Epidemiology and Outcome of Pseudomonas aeruginosa Bacteremia, With Special Emphasis on the Influence of Antibiotic Treatment

Vidal, Francesc; Mensa, José; Almela, Manel; Martínez, José Antonio; Marco, F. De; Casals, Climent; Gatell, José M.; Soriano, E; Anta, M. T. Jiménez de

doi:10.1001/archinte.1996.00440170139015

Cited by 230 publications

(29 citation statements)

References 30 publications

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“…Many studies have compared monotherapy with combination therapy for the management of nosocomial pneumonia, VAP, or bacteremia [65][66][67][68][69][70][71][72][73].…”

Section: Broad-spectrum Versus Narrow-spectrum Therapy and Monotherapmentioning

confidence: 99%

Antimicrobial Resistance: Factors and Outcomes

Fish

Ohlinger

2006

Critical Care Clinics

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“…Many studies have compared monotherapy with combination therapy for the management of nosocomial pneumonia, VAP, or bacteremia [65][66][67][68][69][70][71][72][73].…”

Section: Broad-spectrum Versus Narrow-spectrum Therapy and Monotherapmentioning

confidence: 99%

Antimicrobial Resistance: Factors and Outcomes

Fish

Ohlinger

2006

Critical Care Clinics

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“…seudomonas aeruginosa is a leading cause of nosocomial infections, which are often severe (26,43) and difficult to treat because of their limited susceptibility to antimicrobial agents (35) and the frequent emergence of antibiotic-resistant mutants during therapy (8). Factors related to the host, the organism, and the treatment may increase mortality.…”

mentioning

confidence: 99%

Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections

Peña

Suárez

Gozalo

et al. 2012

Antimicrob Agents Chemother

133

112

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The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities. Pseudomonas aeruginosa is a leading cause of nosocomial infections, which are often severe (26, 43) and difficult to treat because of their limited susceptibility to antimicrobial agents (35) and the frequent emergence of antibiotic-resistant mutants during therapy (8). Factors related to the host, the organism, and the treatment may increase mortality. With regard to the host, the severity of the underlying disease may be synergistic with infection due to resistant organisms; concomitantly, increased virulence could explain the adverse impact of resistant pathogens on clinical outcomes, although this association has not been demonstrated to date. In addition, factors such as decreased antibiotic effectiveness or a delay in the initiation of therapy may contribute to adverse outcomes in patients infected by resistant pathogens (17).The problem of antibiotic-resistant organisms is increasing (18), and the impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations (2, 5, 9, 15, 25-28, 32, 33, 40, 41, 43), although its contribution to mortality remains uncertain. Measurements of its impact on patients are, by necessity, derived essentially from observational studies, and therefore, an adequate control of confound...

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“…aeruginosa bacteremia [6-9,12,25,26]. In our study, inappropriate initial antibiotics were prescribed more frequently in the case group, but mortality was similar in the two groups.…”

Section: Discussionmentioning

confidence: 59%

“…Third generation cephalosporins are most commonly used to treat infectious complications in patients with liver cirrhosis, but their antimicrobial spectra against Pseudomonas aeruginosa are not identical to each other [3-5]. It has been reported that inadequate or delayed antibiotic therapy for pseudomonas bacteremia is associated with poor prognosis [6-9]. Hence, empirical antimicrobial therapy that lacks anti-pseudomonal activity could be harmful in case of pseudomonas bacteremia.…”

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis: a comparison with bacteremia caused by Enterobacteriaceae

et al. 2013

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BackgroundThis study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis.MethodsA retrospective case–control study was designed to identify risk factors for P. aeruginosa bacteremia in cirrhotic patients. The cases were cirrhotic patients with P. aeruginosa bacteremia and the controls were cirrhotic patients with Enterobacteriaceae bacteremia.ResultsSixty-one cases and the same number of controls were enrolled. In a multivariate analysis, younger age {adjusted odds ratio (aOR) per one year: 0.96, 95% confidence interval: 0.93 - 0.99}, nosocomial acquisition (aOR 3.87, 95% confidence interval: 1.50 - 9.94), preexisting biliary disease (aOR 4.79, 95% confidence interval: 1.92 - 10.47), and recent exposure to immunosuppressive agent (aOR 3.10, 95% confidence interval: 1.23 - 7.82) were associated with P. aeruginosa bacteremia. In the case group the frequency of appropriate initial antibiotic regimens was considerably lower than in the control group: 29.5% vs. 65.6% (P <0.01). However, thirty day mortality did not differ significantly between cases and controls (19.7% vs. 24.6%).ConclusionsNosocomial acquisition, preexisting biliary disease, and recent use of immunosuppressive agents are strong predictive factors for P. aeruginosa bacteremia in cirrhotic patients.

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Epidemiology and Outcome of Pseudomonas aeruginosa Bacteremia, With Special Emphasis on the Influence of Antibiotic Treatment

Cited by 230 publications

References 30 publications

Antimicrobial Resistance: Factors and Outcomes

Antimicrobial Resistance: Factors and Outcomes

Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections

Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis: a comparison with bacteremia caused by Enterobacteriaceae

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