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Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study.

Publication ,  Journal Article
Reyes, J; Komarow, L; Chen, L; Ge, L; Hanson, BM; Cober, E; Herc, E; Alenazi, T; Kaye, KS; Garcia-Diaz, J; Li, L; Kanj, SS; Liu, Z; Gao, H ...
Published in: Lancet Microbe
March 2023

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. METHODS: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. FINDINGS: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses. INTERPRETATION: The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. FUNDING: National Institutes of Health.

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Published In

Lancet Microbe

DOI

EISSN

2666-5247

Publication Date

March 2023

Volume

4

Issue

3

Start / End Page

e159 / e170

Location

England

Related Subject Headings

  • United States
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Prospective Studies
  • Humans
  • Carbapenems
  • Anti-Bacterial Agents
  • 3207 Medical microbiology
  • 3204 Immunology
  • 3107 Microbiology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Reyes, J., Komarow, L., Chen, L., Ge, L., Hanson, B. M., Cober, E., … Antibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators, . (2023). Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. Lancet Microbe, 4(3), e159–e170. https://doi.org/10.1016/S2666-5247(22)00329-9
Reyes, Jinnethe, Lauren Komarow, Liang Chen, Lizhao Ge, Blake M. Hanson, Eric Cober, Erica Herc, et al. “Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study.Lancet Microbe 4, no. 3 (March 2023): e159–70. https://doi.org/10.1016/S2666-5247(22)00329-9.
Reyes J, Komarow L, Chen L, Ge L, Hanson BM, Cober E, et al. Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. Lancet Microbe. 2023 Mar;4(3):e159–70.
Reyes, Jinnethe, et al. “Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study.Lancet Microbe, vol. 4, no. 3, Mar. 2023, pp. e159–70. Pubmed, doi:10.1016/S2666-5247(22)00329-9.
Reyes J, Komarow L, Chen L, Ge L, Hanson BM, Cober E, Herc E, Alenazi T, Kaye KS, Garcia-Diaz J, Li L, Kanj SS, Liu Z, Oñate JM, Salata RA, Marimuthu K, Gao H, Zong Z, Valderrama-Beltrán SL, Yu Y, Tambyah P, Weston G, Salcedo S, Abbo LM, Xie Q, Ordoñez K, Wang M, Stryjewski ME, Munita JM, Paterson DL, Evans S, Hill C, Baum K, Bonomo RA, Kreiswirth BN, Villegas MV, Patel R, Arias CA, Chambers HF, Fowler VG, Doi Y, van Duin D, Satlin MJ, Antibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators. Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. Lancet Microbe. 2023 Mar;4(3):e159–e170.

Published In

Lancet Microbe

DOI

EISSN

2666-5247

Publication Date

March 2023

Volume

4

Issue

3

Start / End Page

e159 / e170

Location

England

Related Subject Headings

  • United States
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Prospective Studies
  • Humans
  • Carbapenems
  • Anti-Bacterial Agents
  • 3207 Medical microbiology
  • 3204 Immunology
  • 3107 Microbiology