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Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study

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dc.contributor.authorReyes, Jinnethe
dc.contributor.authorKomarow, Lauren
dc.contributor.authorChen, Liang
dc.contributor.authorGe, Lizhao
dc.contributor.authorHanson, Blake
dc.contributor.authorCober, Eric
dc.contributor.authorHerc, Erica
dc.contributor.authorAlenazi, Thamer
dc.contributor.authorKaye, Keith
dc.contributor.authorGarcia, Julia
dc.contributor.authorLi, Lanjuan
dc.contributor.authorKanj, Souha
dc.contributor.authorLiu, Zhengyin
dc.contributor.authorOñate, Jose
dc.contributor.authorSalata, Robert
dc.contributor.authorMarimuthu, Kalisvar
dc.contributor.authorGao, Hainv
dc.contributor.authorZong, Zhiyong
dc.contributor.authorValderrama, Sandra
dc.contributor.authorYu, Yunsong
dc.contributor.authorTambyah, Paul
dc.contributor.authorWeston, Gregory
dc.contributor.authorSalcedo, Soraya
dc.contributor.authorAbbo, Lillian
dc.contributor.authorXie, Qing
dc.contributor.authorOrdoñez, Karen
dc.contributor.authorWang, Minggui
dc.contributor.authorStryjewski, Martin
dc.contributor.authorMunita, Jose M.
dc.contributor.authorPaterson, David
dc.contributor.authorEvans, Scott
dc.contributor.authorHill, Carol
dc.contributor.authorBaum, Keri
dc.contributor.authorBonomo, Robert
dc.contributor.authorKreiswirth, Barry
dc.contributor.authorVirginia, Maria
dc.contributor.authorPate, Robin
dc.contributor.authorArias, Cesar
dc.contributor.authorChambers, Henry
dc.contributor.authorFowler,Vance
dc.contributor.authorDoi, Yohei
dc.contributor.authorVan Duin, David
dc.contributor.authorSatlin, Michael
dc.contributor.authorAntibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators
dc.date.accessioned2024-05-20T18:07:29Z
dc.date.available2024-05-20T18:07:29Z
dc.date.issued2023
dc.description.abstractBackground: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. Methods: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. Findings: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses.Interpretation: The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. Funding: National Institutes of Health.
dc.description.versionPublicada
dc.identifier.citationReyes J, Komarow L, Chen L, Ge L, Hanson BM, Cober E, Herc E, Alenazi T, Kaye KS, Garcia-Diaz J, Li L, Kanj SS, Liu Z, Oñate JM, Salata RA, Marimuthu K, Gao H, Zong Z, Valderrama-Beltrán SL, Yu Y, Tambyah P, Weston G, Salcedo S, Abbo LM, Xie Q, Ordoñez K, Wang M, Stryjewski ME, Munita JM, Paterson DL, Evans S, Hill C, Baum K, Bonomo RA, Kreiswirth BN, Villegas MV, Patel R, Arias CA, Chambers HF, Fowler VG Jr, Doi Y, van Duin D, Satlin MJ; Antibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators. Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. Lancet Microbe. 2023 Mar;4(3):e159-e170. doi: 10.1016/S2666-5247(22)00329-9
dc.identifier.doihttps://doi.org/10.1016/S2666-5247(22)00329-9
dc.identifier.urihttps://hdl.handle.net/11447/8850
dc.language.isoen
dc.subjectAnti-Bacterial Agents* / therapeutic use
dc.subjectCarbapenems / therapeutic use
dc.subjectPseudomonas Infections* / drug therapy
dc.subjectPseudomonas Infections* / epidemiology
dc.subjectPseudomonas aeruginosa / genetics
dc.titleGlobal epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceThe Lancet Microbe
dspace.entity.typePublication
relation.isAuthorOfPublicationec52b0bf-d0bc-4844-9531-eca4a65f2b8e
relation.isAuthorOfPublication.latestForDiscoveryec52b0bf-d0bc-4844-9531-eca4a65f2b8e

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