Skip to main content Accessibility help

Emergence of Resistance in Pseudomonas aeruginosa and Acinetobacter Species After the Use of Antimicrobials for Burned Patients

  • Andrea C. B. Ferreira (a1), Satiko Gobara (a1), Silvia F. Costa (a1), Nairn Sauaia (a1), Elsa M. Mamizuka (a1), Inneke M. Van der Heijden (a1), Robson E. Soares (a1), Gisele D. Almeida (a1), Carlos Fontana (a1) and Anna S. Levin (a1)...



To evaluate the emergence of resistance of Pseudomonas aeruginosa and Acinetobacter species to imipenem, ciprofloxacin, or both after the use of these drugs and to compare resistant with susceptible isolates by molecular typing.


Cohort study.


Burn intensive care unit (ICU) with 4 beds in a tertiary-care university hospital.


During 16 months, surveillance cultures were performed for all patients admitted to the ICU. Demographic information was obtained for each patient. Molecular typing was done by pulsed-field gel electrophoresis using restriction enzymes for 71 isolates of P. aeruginosa and Acinetobacter species.


Thirty-four patients were admitted and 22 were colonized by susceptible P. aeruginosa or Acinetobacter species before they used the antimicrobials. Nine (41%) of these patients had a resistant isolate after antimicrobial use: 5 had used imipenem alone, 1 had used ciprofloxacin, and 3 had used both drugs. The interval between isolation of the susceptible and resistant isolates ranged from 4 to 25 days, but was 10 or more days for 6 patients. Molecular typing revealed that susceptible and resistant isolates from each patient were different and that although there were no predominant clones among susceptible isolates, there was a predominant clone among resistant isolates of P. aeruginosa and of Acinetobacter.


Resistance was not due to the acquisition of resistance mechanisms by a previously susceptible strain, but rather to cross-transmission. Although various measures involving antimicrobial use have received great attention, it would seem that practices to prevent cross-transmission are more important in controlling resistance.


Corresponding author

Rua Harmonia, 564/52, São Paulo-SP 05435-000, Brazil


Hide All
1.Levin, AS, Mendes, CM, Sinto, SI, et al.An outbreak of multiresistant Acinetobacter baumannii in a university hospital in São Paulo, Brazil. Infect Control Hosp Epidemiol 1996;17:366368.
2.Arruda, EA, Marinho, IS, Boulos, M, et al.Nosocomial infections caused by multiresistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 1999;20:620623.
3.Jacobson, KL, Cohen, SH, Inciardi, JF, et al.The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I beta-lactamase-producing organisms. Clin Infect Dis 1995;21:11071113.
4.Quinn, JP, DiVincenzo, CP, Foster, J. Emergence of resistance to ceftazidime during therapy for Enterobacter cloacae infections. J Infect Dis 1987;155:942947.
5.Preheim, LC, Penn, RG, Sanders, CC, Goering, RV, Giger, DK. Emergence of resistance to beta-lactam and aminoglycoside antibiotics during moxalactam therapy of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1982;22:10371041.
6.Cheng, K, Smyth, RL, Govan, JR, et al.Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet 1996;348:639642.
7.Santucci, SG, Gobara, S, Santos, CR, Fontana, C, Levin, AS. Infections in a burn intensive care unit: experience of seven years. J Hosp Infect 2003;53:613.
8.Lund, CC, Browder, NC. The estimation of areas of burns. Surg Gynecol Obstet 1944;79:352358.
9.Latarjet, J. A simple guide to burn treatment. Burns 1995;21:221225.
10.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
11.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility: Eleventh Informational Supplement. Wayne, PA: National Committee for Clinical Laboratory Standards; 2001. Approved standards M2-A7 and M7-A5.
12.Pfaller, MA. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1993.
13.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
14.Neely, AN, Holder, IA. Antimicrobial resistance. Burns 1999;25:1724.
15.Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lal, H, Quale, J. Endemie carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101106.
16.Richard, P, Le Floch, R, Chamoux, C, Pannier, M, Espaze, E, Richet, H. Pseudomonas aeruginosa outbreak in a burn unit: role of antimicrobials in the emergence of multiply resistant strains. J Infect Dis 1994;170:377383.
17.Villers, D, Espaze, E, Coste-Burel, M, et al.Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182189.
18.Chow, JW, Fine, MJ, Shlaes, DM, et al.Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585590.
19.Carmeli, Y, Troillet, N, Eliopoulos, GM, Samore, MH. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999;43:13791382.
20.O'Brien, TF. Emergence, spread, and environmental effect of antimicrobial resistance: how use of an antimicrobial anywhere can increase resistance to any antimicrobial anywhere else. Clin Infect Dis 2002;34(suppl 3):S78S84.
21.Wilton, P, Smith, R, Coast, J, Millar, M. Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness. Journal of Health Services Research & Policy 2002;7:111117.
22.Hodges, BM, White, RL. Antimicrobial cycling: the future or a fad? Ann Pharmacother 2001;35:12241232.
23.Fridkin, SK. Routine cycling of antimicrobial agents as an infection-control measure. Clin Infect Dis 2003;36:14381444.
24.Hsueh, PR, Teng, LJ, Chen, CY, et al.Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002;8:827832.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed