Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality

Abstract

The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine.Material and methods. All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients' risk factors and mortality caused by P. aeruginosa bacteremia.Results. A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P=0.002). Timely and appropriate treatment and surgery were significant protective factors for 30-day mortality (11.1 and 5.26 times, respectively; P=0.001). Meropenem-resistant Pseudomonas aeruginosa strains caused bacteremia more frequently in patients older than 65 years than meropenem-sensitive strains (57.9%, n=11). All 19 patients with meropenem-resistant Pseudomonas aeruginosa bacteremia received inappropriate empirical antibiotic therapy.Conclusions. Treatment at the intensive care unit, mechanical ventilation, acute respiratory failure, source of infection in respiratory tract, and central vein catheter are the major risk factors associated with an increased mortality rate in patients with Pseudomonas aeruginosa bacteremia.The patients older than 65 years are at increased risk for bacteremia caused by carbapenemresistant Pseudomonas aeruginosa strains.Carbapenems are not antibiotics of the choice of treatment for Pseudomonas aeruginosa bacteremia at Raktažodžiai: Pseudomonas aeruginosa, bakteriemija, rizikos veiksniai.Santrauka. Tyrimo tikslas. Nustatyti pacientų, gydytų Kauno medicinos universiteto klinikose, Pseudomonas aeruginosa sukeltos bakteriemijos dažnį, šių pacientų rizikos veiksnius ir mirštamumą.Tyrimo metodai. Į tyrimą įtraukti visi pacientai, kuriems penkerių metų laikotarpiu iš kraujo buvo išaugintos Pseudomonas aeruginosa padermės. Atlikta retrospektyvioji šių pacientų duomenų analizė, siekiant nustatyti rizikos veiksnius ir su bakteriemija susijusį mirštamumą.Rezultatai. 47 (58,8 proc.) bakteriemijos epizodai buvo nustatyti intensyviosios terapijos skyriuose gydytiems pacientams. Pirminis bakteriemijos židinys buvo nustatytas 50 (62,5 proc.) pacientų. Pacientų mirštamumas -58,8 proc. Mirštamumo riziką statistiškai patikimai didino: dirbtinė plaučių ventiliacija -13,67 karto (p<0,001), pacientų būklė, kai būtinas gydymas intensyviosios terapijos skyriuje -8,51 karto (p<0,001), ūminis kvėpavimo nepakankamumas -8,44 karto (p<0,001), infekcijos židinys kvėpavimo takuose -4,93 karto (p=0,003) ir centr...

Multidrug resistance in Pseudomonas aeruginosa isolated from nosocomial respiratory and urinary infections in Aleppo, Syria

“…This is certainly the case at intensive care units (ICUs), particularly in patients who are put on a mechanical ventilator [3]. Nosocomial bacteremia accounts for over 50% of ICU infections, and the causative pathogen is frequently found to be P. aeruginosa [4].…”

“…These pose a heavy human and economical burden because antibiotics are costly and frequently ineffective, leading to high mortality rates [2][3][4][5][6][7]. Informative data about these types of infections are lacking from Syria; therefore, this study was conducted to probe for prevalence rates of MDR among P. aeruginosa isolates in northern Syria.…”

Prevalence of Oxacillinase Groups I, II and III in Pseudomonas aeruginosa Isolates by Polymerase Chain Reaction and Genotyping by ERIC-PCR Methods

“…The analysis of ERIC-PCR indicated clonal and high genetic diversity among P. aeruginosa isolates isolated from Tabriz hospitals compared with similar studies in Iran (18). This finding may be due to patients' reception from around the province of eastern Azarbayjan in Tabriz; also it can be due to differences in the analysis or difference in software used in the analysis.…”

“…Pseudomonas aeruginosa is an important causative agent of human infection, especially in a host with compromised defense mechanisms (18). Pseudomonas aeruginosa is a leading cause of nosocomial infections via colonization of catheters, skin wounds, ventilator-associated pneumonia and it is also a cause of respiratory infections in individuals with cystic fibrosis (19).…”

“…Pseudomonas aeruginosa is a leading cause of nosocomial infections via colonization of catheters, skin wounds, ventilator-associated pneumonia and it is also a cause of respiratory infections in individuals with cystic fibrosis (19). Pseudomonas aeruginosa has a capacity to expand resistance to several classes of antimicrobial agents; provoking the appearance of multi drug resistant (MDR) isolates (18). Unfortunately, choice of the most suitable antibiotics is complex, due to the capability of P. aeruginosa to extend resistance to multiple classes of antibacterial agents, even during the course of treating an infection (20).…”