Mortality of COPD Patients Infected with Multi-Resistant Pseudomonas aeruginosa: A Case and Control Study

Montero, Milagro; Domínguez, M. Ángeles; Orozco-Levi, Mauricio; Salvadó, M; Knobel, Hernando

doi:10.1007/s15010-008-8125-9

Cited by 50 publications

(40 citation statements)

References 29 publications

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“…Previously, only a case-control study had reported similar results, but it was limited to patients hospitalized with multiresistant PA. Moreover, in that study, patients with susceptible PA accounted for 20% of the controls [9]. Another more recent prospective publication performed in 116 ambulatory patients with severe disease obtained similar results.…”

Section: Discussionsupporting

confidence: 57%

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Pseudomonas aeruginosa and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

Almagro¹,

Salvadó²,

García-Vidal³

et al. 2011

Respiration

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Background:Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD). Objectives: The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was associated with a poorer prognosis after discharge. Methods: We prospectively studied all patients with COPD exacerbation admitted between June 2003 and September 2004. A sputum culture was obtained at admission. Comorbidity, functional dependence, hospitalizations during the previous year, dyspnea, quality of life and other variables previously associated with mortality in COPD were studied. Spirometry and a 6-min walking test were performed 1 month after discharge. Mortality was evaluated 3 years after discharge. Results: A total of 181 patients were included in the study. Of these, 29 (16%) had PA in the sputum. The mean age was 72 years, and mean basal postbronchodilator forced expiratory volume in 1 s was 45.2% predicted (SD 14.4). The mean point value on the BODE index was 5.1 (SD 2.5). At 3 years, 17 of 29 patients (58.6%) in the PA group had died, compared to 53 of the 152 non-PA patients [34.9%; p < 0.004; hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.29–3.86]. In the multivariate analysis, PA remained statistically related to posthospital mortality (p = 0.02; HR 2.2, 95% CI 1.2–4.2) after adjustment for age (p < 0.02; HR 1.04, 95% CI 1.007–1.07), BODE index (p < 0.02; HR 1.15, 95% CI 1.02–1.3) and comorbidity (p < 0.02; HR 1.24, 95% CI 1.03–1.5). Conclusions: PA isolation in sputum in patients hospitalized for acute exacerbation of COPD is a prognostic marker of 3-year mortality. Poor prognosis is independent of other significant predictors of mortality such as BODE index, age and comorbidity, as measured by the Charlson index.

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Section: Discussionsupporting

confidence: 57%

“…Nevertheless, there is a lack of information regarding the relation between PA isolation and subsequent mortality. To our knowledge, only one previous case-control study has shown a higher mortality after hospitalization for COPD in patients with multiresistant PA [9]. …”

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosa and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

Almagro¹,

Salvadó²,

García-Vidal³

et al. 2011

Respiration

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“…This hypothesis is strengthened by the study of Loureiro et al (2002), which demonstrated that prior antibiotic use was associated with bloodstream infections in the NICU. Recently, a case-control study showed that multi-drug resistant (MDR) P. aeruginosa caused significantly higher mortality rates among patients with chronic obstructive pulmonary disease than did infection with non-MDR strains (Montero et al, 2009). MDR strains are also of particular concern in vulnerable infants, such as those being treated in the NICU; Crivaro et al (2009) reported that both deaths associated with P. aeruginosa infections in the NICU outbreak reviewed here were associated with MDR isolates of P. aeruginosa.…”

Section: Biofilm Formation and Antibiotic Resistancementioning

confidence: 83%

Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources

Jefferies

Cooper

Yam

et al. 2012

Journal of Medical Microbiology

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Pseudomonas aeruginosa is a Gram-negative bacterium commonly occurring in soil and water. It is an opportunistic pathogen and an important cause of healthcare-associated infections, particularly among infants in neonatal intensive care units (NICUs). Several reports regarding outbreaks of P. aeruginosa in NICUs have been published. MEDLINE and EMBASE databases were searched using the MeSH terms [Pseudomonas aeruginosa], [Outbreak OR Infection OR bacteraemia, OR sepsis OR disease] and [Neonat* OR baby OR babies OR newborn*]. Fifteen studies describing a total of 414 infants colonized or infected with P. aeruginosa were reviewed. The mean percentage of infections occurring in the populations that had been colonized by the organism (calculated as n infected /n infected +n colonized ) was 22 %. Environmental sampling was performed in 14 studies, nine of which detected P. aeruginosa. The risk factors identified were antimicrobial drug use and the number of days of antimicrobial therapy prescribed before positive blood culture, exposure to particular healthcare workers (HCW), transfusion of blood products, and intravenous delivery of nutrients/electrolytes. Exposure to umbilical venous catheters was associated with bloodstream infections. Increasing age and use of artificial fingernails were risk factors for colonization of hands of HCWs. Low birth weight pre-term infants were at greater risk of mortality from P. aeruginosa infection than older infants. BackgroundPseudomonas aeruginosa is a Gram-negative bacterium commonly occurring in soil and water. It is an opportunistic pathogen, causing disease in vulnerable individuals, such as the immunocompromised, those where host defences have been breached, such as burns patients, and infants in whom the immune system is not yet developed. Most commonly, P. aeruginosa infections occur in the urinary tract, in burn wounds and as chronic lung infections in cystic-fibrosis patients. However, the organism is also an important cause of healthcare-associated infections, particularly among infants in neonatal intensive care units (NICUs) (Jarvis et al., 1987) owing to their underdeveloped immune system and the fact that such infants are often intubated, catheterized with intravascular catheters/devices in-situ, and/or receiving parenteral nutrition, which may increase risk of infection (Gaynes et al., 2005). Unfortunately, such infections in neonates can be fatal, as was the case in a recent UK outbreak in which four babies died (Wise, 2012). The ubiquitous nature of P. aeruginosa in the environment makes the sources of such outbreaks difficult to identify.Several outbreaks of P. aeruginosa colonization and infection in NICUs have been published. Simon et al. (2008) published a systematic review of confirmed outbreaks in both neonatal and paediatric patients that were identified using the PubMed database and the web-based register for nosocomial outbreaks. That review did not search for reports of outbreaks listed in the Embase database and so may have been biased by the omission ...

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“…An important clinical concern related to PA is its acquisition of resistance to one or more antimicrobial agents [14,37]. We previously demonstrated that hospitalized COPD patients had a high incidence of PAR, which was associated with PA persistence in the sputum after antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study

et al. 2018

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Background: Pseudomonas aeruginosa (PA) is a common microorganism related to severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD). However, their role in COPD patients with frequent hospitalized exacerbations (FHE) is not well described. Objectives: We aimed to determine prevalence, risk factors, susceptibility patterns and impact on outcomes of PA in COPD patients with FHE. Methods: Prospective observational multicentre study that included COPD patients with FHE. The cohort was stratified in 2 groups according to the presence or absence of PA isolation in sputum. Patients were followed up for 12 months. Results: We enrolled 207 COPD patients with FHE. In 119 patients (57%), a valid sputum culture was collected. Of them, PA was isolated in 21 patients (18%). The risk factors associated with PA were prior use of systemic corticosteroids (OR 3.3, 95% CI 1.2–9.7, p = 0.01) and prior isolation of PA (OR 4.36, 95% CI 1.4–13.4, p < 0.01). Patients with PA had an increased risk of having ≥3 readmissions (OR 4.1, 95% CI 1.3–12.8, p = 0.01) and higher PA isolation rate (OR 7.7, 95% CI 2.4–24.6, p < 0.001) during the follow-up period. In 14 patients (67%), PA was resistant to at least one antibiotic tested. PA persisted in the sputum in 70% of patients. Conclusions: The presence of PA was related to 3 or more readmissions during the 1-year follow-up and PA persisted in the sputum despite an appropriate antibiotic treatment. This finding suggested an important role of PA in the course of the disease of COPD patients with FHE.

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Mortality of COPD Patients Infected with Multi-Resistant Pseudomonas aeruginosa: A Case and Control Study

Abstract: In COPD patients admitted to the general ward, acute exacerbation with MDRP in sputum was associated with higher mortality.

Cited by 50 publications

References 29 publications

<b><i>Pseudomonas aeruginosa</i></b> and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

<b><i>Pseudomonas aeruginosa</i></b> and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources

<b><i>Pseudomonas aeruginosa</i></b> in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study

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