Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Rechling, C.
Epidemiology of and risk factors for community and hospital acquired pseudomonas lung infections in cystic fibrosis and non cystic fibrosis patients
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 89
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Meilinger Michael
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- Abstract:
- Background: P. aeruginosa infection is a major cause of morbidity and mortality in patients with CF. It is the major cause of ventilator- associated pneumonia (VAP) with a high rate of attributable mortality and the second most common cause of nosocomial pneumonia in general. Treatment of P. aeruginosa infections is complicated due to its intrinsic and acquired resistance mechanism. Growing resistance in P. aeruginosa can also be found for many antibiotics in Austria. Material and Methods: We retrospectively analysed data of 289 patients with P. aeruginosa infection/colonisation of the respiratory tract. The isolates were taken in the period of 01.01.2011 until 31.12.2011 from the Institute of Hygiene, Microbiology and Environmental Medicine of the Medical University of Graz and the Laboratory of Infectiology and Microbiology of the Department of Internal Medicine of the University Hospital Graz. We examined resistances to 37 antibiotic drugs e.g. combinations of antibiotics in CF-patients and non-CF-patients. Furthermore we figured out which accompanying diseases can be found in our patient population, whether they were hospitalised in the last six months, whether they were intubated or had a tracheostomy and whether they stayed on an ICU when P. aeruginosa was detected. In CF-patients we examined whether they are more frequently infected with S. aureus, the number of pneumoniae and whether there are differences in resistances to antibiotics compared to non-CF-patients. Results: Highest susceptibilities for single antibiotics were found for tobramycin (95.8%), Amikacin (95.7%), Colistin (92.1%), Cefepim (91.0%), Piperacillin/Tazobactam (90.4%) and Ceftazidim (90.2%). The most effective combination treatments were Ciprofloxacin plus Colistin (100%), Colistin plus Ciprofloxacin (100%), Tobramycin plus Ceftazidim (100%), Ceftazidim plus Amikacin (98.2%), Ceftazidim plus Tobramycin (98.2%), Meropenem plus Amikacin (98.2%), Meropenem plus Tobramycin (98.2%) and Tobramycin plus Meropenem (97%). Most significant differences between susceptibility rates in CF-patients and non-CF-patients were found for Aztreonam (61.4% higher in CF-patients), Doripenem (25% less in CF-patients), Imipenem (24.3% less in CF-patients) and Gentamicin (22.5% less in CF-patients). A highly significant correlation was found for S. aureus coinfection and cystic fibrosis (p=0.000) compared to non-CF patients. In nearly half of our patients Pseudomonas was detected while staying on ICU. Most of them were intubated. Among accompanying diseases COPD, CF and bronchiectasis were most common. Conclusion: Growing resistances in P. aeruginosa can be found for many antibiotics in Austria. Susceptibilities to some antimicrobial agents are still high, especially to tobramycin and colistin. Combinations of two antibiotics show excellent susceptibility, but resistances to some combination preparations can already be found. Resistances are generally more prevalent in CF-patients. This is a serious problem because mucoid strains of P. aeruginosa, which are very frequent in the airways of CF-patients, are associated with decreased lung function, increased episodes of exacerbation and higher mortality. Stays on ICUs and intubation are common risk factors for acquiring Pseudomonas.