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Antimicrobial Agents and Chemotherapy, June 1999, p. 1379-1382, Vol. 43, No. 6
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Emergence of Antibiotic-Resistant Pseudomonas aeruginosa: Comparison of Risks Associated with Different Antipseudomonal Agents

Yehuda Carmeli,* Nicolas Troillet, George M. Eliopoulos, and Matthew H. Samore

Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts

Received 24 November 1998/Returned for modification 13 January 1999/Accepted 17 March 1999

Pseudomonas aeruginosa is a leading cause of nosocomial infections. The risk of emergence of antibiotic resistance may vary with different antibiotic treatments. To compare the risks of emergence of resistance associated with four antipseudomonal agents, ciprofloxacin, ceftazidime, imipenem, and piperacillin, we conducted a cohort study, assessing relative risks for emergence of resistant P. aeruginosa in patients treated with any of these drugs. A total of 271 patients (followed for 3,810 days) with infections due to P. aeruginosa were treated with the study agents. Resistance emerged in 28 patients (10.2%). Adjusted hazard ratios for the emergence of resistance were as follows: ceftazidime, 0.7 (P = 0.4); ciprofloxacin, 0.8 (P = 0.6); imipenem, 2.8 (P = 0.02); and piperacillin, 1.7 (P = 0.3). Hazard ratios for emergence of resistance to each individual agent associated with treatment with the same agent were as follows: ceftazidime, 0.8 (P = 0.7); ciprofloxacin, 9.2 (P = 0.04); imipenem, 44 (P = 0.001); and piperacillin, 5.2 (P = 0.01). We concluded that there were evident differences among antibiotics in the likelihood that their use would allow emergence of resistance in P. aeruginosa. Ceftazidime was associated with the lowest risk, and imipenem had the highest risk.

* Corresponding author. Mailing address: Division of Infectious Diseases, Tel Aviv Medical Center, 6 Weizman St., Tel Aviv 64239, Israel. Phone: (972) 3 697-3317. Fax: (972) 3 697-4996. E-mail: ycarmeli{at}mailexcite.com.

Antimicrobial Agents and Chemotherapy, June 1999, p. 1379-1382, Vol. 43, No. 6
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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