Prior carbapenem exposure ups risk of drug-resistant Pseudomonas aeruginosa infection

Children with prior exposure to carbapenems and bronchoscopy have a higher risk of developing carbapenem-resistant Pseudomonas aeruginosa (CRPA), reveals a study.

“CRPA is rapidly emerging as a life-threatening nosocomial infection,” said the researchers, led by Lu Li, from the Department of Infectious Children’s Hospital of Chongqing Medical University in China.

Li and colleagues conducted this retrospective study to identify the risk factors for CRPA infection in children, especially antimicrobials use and invasive procedures. They included a cohort of patients with PA infection from January 2016 to December 2020.

Using propensity-score matching, patients were matched and assigned to a carbapenem-susceptible PA group or to a CRPA group. The authors then performed univariate and multivariate analyses to estimate the risk factors of CRPA.

Of the 1,025 patients identified in the study, 172 were included in the analyses. Univariate analysis revealed that prior treatment with some antimicrobials and invasive procedures were associated with CRPA infection (p<0.05).

In multivariate analysis, however, only prior exposure to carbapenems (odds ratio [OR], 0.102, 95 percent confidence interval [CI], 0.033‒0.312; p<0.001) and bronchoscopy (OR, 0.147, 95 percent CI, 0.032‒0.678; p=0.014) during time at risk, previous invasive therapy in the last year (OR, 0.353, 95 percent CI, 0.159‒0.780; p=0.013), and previous use of β-lactams/β-lactamase inhibitors within the last 90 days (OR, 0.327, 95 percent CI, 0.121‒0.884; p=0.03) were found to be associated with CRPA infection.

“The spread of CRPA could be influenced by invasive therapy, and we need [to] pay attention to it,” the researchers said. “Moreover, we should take restrictions in the clinical use of carbapenems into account.”