Pseudomonas aeruginosaBacteremia: Risk Factors for Mortality and Influence of Delayed Receipt of Effective Antimicrobial Therapy on Clinical Outcome

Abstract

Among the nosocomial pathogens, Pseudomonas aeruginosa is recognized as a major cause of morbidity and mortality. Data on 136 patients with P. aeruginosa bacteremia were retrospectively analyzed to evaluate risk factors for mortality. The median age of the patients was 55 years (range, 15-85 years), 78.7% of the cases were hospital-acquired, and the 30-day mortality rate was 39% (53 of 136 patients). Multivariate analysis demonstrated that risk factors for mortality included severe sepsis, pneumonia, delay in starting effective antimicrobial therapy, and an increasing APACHE II score (all P values <.05). In 123 of the 136 patients (excluding 13 patients treated with inadequate definitive antibiotics), 30-day mortality was 27.7% (13 of 47 patients) in the group of patients who received initially effective empirical antimicrobial therapy, and 43.4% (33 of 76) in the group of patients who received delayed effective antimicrobial therapy (P=.079). There was a trend toward higher mortality as the length of delay increased. Delay in starting effective antimicrobial therapy for P. aeruginosa bacteremia tended to be associated with higher mortality.

<i>Pseudomonas aeruginosa</i> Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival

“…We performed a subgroup analysis using the Kaplan-Meier method, and the log-rank test showed a significant influence of initial antibiotic therapy in immunocompromised patients, whereas it did not show any therapeutic benefit in immunocompetent patients. Similar findings that support our results were observed in neutropenic and non-neutropenic patients with bacteremia (29,30). Therefore, considering these observations, initial antibiotic therapy for P. aeruginosa bacteremia should be highlighted in patients with immunocompromised status.…”

Survey of blood cultures methods in Italy in 2010

“…Questa è l'esperienza anche dei laboratori di Microbiologia dell'ospedale Careggi di Firenze e Ospedali Riuniti di Bergamo. Anticipare di 24 ore il risultato, almeno dell'antibiogramma, potrebbe avere una positiva ricaduta clinica (18,19), tanto più importante in una patologia, la sepsi, che può avere una rapida evoluzio-ne clinica e, nelle forme gravi o con shock, una alta mortalità, compresa tra il 20 e il 50%. In altri Paesi molti lab effettuano test diretti: dall'indagine americana, già citata (19,20) g) Collaborazione con i clinici Già nel precedente lavoro fu sottolineata ed enfatizzata l'utilità di una stretta collaborazione tra medico curante e microbiologo e risulta particolarmente importante nel caso dell'emocoltura: tre gli aspetti considerati dal questionario.…”

Rats as possible agents of antibiotic resistant Pseudomonas aeruginosa transmission through poultry in Ibadan, Oyo State, Nigeria

“…Pseudomonas aeruginosa; one important opportunistic Gram negative infectious agent requires prompt and appropriate antibiotic treatment, otherwise could often lead to a higher tendencies for mortalities in infected individuals ( Kang et al, 2003;Micek et al, 2005). Of all the infections by Gram negative bacteria, it has been noted for its high morbidity and mortalities particularly among critically ill and immune-compromised patients (Marshal et al, 1993;Andremont et al, 1989;Dantas and Moretti-Branchini, 2003;Aliaga et al, 2002).…”

“…Prompt and correct selection of appropriate definitive therapy is critical for the successful treatment of Pseudomonas related infection, because delayed treatment had been associated with mortality ( (Kang et al, 2003;Obritsch et al, 2004). All around the world, Nigeria inclusive, a choice of treatment options for Pseudomonas infection is usually made between three classes of antibiotics, namely: lactams, fluoroquinolones and aminoglycosides (Giamarellou and Antoniadou.…”