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Antimicrobial Agents and Chemotherapy, March 2002, p. 854-858, Vol. 46, No. 3
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.3.854-858.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Risk Factors for Piperacillin-Tazobactam-Resistant Pseudomonas aeruginosa among Hospitalized Patients

Anthony D. Harris,1,2* Eli Perencevich,3 Mary-Claire Roghmann,1,2 Glenn Morris,1 Keith S. Kaye,4 and Judith A. Johnson2,5

Department of Epidemiology and Preventive Medicine,1 Department of Pathology, University of Maryland,5 VA Maryland Health Care System, Baltimore, Maryland,2 Beth Israel Deaconess Medical Center, Boston, Massachusetts,3 Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina4

Received 5 June 2001/ Returned for modification 29 September 2001/ Accepted 7 December 2001

Antimicrobial resistance is an emerging problem with Pseudomonas aeruginosa. This study determined risk factors for the recovery of piperacillin-tazobactam-resistant P. aeruginosa from clinical cultures from hospitalized patients. A case-control study design was used to compare two groups of case patients with control patients. The first group of case patients was defined by nosocomial isolation of piperacillin-tazobactam-resistant P. aeruginosa, and the second group of cases yielded piperacillin-tazobactam-susceptible P. aeruginosa. Controls were selected in a 6:1 ratio from the same medical or surgical services among which piperacillin-tazobactam-resistant P. aeruginosa arose in patients. Risk factors analyzed included antimicrobial drug exposure, comorbid conditions, and demographics. Bivariate and multivariable analyses were performed. Piperacillin-tazobactam-resistant P. aeruginosa was isolated from 179 patients, and piperacillin-tazobactam-susceptible P. aeruginosa was isolated from 624 patients over a 2.5-year period. Piperacillin-tazobactam (odds ratio [OR] = 6.82; 95% confidence interval [CI], 4.56 to 10.21), imipenem (OR = 2.42; 95% CI, 1.19 to 4.94), aminoglycosides (OR = 2.18; 95% CI, 1.44 to 3.28), vancomycin (OR = 1.87; 95% CI, 1.21 to 2.89), and broad-spectrum cephalosporins (OR = 2.38; 95% CI, 1.45 to 3.88) were the antibiotics associated with the isolation of piperacillin-tazobactam-resistant P. aeruginosa. Exposure to vancomycin (OR = 1.53; 95% CI, 1.13 to 2.06) or ampicillin-sulbactam (OR = 2.28; 95% CI, 1.62 to 3.21) was associated with recovery of piperacillin-tazobactam-susceptible P. aeruginosa. In this study, antibiotics associated with piperacillin-tazobactam-susceptible P. aeruginosa were different from antibiotics associated with piperacillin-tazobactam-resistant P. aeruginosa. Piperacillin-tazobactam was a strong risk factor for piperacillin-tazobactam-resistant P. aeruginosa. Our results suggest that the nosocomial isolation of piperacillin-tazobactam-resistant P. aeruginosa may be affected by multiple antibiotics.

* Corresponding author. Mailing address: Division of Healthcare Outcomes Research, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine-VA Maryland Health Care System, 10 North Greene St., Room 5D151, Baltimore, MD 21201. Phone: (410) 605-7000, ext. 5211. Fax: (410) 605-7914. E-mail: aharris{at}epi.umaryland.edu.

Antimicrobial Agents and Chemotherapy, March 2002, p. 854-858, Vol. 46, No. 3
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.3.854-858.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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