Risk Factors and Outcomes of Antibiotic-resistant Pseudomonas aeruginosa Bloodstream Infection in Adult Patients With Acute Leukemia

Abstract

Background Pseudomonas aeruginosa (PA) bloodstream infection (BSI) is a common complication in patients with acute leukemia (AL), and the prevalence of antibiotic-resistant strains poses a serious problem. However, there is limited information regarding antibiotic resistance, clinical characteristics, and outcomes of PA BSI in AL patients. This study explored characteristics associated with the clinical outcomes of AL patients with PA BSI and analyzed factors associated with BSI caused by multidrug-resistant (MDR) or carbapenem-resistant strains. Methods This single-center retrospective study enrolled hospitalized AL patients who developed PA BSI during January 2014–December 2019. The Kaplan-Meier method was used to plot survival curves. Multivariate logistic regression analyses were also performed. Results Of 293 eligible patients with PA BSI, 55 (18.8%) received inappropriate empirical antibiotic therapy within 48 hours of BSI onset, whereas up to 65.8% MDR-PA BSI patients received inappropriate empirical treatment. The 30-day mortality rate was 8.5% for all patients. However, the 30-day mortality rates were 28.9% and 5.5% in MDR-PA BSI and non–MDR-PA BSI patients, respectively (P < .001). On multivariate analysis, previous use of quinolones (odds ratio [OR], 5.851 [95% confidence interval {CI}, 2.638–12.975]) and piperacillin/tazobactam (OR, 2.837 [95% CI, 1.151–6.994]) were independently associated with MDR-PA BSI; and MDR-PA BSI (OR, 7.196 [95% CI, 2.773–18.668]), perianal infection (OR, 4.079 [95% CI, 1.401–11.879]), pulmonary infection (OR, 3.028 [95% CI, 1.231–7.446]), and age ≥55 years (OR, 2.871 [95% CI, 1.057–7.799]) were independent risk factors for 30-day mortality. Conclusions MDR increases mortality risk in PA BSI patients, and previous antibiotic exposure is important in MDR-PA BSI development. Rational antibiotic use based on local antimicrobial susceptibility and clinical characteristics can help reduce antibiotic resistance and mortality.

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies – The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study

“… 8 , 10 Patients with HMs who have disease-related immunosuppression and long-term exposure to broad-spectrum antibiotics are especially at risk. 34 …”

“…8,10 Patients with HMs who have disease-related immunosuppression and long-term exposure to broad-spectrum antibiotics are especially at risk. 34 Whether pathogen type or patterns of antibiotic resistance affect the prognosis of patients with HMs remains debatable. 3,8,[10][11][12] Our previous studies showed that endogenous (host-related factors, such as disease status, organ functions, and nutritional status) factors or exogenous (treatment-related factors, such as inappropriate initial antimicrobial therapy (IIAT)) factors had impact on patient prognoses.…”

Novel phenotypes of coronavirus disease: a temperature-based trajectory model

“…In the current study, the effectiveness of corticosteroids and gamma-globulin therapy differed significantly between phenotypes with low (Phenotypes 1 and 2) and high (Phenotypes 3 and 4) inflammatory responses. Notably, although owing to the retrospective study design, the measurement of effectiveness of these therapies may have been biased by their close association with disease severity, owing to their selective use in clinical practice (e.g., corticosteroids are more commonly used in patients with the severe disease) [ 39 ], our findings still suggest a different response to immunotherapies therapy within different phenotypes. This needs to be considered in future trials.…”

Immunologically relevant aspects of the new COVID-19 vaccines—an ÖGAI (Austrian Society for Allergology and Immunology) and AeDA (German Society for Applied Allergology) position paper

“…Sufficient immunity is expected approximately seven days after the 2nd injection with the vaccine BNT162b2 and approximately after 14 days with mRNA-1273. The vaccine AZD1222 should already show a protective effect three weeks after the 1st vaccine shot; the 2nd vaccination should consolidate the vaccination success [ 89 ].…”