<i>Pseudomonas aeruginosa</i> Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival

Abstract

SUMMARY: Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6z) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8z vs. 30z, P ＜ 0.01; 30-day mortality, 23z vs. 39z, P ＝ 0.053). Multivariate analysis showed that a higher sequential organ failure assessment score (hazard ratio [HR]: 1.27, P ＜ 0.01) and underlying malignancies (HR: 3.33, P ＜ 0.01) were independently associated with 30-day mortality. Initial antibiotic therapy (HR: 0.21, P ＜ 0.01) and patients' immune status (HR: 0.29, P ＝ 0.02) also had a significant impact on survival. However, there was a significant interaction between these 2 variables (P ＝ 0.03 for interaction). A subgroup analysis showed that in immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5z vs. 66.7z, P ＜ 0.01 by log-rank test).

Competitive Cell Death Interactions in Pulmonary Infection: Host Modulation Versus Pathogen Manipulation

“…Pseudomonas aeruginosa is an extracellular, Gram-negative pathogen (59). While considered primarily an extracellular pathogen, Bajmoczi et al, have reported that P. aeruginosa can be found in epithelial cells (60).…”

“…P. aeruginosa opportunistically causes serious infections and is a leading cause of nosocomial pneumonia. It also contributes to morbidity and mortality due to respiratory failure and sepsis in immunocompromised patients, particularly in cystic fibrosis patients (59,61). It is noteworthy that there has been a significant increase in the incidence of multi-drug resistant isolates of P. aeruginosa in hospital settings, making complementary therapeutic approaches to augment immune clearance and control RCD in epithelial and endothelial pulmonary tissue more essential (62).…”

Synergy and Order Effects of Antibiotics and Phages in Killing Pseudomonas aeruginosa Biofilms

“…In addition to being the immediate cause of mortality of many cystic fibrosis patients [20], P . aeruginosa is a major source of morbidity and mortality in burn patients [21], immune-compromised patients [22] and patients with the skin ulcers that commonly plague diabetics [23]. P .…”

Pseudomonas aeruginosa Toxin ExoU as a Therapeutic Target in the Treatment of Bacterial Infections

“…Pseudomonas aeruginosa is a motile, Gram-negative rod-shaped bacterium that causes a wide range of opportunist infections including corneal, soft tissue, urinary tract, and respiratory tract infections; often with high rates of morbidity and mortality [1][2][3][4][5]. It is a major cause of intensive care unit-acquired pneumonia (ICUAP), as well as a known coloniser of patients with cystic fibrosis and those who are immunocompromised [6][7][8]. Furthermore, multidrug-resistant P. aeruginosa is a major threat, as recently highlighted when the World Health Organisation (WHO) listed carbapenem-resistant P. aeruginosa as the highest priority for the development of new antibiotics [9].…”