Prevalence and risk factors associated with colonization and infection of extensively drug-resistant Pseudomonas aeruginosa: a systematic review

Abstract

Pseudomonas aeruginosa is a Gram-negative human pathogen with extensively drug-resistant (XDR) strains emerging in hospitals across the globe. This systematic review is focused on the worldwide prevalence of XDR P. aeruginosa (XDR-PA) and on the risk factors associated with its colonization and infection, based on literature available through PubMed, Web of Science and BioMed Central databases. An overview of surveillance systems is provided as well as a synopsis on the prevalence of XDR-PA, showing an increase in recent reports. Risk factors independently associated with XDR-PA colonization or infections are described in four groups with reference to antimicrobial therapy, medical devices as well as patient- and hospital environment-related factors.

Keywords:

• acquisition
• colonization
• extensive drug resistance
• extensively drug-resistant
• infection
• prevalence
• Pseudomonas aeruginosa
• review
• risk factors

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Key issues

• A recent consensus definition by European (CDC)-CDC allows a uniformly used classification of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA).

• Surveillance networks provide data on resistant P. aeruginosa, but mostly not on the particular resistance pattern defining XDR-PA.

• Prevalence of XDR-PA is increasing and regional outbreaks are described.

• XDR-PA is reported worldwide and spread of high-risk clones is common with geographically confined predominance.

• Antimicrobial therapy was the most frequently reported independent risk factor for XDR-PA acquisition, attributed to prior patient exposure to antimicrobials such as fluoroquinolones, carbapenems, amikacin and trimethoprim-sulfamethoxazole.

• Further groups of independent risk factors for XDR-PA acquisition were medical devices, patient- and hospital environment-related factors.

• Both colonization and infection with XDR-PA may be associated with either one or several out of these groups of risk factors.

• Most study data are available on XDR-PA infection, with a number of studies having investigated bloodstream infection.

• Based on the knowledge about prevalence and risk factors for XDR-PA, in particular affecting immunocompromised patients and intensive care environments, measures should be implemented to minimize colonization, infection and subsequent mortality.

Notes