IntroductionPseudomonas aeruginosa is a virulent pathogen. It can exist both in the environment and the human host. Recent work by Turner et al suggests that it is the environment that P. aeruginosa exists that determines the virulence factors that are expressed [1]. P. aeruginosa bloodstream infections (BSI) are predominantly seen in the hospital or healthcareassociated host [2][3][4][5]. This BSI is no longer the rare entity of the original case series in the 1950's, with increasing prevalence over the subsequent decades [6,7]. The associated morbidity and mortality with this infection is considerable [2,[8][9][10]. This has not improved over time [7].The antibiotic treatment options available, in the current age of global antibiotic resistance, has not kept pace. A mortality benefit of combination antibiotic therapy in the setting of P. aeruginosa BSI has not been consistently shown [11][12][13][14][15][16][17]. In the settings of drug resistance or the immunocompromised host, more effective ways to utilise current antibiotic therapy must be considered.It is therefore timely that we further characterise the clinical and molecular epidemiology, virulence genotype and outcome of P. aeruginosa BSI.
MethodsBSI episode data was collected retrospectively over a three-year time period from the first of January 2008 to the first of January 2011. This involved seven tertiary care institutions, servicing an urban population of 2.24 million. Extensive epidemiological, clinical, laboratory, treatment and outcome data was collected as per a pre-formulated data collection sheet (Appendix A). For purposes of the study on BSI in the setting of febrile neutropenia, data was collected from a single institution over an extended period of time from the 1 st of January 2006 to the 1 st of April 2014.Ethics approval was obtained from each of the study sites.A P. aeruginosa BSI isolate collection was also collated for study. This involved five public and private laboratories. Isolates were collected from the time period of the first of January 2008 to the first of January 2013. The laboratories service eight tertiary care institutions and one secondary care institution. Permission was obtained from each of the laboratories.ii Results 595 P. aeruginosa BSI episodes were characterised from the study centres. 942 BSI isolates were collated and analysed as part of the BSI isolate collection.A retrospective cohort study of monomicrobial P. aeruginosa BSI described the recent Australian epidemiology of this BSI. The longitudinal mortality of this infection was found to increase with time and at one year was greater than would be expected for the comparative death rate predicted by the median Charlson's co-morbidity index (CCI) of the cohort [18].Detailed description of a retrospective cohort of community acquired (CAI) P. aeruginosa BSI gave new insight into the epidemiology of this group of patients. Multivariate analysis comparing CAI and health-care associated infection cohorts (HCAI) found that CAI is not associated with a shorter len...