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