Skip to main content Accessibility help
×
Home

Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality

  • M. TUMBARELLO (a1), E. REPETTO (a2), E. M. TRECARICHI (a1), C. BERNARDINI (a2), G. DE PASCALE (a1), A. PARISINI (a2), M. ROSSI (a1), M. P. MOLINARI (a3), T. SPANU (a4), C. VISCOLI (a2), R. CAUDA (a1) and M. BASSETTI (a2)...

Summary

We retrospectively studied patients diagnosed with P. aeruginosa bloodstream infections (BSIs) in two Italian university hospitals. Risk factors for the isolation of multidrug-resistant (MDR) or non-MDR P. aeruginosa in blood cultures were identified by a case-case-control study, and a cohort study evaluated the clinical outcomes of such infections. We identified 106 patients with P. aeruginosa BSI over the 2-year study period; 40 cases with MDR P. aeruginosa and 66 cases with non-MDR P. aeruginosa were compared to 212 controls. Independent risk factors for the isolation of MDR P. aeruginosa were: presence of central venous catheter (CVC), previous antibiotic therapy, and corticosteroid therapy. Independent risk factors for non-MDR P. aeruginosa were: previous BSI, neutrophil count <500/mm3, urinary catheterization, and presence of CVC. The 21-day mortality rate of all patients was 33·9%. The variables independently associated with 21-day mortality were presentation with septic shock, infection due to MDR P. aeruginosa, and inadequate initial antimicrobial therapy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Dr M. Tumbarello, Istituto Malattie Infettive, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy. (Email: tumbarello@rm.unicatt.it)

References

Hide All
1.Kang, CI, et al. Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clinical Infectious Diseases 2003; 37: 745751.
2.Lodise, TP Jr., et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection. Antimicrobial Agents and Chemotherapy 2007; 51: 35103515.
3.Osih, RB, et al. Impact of empiric antibiotic therapy on outcomes in patients with Pseudomonas aeruginosa bacteremia. Antimicrobial Agents and Chemotherapy 2007; 51: 839844.
4.Wisplinghoff, H, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases 2004; 39: 309317.
5.Giske, CG, et al. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrobial Agents and Chemotherapy 2008; 52: 813821.
6.Falagas, ME, Kopterides, P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. Journal of Hospital Infection 2006; 64: 715.
7.Schechner, V, et al. Gram-negative bacteremia upon hospital admission: when should Pseudomonas aeruginosa be suspected? Clinical Infectious Diseases 2009; 48: 580586.
8.Aloush, V, et al. Multidrug-resistant Pseudomonas aeruginosa: risk factors and clinical impact. Antimicrobial Agents and Chemotherapy 2006; 50: 4348.
9.Tam, VH, et al. Prevalence, resistance mechanisms, and susceptibility of multidrug-resistant bloodstream isolates of Pseudomonas aeruginosa. Antimicrobial Agents and Chemotherapy 2010; 54: 11601164.
10.Defez, C, et al. Risk factors for multidrug-resistant Pseudomonas aeruginosa nosocomial infection. Journal of Hospital Infection 2004; 57: 209216.
11.Falagas, ME, et al. Risk factors for isolation of strains susceptible only to polymyxin among patients with Pseudomonas aeruginosa bacteremia. Antimicrobial Agents and Chemotherapy 2006; 50: 25412543.
12.Russell, JA. Management of sepsis. New England Journal of Medicine 2006; 355: 16991713.
13.Charlson, ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987; 40: 373383.
14.Knaus, WA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 16191636.
15.Harris, AD, et al. Methodological principles of case–control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clinical Infectious Diseases 2001; 32: 10551061.
16.Tumbarello, M, et al. Bloodstream infections caused by extended-spectrum-b-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrobial Agents and Chemotherapy 2006; 50: 498504.
17.Garner, JS, et al. CDC definitions for nosocomial infections, 1988. American Journal of Infection Control 1988; 16: 128140.
18.Friedman, ND, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Annals of Internal Medicine 2002; 137: 791797.
19.Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 17th Informational Supplement. Document M100-S17. Wayne, PA: CLSI, 2007.
20.Marchaim, D, et al. Epidemiology of bacteremia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient age. European Journal of Clinical Microbiology & Infectious Diseases 2008; 27: 10451051.
21.Carmeli, Y, et al. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrobial Agents and Chemotherapy 1999; 43: 13791382.
22.Gasink, LB, et al. Risk factors for and impact of infection or colonization with aztreonam-resistant Pseudomonas aeruginosa. Infection Control and Hospital Epidemiology 2007; 28: 11751180.
23.Van Delden, C. Pseudomonas aeruginosa bloodstream infections: how should we treat them? International Journal of Antimicrobial Agents 2007; 30: 7175.
24.El Amari, EB, et al. Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates. Clinical Infectious Diseases 2001; 33: 18591864.
25.Colom, K, et al. Emergence of resistance to beta-lactam agents in Pseudomonas aeruginosa with group I beta-lactamases in Spain. European Journal of Clinical Microbiology and Infectious Diseases 1995; 14: 964971.
26.Livermore, DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clinical Infectious Diseases 2002; 34: 634640.
27.Paterson, DL. Looking for risk factors for the acquisition of antibiotic resistance: a 21st-century approach. Clinical Infectious Diseases 2002; 34: 15641567.
28.Raymond, DP, et al. Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients. Critical Care Medicine 2003; 31: 10351041.
29.Tejada Artigas, A, et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Critical Care Medicine 2001; 29: 304309.
30.Cheong, HS, et al. Clinical significance and predictors of community-onset Pseudomonas aeruginosa bacteremia. American Journal of Medicine 2008; 121: 709714.
31.Wisplinghoff, H, et al. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clinical Infectious Diseases 2003; 36: 11031110.
32.Tumbarello, M, et al. Factors associated with mortality in bacteremic patients with hematologic malignancies. Diagnostic Microbiology and Infectious Diseases 2009; 64: 320326.
33.Wenzel, RP. Treating sepsis. New England Journal of Medicine 2002; 347: 966967.
34.Cheong, HS, et al. Inappropriate initial antimicrobial therapy as a risk factor for mortality in patients with community-onset Pseudomonas aeruginosa bacteraemia. European Journal of Clinical Microbiology and Infectious Diseases 2008; 27: 12191225.
35.Micek, ST, et al. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrobial Agents and Chemotherapy 2005; 49: 13061311.
36.Tam, VH, et al. Impact of multidrug-resistant Pseudomonas aeruginosa bacteremia on patient outcomes. Antimicrobial Agents and Chemotherapy 2010; 54: 37173722.
37.Wu, YJ, Lin, SW, Chang, AC.48th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, 25–28 October 2008. Abstract, K-3500.
38.Kang, CI, et al. Risk factors for antimicrobial resistance and influence of resistance on mortality in patients with bloodstream infection caused by Pseudomonas aeruginosa. Microbial Drug Resistance 2005; 11: 6874.
39.Blot, S, et al. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clinical Infectious Diseases 2002; 34: 16001606.

Keywords

Metrics

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