Sains Malaysiana 44(2)(2015): 257–260

Risk Factors for Multidrug-resistant Pseudomonas aeruginosa Among Hospitalized Patients at a Malaysian Hospital

(Faktor Risiko Daya Tahan Multidrug dalam Kalangan Pesakit yang Dimasukkan

ke Hospital di Malaysia)

M.D. MOHD NASIR¹, M.H. NURNAJWA², J. LAY², J.C. TEOH,² A.N. SYAFINAZ²

& M.T. NIAZLIN²*

¹Department of Biomedical Science, Faculty of Medicine & Health Sciences

Universiti Putra Malaysia, 43400 Serdang, Selangor D.E. Malaysia

²Department of Medical Microbiology & Parasitology, Faculty of Medicine & Health Sciences

Universiti Putra Malaysia, 43400 Serdang, Selangor D.E. Malaysia

Diserahkan: 2 Mei 2013/Diterima: 5 Ogos 2014

ABSTRACT

A case-control study was conducted based on medical cases of 100 hospitalized patients with Pseudomonas aeruginosa-isolation at a Malaysian hospital. Cases with 50 multidrug-resistant P. aeruginosa MDRPA and 50 non-multidrug-resistant P. aeruginosa (NMDRPA) were randomly included and compared with socio-demographic and clinical data of the patients, using Chi-square and Fisher’s exact tests as the statistical tool. Analysis found no significant association between MDRPA with ages, gender and ethnicity of patients (p>0.050). Other risk factors being investigated were invasive procedure, immunosuppression, bedridden and clinical diagnosis such as central nervous- and respiratory-system disorder, as well as antibiotic exposure during hospitalization and duration of hospital stay with only the last two were found to have significant association (p=0.035 and 0.019, respectively). Some other studies also reported a similar association indicating that the two factors could serve as an important predictive tool for isolation of MDRPA. More studies involving a larger sampling size are warranted to establish the association.

Keywords: Antibiotic exposure; hospital stay; multidrug resistant Pseudomonas aeruginosa; risk factor

ABSTRAK

Kajian secara kes kawalan ini dijalankan ke atas 100 kes pesakit yang dimasukkan ke hospital yang mengidap jangkitanPseudomonas aeruginosa di Malaysia. Secara rawak 50 kes multidrug rintanganP. aeruginosa dan 50 kes tiada multidrug rintanganP. aeruginosa dibandingkan secara sosio-demografik dan data klinikal pesakit menggunakan ‘Chi-square’ dan ‘Fisher’s exact tests’ sebagai kaedah statistik. Analisis tersebut tidak menunjukkan hubungan yang signifikan dengan umur, jantina dan etnik pesakit (p>0.050). Faktor risiko lain yang dikaji adalah prosedur invasif, kekurangan imun, terlantar di katil dan diagnosis klinikal seperti sistem saraf dan pernafasan, pendedahan kepada antibiotik ketika berada di hospital dan tempoh tinggal di hospital. Keputusan kajian menunjukkan hanya dua faktor mempunyai hubungan signifikan (masing-masingp=0.035 dan 0.019). Beberapa kajian lain juga turut melaporkan keputusan yang sama; yang menunjukkan bahawa kedua-dua faktor boleh bertindak sebagai faktor penyebab daya tahan multidrug P. aeruginosa. Lebih banyak kajian yang melibatkan saiz sampel yang lebih besar diperlukan untuk memperkukuhkan lagi hubungan tersebut.

Kata kunci: Daya tahan multidrug Pseudomonas aeruginosa; faktor risiko; pendedahan antibiotik; tempoh tinggal di hospital

RUJUKAN

Aloush, V., Navon-Venezia, S., Seigman-Igra, Y., Cabili, S. & Carmeli, Y. 2006. Multidrug-resistant Pseudomonas aeruginosa: Risk factors and clinical impact. Antimicrob. Agents Chemother. 50: 43-48.

Bahmani, N. & Ramazanzadeh, R. 2013. Detection of SHV type extended-spectrum B-lactamase and risk factors in Pseudomonas aeruginosa clinical isolates. Pak. J. Med. Sci. 29: 788-792.

Ghibu, L., Miftode, E., Teodor, A., Bejan, C. & Dorobăţ, C.M. 2010. Rev. Med. Chir. Soc. Med. Nat. Iasi. 114: 1012-1016.

Hsu, D.I., Okamoto, M.P., Murthy, R. & Wong-Beringer, A. 2005. Fluoroquinolone-resistant Pseudomonas aeruginosa: Risk factors for acquisition and impact on outcomes. J. Antimicrob. Ther. 55: 535-541.

Idris, S.N.A., Desa, M.N.M., Aziz, M.N. & Taib, N.M. 2012. Antimicrobial susceptibility pattern and distribution of ExoU and ExoS genes in clinical isolates of Pseudomonas aeruginosa at a Malaysian Hospital. Southeast Asian J. Trop. Med. Public Health 43: 116-123.

Lodise, T.P., Christopher, D.M., Jeffrey, G., Furuno, J.P., McGregor, J.C., Ben, L., Graffunder, E. & McNutt, L.A. 2007. Clinical prediction tool to identify patients with Pseudomonas aeruginosa respiratory tract infections at greatest risk for multidrug resistance. Antimicrob. Agents Chemother. 51: 417-422.

Maruyama, T., Fujisawa, T., Okuno, M., Toyoshima, H., Tsutsui, K., Maeda, H., Yuda, H., Yoshida, M., Kobayashi, H., Taguchi, O., Gabazza, E.C., Takei, Y., Miyashita, N., Ihara, T., Brito, V. & Niederman, M.S. 2013. A new strategy for healthcare-associated pneumonia: A 2-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clinical Infectious Diseases 57: 1373-1383.

Padmakrishnan, R.A., Murugan, T. & Renuga Devi, M.P. 2009. Studies on multidrug resistant Pseudomonas aeruginosa from pediatric population with special reference to extended spectrum beta lactamase. Indian Journal of Science and Technology 2: 11-13.

Shanthi, M. & Sekar, U. 2009. Multi-drug resistant Pseudomonas aeruginosa and Acinetobacter baumanniiinfections among hospitalized patients: Risk factors and outcomes. J. Assoc. Physicians India 57: 638-640.

*Pengarang untuk surat-menyurat; email: niazlin@upm.edu.my