Cargando…

Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia...

Descripción completa

Detalles Bibliográficos
Autores principales: Montero, María Milagro, López Montesinos, Inmaculada, Knobel, Hernando, Molas, Ema, Sorlí, Luisa, Siverio-Parés, Ana, Prim, Nuria, Segura, Concepción, Duran-Jordà, Xavier, Grau, Santiago, Horcajada, Juan Pablo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074151/
https://www.ncbi.nlm.nih.gov/pubmed/32074947
http://dx.doi.org/10.3390/jcm9020514
_version_ 1783506771662340096
author Montero, María Milagro
López Montesinos, Inmaculada
Knobel, Hernando
Molas, Ema
Sorlí, Luisa
Siverio-Parés, Ana
Prim, Nuria
Segura, Concepción
Duran-Jordà, Xavier
Grau, Santiago
Horcajada, Juan Pablo
author_facet Montero, María Milagro
López Montesinos, Inmaculada
Knobel, Hernando
Molas, Ema
Sorlí, Luisa
Siverio-Parés, Ana
Prim, Nuria
Segura, Concepción
Duran-Jordà, Xavier
Grau, Santiago
Horcajada, Juan Pablo
author_sort Montero, María Milagro
collection PubMed
description This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.
format Online
Article
Text
id pubmed-7074151
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-70741512020-03-19 Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes? Montero, María Milagro López Montesinos, Inmaculada Knobel, Hernando Molas, Ema Sorlí, Luisa Siverio-Parés, Ana Prim, Nuria Segura, Concepción Duran-Jordà, Xavier Grau, Santiago Horcajada, Juan Pablo J Clin Med Article This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources. MDPI 2020-02-14 /pmc/articles/PMC7074151/ /pubmed/32074947 http://dx.doi.org/10.3390/jcm9020514 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Montero, María Milagro
López Montesinos, Inmaculada
Knobel, Hernando
Molas, Ema
Sorlí, Luisa
Siverio-Parés, Ana
Prim, Nuria
Segura, Concepción
Duran-Jordà, Xavier
Grau, Santiago
Horcajada, Juan Pablo
Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title_full Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title_fullStr Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title_full_unstemmed Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title_short Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
title_sort risk factors for mortality among patients with pseudomonas aeruginosa bloodstream infections: what is the influence of xdr phenotype on outcomes?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074151/
https://www.ncbi.nlm.nih.gov/pubmed/32074947
http://dx.doi.org/10.3390/jcm9020514
work_keys_str_mv AT monteromariamilagro riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT lopezmontesinosinmaculada riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT knobelhernando riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT molasema riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT sorliluisa riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT siverioparesana riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT primnuria riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT seguraconcepcion riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT duranjordaxavier riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT grausantiago riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes
AT horcajadajuanpablo riskfactorsformortalityamongpatientswithpseudomonasaeruginosabloodstreaminfectionswhatistheinfluenceofxdrphenotypeonoutcomes