Concise Communication In contrast to prior investigations,3,4 patients with CSPA BSIs
did not suffer significantly worse outcomes compared to patients with CRPA BSI (Table 1). We believe this was due to the study design, which resulted in selecting a control group which was truly representative of the source population and also due to limitations in sample size and power in the current study (though it was powered to detect differences in the primary outcome).6 Our study had several limitations. It was a single-centered, retrospective with a relatively small sample size. However, by overcoming prior limitations, this study generated valuable data regarding stewardship and infection control aspects, pertaining to the management of P. aeruginosa infections in hospitalized patients. Results should be validated in other centers and on larger populations. Based on these results, infection control programs should not
focus solely on carbapenem resistance. The case–case-control study design identified independent predictors for CRPA (ie, recent exposure to carbapenems and a rapidly fatal McCabe score). This information can be used to develop successful stew- ardship interventions and to reduce DAAT and improve patient outcomes.
Acknowledgments. This work was performed in partial fulfillment of the M. D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Financial support. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest. All authors reported no conflicts of interest relevant to this article.
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5. CLSI. Performance standards for antimibrobial susceptibility testing. Nineteenth informational supplement. Approved standard M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute; 2016. Approved standard M100-S26.
6. Kaye KS, Harris AD, Samore M, Carmeli Y. The case–case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance. Infect Control Hosp Epidemiol 2005;26:346–351.
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