Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic Selection

Abstract

Although a growing number of studies have found a relationship between delayed appropriate antibiotic therapy and mortality, few have attempted to quantify the temporal association between delayed appropriate antibiotic therapy and mortality. This study was designed to measure the elapsed time associated with an increased risk of 30-day mortality among patients with Pseudomonas aeruginosa bacteremia. The retrospective cohort study was conducted among immunocompetent, adult patients with P. aeruginosa bacteremia onset at least 2 days after hospital admission between 1 January 2001 and 30 September 2006. Classification and regression tree analysis (CART) was used to identify the delay in appropriate antibiotic therapy that was associated with an increased risk of 30-day mortality. During the study period, 100 patients met the inclusion criteria. The CART-derived breakpoint between early and delayed treatment was 52 h. The delayed treatment group experienced a >2-fold significant increase in 30-day mortality compared to the early treatment group (44 and 19%, respectively, P ‫؍‬ 0.008). Delayed appropriate therapy of >52 h (odds ratio [OR] ‫؍‬ 4.1; 95% confidence interval [CI] 1.2 to 13.9, P ‫؍‬ 0.03) was independently associated with 30-day mortality in the multivariate analysis. Antibiotic resistance >3 classes (adjusted OR [AOR] ‫؍‬ 4.6; 95% CI ‫؍‬ 1.9 to 11.2, P ‫؍‬ 0.001) and chronic obstructive pulmonary disease (AOR ‫؍‬ 5.4; 95% CI ‫؍‬ 1.5 to 19.7, P ‫؍‬ 0.01) were independently associated with delayed appropriate therapy of >52 h. The data strongly suggest that delaying appropriate therapy for approximately 2 days significantly increases the risk of 30-day mortality in patients with P. aeruginosa bloodstream infections.

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

“…Previously reported risk factors for mortality in patients with P. aeruginosa bacteremia include age, severity of illness (acute physiology and chronic health evaluation and SOFA scores), underlying comorbidities (malignancy, liver disease, and renal failure), and initial site of infection (23)(24)(25). Our results showed significant associations of a higher SOFA score and malignancy with mortality.…”

Phenylethanoid Glycosides: Research Advances in Their Phytochemistry, Pharmacological Activity and Pharmacokinetics

“…Pseudomonas aeruginosa is the major pathogen implicated in sepsis and pneumonia [77,78]. Total phenylethanoid glycosides (TPG) from Monochasma savatieri prolonged survival rate of mice with P. aeruginosa or Staphylococcus aureus infection-induced sepsis in vivo.…”

Multidrug resistant Pseudomonas aeruginosa bloodstream infection in adult patients with hematologic malignancies

“…The inadequacy of empirical antimicrobial treatment has been shown to predict mortality in patients with bloodstream infection and severe sepsis, and it is more likely to occur in BSIs caused by antibiotic resistant bacteria. 2,3,7 In addition, we have previously demonstrated that IIAT was the strongest independent predictor of 30-day mortality in patients suffering from hematologic malignancies with BSIs caused by E. coli, 4 despite prompt administration of empirical broad-spectrum antibacterial therapy as recommended by the current clinical practice guidelines for the management of high-risk febrile neutropenic patients with cancer.…”