Analysis of prognosis factors for Pseudomonas aeruginosa bacteremia and risk factors for multidrug-resistant Pseudomonas aeruginosa bacteremia with emphasis on the effect of ntimicrobial therapy
Date Issued
2008
Date
2008
Author(s)
Wu, Yee-Jen
Abstract
Objectives:his study is aim to evaluate the impact of antibiotic combination therapy and adequate empirical treatment on clinical outcomes and to identify the prognosis factors for Pseudomonas aeruginosa bacteremia. The other goal of this study is to investigate the risk factors for multidrug-resistant Pseudomonas aeruginosa (MDRPA) bacteremia.tudy location、design and study populations: retrospective cohort analysis was performed for all adult patients admitted to the National Taiwan University Hospital (NTUH) with positive P. aeruginosa blood culture between 1 January 2007 and 31 November 2007 .ethods:ata were collected from medical records and hospital computerized databases. The data retrieved for each patient included patients’ profile, underlying diseases, previous hospitalization history, previous P. aeruginosa infection or colonization history, antibiotics exposure before bacteremia onset, clinical presentation, antibiotics regimens at bacteremia onset, management and clinical response after bacteremia. The primary endpoint was 30 day all-caused mortality. Risk factors of MDRPA bacteremia were also analysed. Risk factors and clinical outcomes were examed using univariate analysis and multivariate logistic regression analysis. Survival curves shown by Kaplan-Meier method were compared with Log-rank test. esult:ne hundred and eighty six episodes were included in this study, 120 (65%) were monomicrobial infections and 66 polymicrobial infections. Patients’ average age was 61.2±18.4 and 56% of them were male. The average Charlson comorbidity index of included patients was 4.09±2.37. Previous exposure to antibiotics and anti- Pseudomonas antibiotics were 76.2% and 43.8% respectively. Patients’ average Pitt bacteremia scores were 3.8±3.5. All episodes were presented with sepsis with 39.8% of septic shock. After the onset of symptoms, it took an average of 34±46 hours to initiate an adequate therapy. Empirical combination therapy was given only in 14 episodes (7.7%) and definitive combination therapy was used in 38 episodes (24.4%).There were 27 (14.2%) MDRPA episodes. The overall D30 mortality was 41.4%, and 46.7% for monomicrobial infections.mpirical monotherapy and combination therapy provided comparably adequate therapy (77.8% vs. 61.5 %, P=0.48) with similar D30 mortality in combination therapy and monotherapy (44.4% vs. 46.8%, P=1.00). Also, the superinfection and emergence of resistance after the bacteremia onset did not differ significantly between two regimens.ultivariate logistic regression identified the following variables as significant independent risk factors for MDRPA bacteremia: P. aeruginosa infection or colonization within previous 6 months (OR 28.27, P<0.0001), fluoroquinolone usage (OR 9.30, P=0.005), carbapenem usage (OR 12.2, P=0.0001), cerebrovascular accidents (OR 5.45, P=0.02) and lengh of hospital stay before bacteremia (OR 1.01, P=0.02).ach of the following factors were independently associated with 30-day mortality in all patients: septic shock (OR 4.15, P=0.008), hepatobiliary diseases (OR 3.82, P=0.02), exposure to anti- Pseudomonas agents (OR 3.11, P=0.02), immunosuppressant (OR 2.98, P=0.02), Pitt bacteremia score (OR 1.52, P<0.0001) and Charlson’s comorbidity index (OR 1.22, P=0.04). Polymicrobial infection was a protective factor (OR 0.31, P=0.02). Empirical therapy was not significantly associated with mortality in all and monomicrobial patients. onclusion:his study showed empirical therapy did not affect mortality in P. aeruginosa bacteremia patients. Patients’ comorbidity and severity of illness at bacteremia onset played important roles on mortality. Exposure to carbapenem and fluoroquinolone were associated with MDRPA bacteremia acquisition.
Subjects
Psuedomonas aeruginosa
bacteremia
multidrug-resistant Psuedomonas aeruginosa
risk factors
treatment outcomes
mortality
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