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Volume 17, Number 6—June 2011

CME ACTIVITY

Cefepime-Resistant Pseudomonas aeruginosa

Ehimare Akhabue, Marie Synnestvedt, Mark G. Weiner, Warren B. Bilker, and Ebbing LautenbachComments to Author 
Author affiliations: Author affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Main Article

Table 1

Bivariable analysis comparing patient exposures to cefepime-resistant and cefepime-susceptible Pseudomonas aeruginosa, Philadelphia, PA, USA, 2001–2006*

Variable No. (%) case-patients, n = 213 No. (%) controls,
n = 2,316 OR (95% CI) p value†
General
Male sex 132 (62.0) 1,307 (56.4) 1.26 (0.94–1.70) 0.13
Race, white 95/207 (45.9) 1021/2,270 (45.0) 1.04 (0.77–1.39) 0.83
Hospital, PPMC 44 (20.7) 501 (21.6) 0.94 (0.65–1.34) 0.79
Transfer from another facility‡ 73/212 (34.4) 509/2,304 (22.1) 1.85 (1.35–2.52) <0.001
In ICU at time of culture 104/202 (51.5) 831/2,132 (39.0) 1.66 (1.23–2.24) 0.001
Prior hospitalization in past 30 d
60 (28.2)
526 (22.7)
1.33 (0.96–1.84)
0.07
APR-DRG§ 152 (71.4) 1,328 (57.5) 1.84 (1.34–2.55) <0.001
Concurrent illness
Renal insufficiency 34 (16.0) 305 (13.2) 1.25 (0.82–1.86) 0.25
Malignancy 22 (10.3) 358 (15.5) 0.63 (0.38–0.99) 0.05
Diabetes 43 (20.2) 511 (22.1) 0.89 (0.62–1.28) 0.60
Liver disease 9 (4.2) 46 (2.0) 2.18 (0.92–4.58) 0.04
Congestive heart failure 2 (0.9) 37 (1.6) 0.58 (0.07–2.29) 0.77
Chronic pulmonary disease 52 (24.4) 453 (19.6) 1.33 (0.94–1.86) 0.11
Immunosuppressive therapy 39 (18.3) 256 (11.1) 1.80 (1.21–2.63) 0.004
HIV infection
5 (2.4)
54 (2.3)
1.01 (0.31–2.54)
>0.99
Antimicrobial drug use¶
Any 150 (70.4) 1,458 (63.0) 1.40 (1.02–1.93) 0.03
Aminoglycoside 38 (17.8) 382 (16.5) 1.10 (0.74–1.60) 0.63
Quinolones 58 (27.2) 290 (12.5) 2.61 (1.85–3.65) <0.001
Extended-spectrum penicillins 31 (14.6) 125 (5.4) 2.99 (1.89–4.60) <0.001
Extended-spectrum cephalosporin 80 (37.6) 401 (17.3) 2.87 (2.10–3.90) <0.001
Prior carbapenem 14 (6.6) 58 (2.5) 2.74 (1.38–5.08) 0.002
Prior anaerobic therapy 111 (52.1) 896 (38.7) 1.72 (1.29–2.31) <0.001
Prior tetracyclines 1 (0.5) 18 (0.8) 0.60 (0.01–3.85) >0.99
Prior macrolide 8 (3.8) 117 (5.1) 0.73 (0.31–1.52) 0.51

*OR, odds ratio; CI, confidence interval; PPMC, Penn Presbyterian Medical Center; ICU, intensive care unit; APR-DRG: all-patient refined-diagnosis–related group. Case-patients, those with cefepime-resistant P. aeruginosa; median (interquartile range) duration of stay before culture 8 (4–12) d; and Charlson index 2. Controls, those with cefepime-susceptible P. aeruginosa (interquartile range) duration of stay before culture 4 (4–5) d; and Charlson index 2.
†Fisher exact test for categorical variables; Wilcoxon rank-sum test for continuous variables.
‡Outside hospital, long-term care facility, or rehabilitation center.
§Patients in the extreme illness category.
¶Inpatient use within previous 30 d before culture during same hospitalization.

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