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Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland

Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland. Rosy Reynolds, Russell Hope, Kirsty Maher on behalf of The BSAC Working Party on Resistance Surveillance. O348 22 nd ECCMID, London, 31 Mar - 3 Apr 2012 rosy.reynolds@nbt.nhs.uk. 2012.

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Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland

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  1. Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland Rosy Reynolds, Russell Hope, Kirsty Maher on behalf ofThe BSAC Working Party on Resistance Surveillance O348 22nd ECCMID, London, 31 Mar - 3 Apr 2012 rosy.reynolds@nbt.nhs.uk

  2. 2012 BSAC Resistance Surveillance Project • Bacteraemia (2003 - 2010) • Hospital-onset lower respiratory infection (2008/09 - 2010/11) • Target: 280 P.aeruginosa isolates /year in each programme (was 250) • Excluding duplicate within 14 days and (in RTI) cystic fibrosis • Central testing - HPA, London; Quotient Bioresearch, Fordham. • BSAC agar dilution MICs & breakpoints. • UK & Ireland • 40 laboratories • (25 up to 2009) www.bsacsurv.org

  3. ACKNOWLEDGEMENTS BSACResistance Surveillance Project 2003-11

  4. 4/1686 2 centres 4 years bacteraemia Single & multiple non-susceptibility

  5. 5/668 3 centres 2 years bacteraemia respiratory Single & multiple non-susceptibility

  6. Age Distribution of Patients 1686 isolates

  7. Age Distribution of Patients 668 isolates

  8. Age Distribution of Patients

  9. male % Respiratory Respiratory Respiratory Respiratory ICU/HDU % Bacteraemia Bacteraemia Bacteraemia Bacteraemia hospital onset % respiratory focus % Known focus Detail of focus in bacteraemia Original data Other patient characteristics

  10. Predictors considered Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

  11. Predictors considered Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

  12. Predictors considered Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

  13. Age

  14. Estimate & 95% CI Age Patient with line-derived infection, not in ICU

  15. OR 2.45 KEY other speciality intensive care / high dependency Intensive Care Observed - unadjusted Model Model shows patient aged 65 with line-derived infection

  16. OR 0.95 OR 0.32 KEY RTI line/SSSI/GI UTI unknown/minor Focus of infection Observed - unadjusted Model Model shows patient aged 65, not in ICU

  17. Multiple resistance in Pseudomonas aeruginosa from bloodstream and hospital-onset respiratory infection in the UK and Ireland: • remains fairly uncommon (3-7%) • but is more likely in • in younger patients (except infants) • patients in intensive care • and less likely in • infections from the genitourinary tract

  18. Multiply-resistant P. aeruginosa 62 bacteraemia, 49 respiratory.

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