID


Suggested Citation for this Article
Akhabue E, Synnestvedt M, Weiner MG, Bilker WB, Lautenbach E. Cefepime-resistant Pseudomonas aeruginosa. Emerg Infect Dis [serial on the Internet]. 2011 Jun [date cited]. http://www.cdc.gov/EID/content/17/6/1037.htm

DOI: 10.3201/eid1706.100358



1Current affiliation: Duke University School of Medicine, Durham, North Carolina, USA.


Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Ebbing Lautenbach, University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, USA; email: ebbing@mail.med.upenn.edu