Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections : what is the Influence of XDR Phenotype on Outcomes?
Montero, María Milagro (Universitat Autònoma de Barcelona. Departament de Medicina)
López Montesinos, Inmaculada (Universitat Autònoma de Barcelona. Departament de Medicina)
Knobel Freud, Hernando (Universitat Autònoma de Barcelona. Departament de Medicina)
Molas, Ema (Universitat Autònoma de Barcelona. Departament de Medicina)
Sorlí, Luisa (Institut Hospital del Mar d'Investigacions Mèdiques)
Siverio Pares, Ana Cristina (Hospital del Mar (Barcelona, Catalunya))
Prim, Núria (Hospital del Mar (Barcelona, Catalunya))
Segura, Concepción (Hospital del Mar (Barcelona, Catalunya))
Duran-Jordà, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Grau, Santiago (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)
Horcajada, Juan Pablo (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2020
Resumen:	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.
Ayudas:	Instituto de Salud Carlos III PI16/00669 Instituto de Salud Carlos III PI17/00251 Instituto de Salud Carlos III CM18/00047 Instituto de Salud Carlos III RD16/0016/0015
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Estudi clínic ; recerca ; Versió publicada
Materia:	Extensively drug-resistant Pseudomonas aeruginosa ; Multidrug resistance ; High-risk clones ; Combined antimicrobial therapy ; Bacteremia ; Outcome
Publicado en:	Journal of clinical medicine, Vol. 9 Núm. 2 (2020) , p. 514, ISSN 2077-0383

DOI: 10.3390/jcm9020514
PMID: 32074947

14 p, 627.0 KB

El registro aparece en las colecciones:
Artículos > Artículos de investigación
Artículos > Artículos publicados