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Volume 25, Number 7—July 2019

Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015

Maroya Spalding WaltersComments to Author , Julian E. Grass, Sandra N. Bulens, Emily B. Hancock, Erin C. Phipps, Daniel Muleta, Jackie Mounsey, Marion A. Kainer, Cathleen Concannon, Ghinwa Dumyati, Chris Bower, Jesse Jacob, P. Maureen Cassidy, Zintars Beldavs, Karissa Culbreath, Walter E. Phillips, Dwight J. Hardy, Roberto L. Vargas, Margret Oethinger, Uzma Ansari, Richard Stanton, Valerie Albrecht, Alison Laufer Halpin, Maria Karlsson, J. Kamile Rasheed, and Alexander Kallen
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.S. Walters, J.E. Grass, S.N. Bulens, U. Ansari, R. Stanton, V. Albrecht, A.L. Halpin, M. Karlsson, J.K. Rasheed, A. Kallen); New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA (E.B. Hancock, E.C. Phipps); University of New Mexico, Albuquerque, New Mexico, USA (E.B. Hancock, E.C. Phipps, K. Culbreath); Tennessee Department of Public Health, Nashville, Tennessee, USA (D. Muleta, J. Mounsey, M.A. Kainer); University of Rochester, Rochester, New York, USA (C. Concannon, G. Dumyati, D.J. Hardy); Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA (C. Bower); Atlanta Research and Education Foundation, Decatur (C. Bower); Georgia Emerging Infections Program, Atlanta (C. Bower, J. Jacob); Emory University School of Medicine, Atlanta (J. Jacob); Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy, Z. Beldavs); TriCore Reference Laboratories, Albuquerque (K. Culbreath); Tristar Centennial Medical Center, Nashville (W.E. Phillips, Jr.); Rochester Regional Health, Rochester (R.L. Vargas); Providence Health and Services, Renton, Washington, USA (M. Oethinger)

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Table 3

Culture source, provider-reported infection type, and prior healthcare risk factors in incident carbapenem-resistant Pseudomonas aeruginosa cases, United States, July–October 2015

Characteristic No. (%) cases
Culture source N = 294
Any sterile site* 21 (7.1)
Blood 10 (47.6)
Internal abscess 7 (33.3)
Pericardial fluid 1 (4.8)
Peritoneal fluid 1 (4.8)
Joint/synovial fluid 1 (4.8)
Other normally sterile sites 1 (4.8)
Nonsterile site† 273 (92.9)
Respiratory‡ 120 (44.0)
Urine 111 (40.7)
Wound 35 (12.8)
Other nonsterile sites
9 (3.3)
Infection type§ N = 268
Urinary tract infection 85 (31.7)
Pneumonia 78 (29.1)
Septic shock 20 (7.5)
Bacteremia 20 (7.5)
Internal abscess 11 (4.5)
Other infection types¶ 57 (21.3)
>1 Infection type 38 (14.2)
No infection
35 (13.1)
Risk factors
Any healthcare exposure, n = 280# 257 (91.8)
Indwelling device placed <7 d before culture, n = 280 194 (69.3)
Surgery in prior year, n = 280 111 (39.6)
Long-term care facility resident in prior year, n = 280 84 (30.0)
Culture collected after hospital day 3, n = 280 64 (22.9)
Long-term acute care hospitalization in prior year, n = 280 40 (14.3)
Current chronic dialysis, n = 280 29 (10.4)
Hospitalization in prior year, n = 247 205 (83.0)
Antimicrobial drug <14 d before culture collection, n = 155** 101 (65.2)

*Includes 5 cases with CRPA from both sterile and nonsterile sites collected at time of incident culture (1 blood and tracheal aspirate; 1 blood and catheter tip; 1 blood and urine; 1 internal abscess and sputum; 1 pericardial fluid and wound).
†Total number of nonsterile sites is >273 because 2 case-patients had CRPA in multiple nonsterile sites at time of incident culture (1 sputum and tracheal aspirate; 1 urine and tracheal aspirate).
‡Includes sputum (n = 70), tracheal aspirate (n = 38), and bronchoalveolar lavage (n = 12).
§Total number of incident cases with completed case report form, excluding 13 cases with unknown infections.
¶Other infection types include the following: cellulitis (n = 9), decubitus/pressure ulcer (n = 7), chronic ulcer/wound (n = 6), bronchitis (n = 6), osteomyelitis (n = 6), surgical incision infection (n = 4), infection, not specified (n = 3), upper respiratory tract infection (n = 3), pyelonephritis (n = 2), cystic fibrosis exacerbation (n = 2), surgical site infection (n = 2), catheter site infection (n = 1), peritonitis (n = 1), skin abscess (n = 1), empyema (n = 1), septic arthritis (n = 1), wound (n = 1), other infection (n = 1).
#Total number of incident cases with completed case report form, excluding 1 case with unknown healthcare risk factors.
**Total number of incident cases with completed case report form and their culture collected in a short-stay or long-term acute care hospital.

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Page created: June 17, 2019
Page updated: June 17, 2019
Page reviewed: June 17, 2019
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