Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
Open Access
- 13 February 2020
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 9 (2), 514
- https://doi.org/10.3390/jcm9020514
Abstract
This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.Keywords
Funding Information
- Instituto de Salud Carlos III (PI16/00669, CM18/00047)
This publication has 49 references indexed in Scilit:
- Antibiotic Resistance inPseudomonas Aeruginosais Associated with Decreased FitnessCellular Physiology and Biochemistry, 2013
- Genetic Markers of Widespread Extensively Drug-Resistant Pseudomonas aeruginosa High-Risk ClonesAntimicrobial Agents and Chemotherapy, 2012
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistanceClinical Microbiology & Infection, 2012
- Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream InfectionsAntimicrobial Agents and Chemotherapy, 2012
- Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistanceFEMS Microbiology Reviews, 2011
- Impact of Multidrug-Resistant Pseudomonas aeruginosa Bacteremia on Patient OutcomesAntimicrobial Agents and Chemotherapy, 2010
- Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infectionInternational Journal of Infectious Diseases, 2010
- Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic SelectionAntimicrobial Agents and Chemotherapy, 2007
- Impact of Empiric Antibiotic Therapy on Outcomes in Patients with Pseudomonas aeruginosa BacteremiaAntimicrobial Agents and Chemotherapy, 2007
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987