A retrospective analysis of Pseudomonas aeruginosa bloodstream infections: prevalence, risk factors, and outcome in carbapenem-susceptible and -non-susceptible infections

Abstract

Background Pseudomonas aeruginosa (PA) is a leading cause of nosocomial infections, and carbapenem non-susceptible strains are a major threat to patient safety. Methods A single center, retrospective comparative analysis of carbapenem-non-susceptible PA (CnSPA) and carbapenem-susceptible PA (CSPA) bloodstream infections (BSIs) was conducted between January 1, 2007, and December 31, 2016. Prevalence and risk factors associated with CnSPA BSIs were examined. Results The study enrolled 340 patients with PA BSIs; 30.0% ( N = 101) of patients had CnSPA. High APACHE II scores (≥15), central venous catheterization, and delayed application of appropriate definitive therapy were independently associated with higher risk of mortality in PA BSIs. Multivariate analysis revealed that respiratory disease and exposure to carbapenems within the previous 90 days to onset of BSI were independent risk factors for acquisition of CnSPA BSIs. Overall all-cause 30-day mortality associated with PA BSIs was 26.8% (91/340). In addition, mortality was higher in patients with CnSPA than in those with CSPA (37.6% vs. 22.2%, respectively; P = 0.003). Corticosteroid therapy and delayed receipt of effective definitive therapy were independent risk factors for death from CnSPA BSIs. Conclusion Increased incidence of CnSPA BSIs was observed during the study period, with higher mortality seen in patients with these infections. Respiratory disease and exposure to carbapenems were independent risk factors for development of CnSPA BSIs. Appropriate definitive therapy reduced mortality rates. BLBLIs were as effective as carbapenems as a treatment for PA BSIs. Electronic supplementary material The online version of this article (10.1186/s13756-019-0520-8) contains supplementary material, which is available to authorized users.

<p>Risk Factors for Mortality of Inpatients with <em>Pseudomonas aeruginosa</em> Bacteremia in China: Impact of Resistance Profile in the Mortality</p>

“…As with the previous research, 9 , 16 , 28 , 29 the present study had also demonstrated that the mortality was higher in patients with older ages, serious underlying host diseases (cardiovascular disease, chronic lung disease and diabetes mellitus), the primary site of lung infection and coinfection with other bacteria in univariate analysis. Even so, the results of the multivariate analysis indicated that cardiovascular disease, rather than others above, had 3.978 times the risk of death than those without.…”

“… 37 , 38 Thus, an appropriate choice of effective antibiotics according to the antimicrobial sensitivity test in vitro is critical to improving poor outcomes for patients with P. aeruginosa bacteremia. 29 , 36 Furthermore, the previous studies have reported the existence of the correlation between the virulence genotype and antimicrobial resistance including carbapenems. 10 , 39 As a result, it is also essential to study the associations between virulence and CRPA or MDRPA phenotype to clarify the mechanism for disease severity in patients with drug-resistant phenotypes in future, which will provide the theory of basis for the development of novel antimicrobial agents.…”

“…Our results supported the findings from a previous investigation that patients with CRPA and MDRPA bacteremia were more likely to have a higher risk of 30-day mortality. 29,36 These findings suggested that the high resistance levels of P. aeruginosa in invasive infections might be a therapeutic challenge for clinicians. 37,38 Thus, an appropriate choice of effective antibiotics according to the antimicrobial sensitivity test in vitro is critical to improving poor outcomes for patients with P. aeruginosa bacteremia.…”

Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres from Poland

“…The obtained data regarding antimicrobial resistance indicate that levels of resistance of P. aeruginosa strains isolated from north-western Poland are comparable with results for the whole country [28]. According to the 2017 ECDC survey, the average resistance rate to carbapenems (imipenem + meropenem) was 24.2% across Poland, whereas in this research, 28.71% of strains were resistant to carbapenems.…”

Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres in Poland

“…In other medical units, the transmission of strains between patients was also possible, however, less frequent. The risk of colonisation by P. aeruginosa hospital strains at ICUs is higher presumably due to the prolonged stay of patients, the severity of their illness and exposure to invasive medical procedures [ 28 ]. Detection of strains disseminated in hospital wards seems critically important for immunocompromised patients and other patients susceptible to P. aeruginosa infections.…”