#Predictors of #Mortality in #Bloodstream #Infections Caused by #Pseudomonas aeruginosa: Impact of #Antimicrobial #Resistance and Bacterial Virulence (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Predictors of Mortality in Bloodstream Infections Caused by Pseudomonas aeruginosa: Impact of Antimicrobial Resistance and Bacterial Virulence

Raúl Recio, Mikel Mancheño, Esther Viedma, Jennifer Villa, María Ángeles Orellana, Jaime Lora-Tamayo, Fernando Chaves

DOI: 10.1128/AAC.01759-19

 

ABSTRACT

Whether multidrug-resistance (MDR) is associated with mortality in patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) remains controversial. Here, we explored the prognostic factors of PA BSI with emphasis on antimicrobial resistance and virulence. All PA BSI episodes in a 5-year period were retrospectively analyzed. The impact in early (5-day) and late (30-day) crude mortality of host, antibiotic treatment and pathogen factors was assessed by multivariate logistic regression analysis. Of 243 episodes, 93 (38.3%) were caused by MDR-PA. Crude 5-day (20%) and 30-day (33%) mortality was more frequent in patients with MDR-PA (34.4% vs. 11.3%, p<0.001 and 52.7% vs. 21.3%, p<0.001, respectively). Early mortality was associated with neutropenia (adjusted odds ratio [aOR], 9.21; 95% confidence interval [95% CI], 3.40-24.9; p<0.001), increased Pitt score (aOR, 2.42; 95% CI, 1.34-4.36; p=0.003), respiratory source (aOR, 3.23; 95% CI, 2.01-5.16; p<0.001), inadequate empirical therapy (aOR, 4.57; 95% CI, 1.59-13.1; p=0.005), shorter time to positivity of blood culture (aOR, 0.88; 95% CI, 0.80-0.97; p=0.010), exoU-positive genotype (aOR, 3.58; 95% CI, 1.31-9.79; p=0.013), and O11 serotype (aOR, 3.64; 95% CI, 1.20-11.1; p=0.022). These risk factors were also identified for late mortality, as well as MDR phenotype (aOR, 2.18; 95% CI, 1.04-4.58; p=0.040). Moreover, O11 serotype (15.2%, 37/243) was common among MDR (78.4%, 29/37) and exoU-positive (89.2%, 33/37) strains. Besides relevant clinical variables and inadequate empirical therapy, pathogen factors such as MDR phenotype, exoU-positive genotype, and O11 serotype adversely affect the outcome of PA BSI.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Pseudomonas aeruginosa; Bacteremia.

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Giuseppe Michieli

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.