Impact of AmpC overexpression on outcomes of patients with Pseudomonas aeruginosa bacteremia

Abstract AmpC overexpression (AmpC++) is a significant mechanism of β-lactam resistance in Pseudomonas aeruginosa , but its impact on clinical outcomes is not well established. To examine the influence of AmpC++ on clinical outcomes of patients with P. aeruginosa bacteremia, we screened all bloodstr...

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Bibliographic Details
Published in:Diagnostic microbiology and infectious disease 2009-03, Vol.63 (3), p.279-285
Main Authors: Tam, Vincent H, Chang, Kai-Tai, Schilling, Amy N, LaRocco, Mark T, Genty, Layne O, Garey, Kevin W
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
AmpC overexpression
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy
Bacteremia - microbiology
Bacterial diseases
Bacterial Proteins - biosynthesis
Bacterial sepsis
Bacteriology
beta-Lactam Resistance
beta-Lactamases - biosynthesis
Biological and medical sciences
Female
Fundamental and applied biological sciences. Psychology
Gene Expression
Human bacterial diseases
Humans
Infectious Disease
Infectious diseases
Internal Medicine
Male
Medical sciences
Microbiology
Middle Aged
Miscellaneous
Outcomes
Pseudomonas aeruginosa
Pseudomonas aeruginosa - drug effects
Pseudomonas aeruginosa - enzymology
Pseudomonas Infections - drug therapy
Pseudomonas Infections - microbiology
Retrospective Studies
Treatment Outcome
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Summary:Abstract AmpC overexpression (AmpC++) is a significant mechanism of β-lactam resistance in Pseudomonas aeruginosa , but its impact on clinical outcomes is not well established. To examine the influence of AmpC++ on clinical outcomes of patients with P. aeruginosa bacteremia, we screened all bloodstream P. aeruginosa isolates obtained from 2003 to 2006 for AmpC++. Demographics and outcomes were retrospectively compared between patients with P. aeruginosa bacteremia caused by AmpC++ and pan-susceptible strains (wild-type controls). Of the 263 isolates screened, 63 (24.0%) were nonsusceptible to ceftazidime. Clinical data of 42 AmpC++ isolates from 21 patients were compared with 33 control patients. The 2 groups were similar in sex and race. Patients in the AmpC++ group was more likely to receive inappropriate empiric antibiotics (odds ratio [OR] = 67.5; 95% confidence interval [CI], 6.3–720.0) and experience microbiologic persistence (OR = 12.2; 95% CI, 1.7–87.7). In institutions with a high prevalence of AmpC++, empiric therapy with agents with activity against AmpC++ strains may be warranted.
ISSN:0732-8893
1879-0070
DOI:10.1016/j.diagmicrobio.2008.11.007