Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients : Impact of Empirical Antibiotic Therapy
Royo-Cebrecos, Cristina (Hospital Nostra Senyora de Meritxell)
Laporte-Amargós, Júlia (Hospital Universitari de Bellvitge)
Peña, Marta (Hospital Universitari de Bellvitge)
Ruiz-Camps, Isabel (Hospital Universitari Vall d'Hebron)
Garcia-Vidal, Carolina (Hospital Clínic i Provincial de Barcelona)
Abdala, Edson (Univesity of São Paulo)
Oltolini, Chiara (IRCCS San Raffaele Scientific Institute)
Akova, Murat (Hacettepe University School of Medicine)
Montejo, Miguel (Hospital Universitario de Cruces)
Mikulska, Malgorzata (University of Genoa (DISSAL))
Martín-Dávila, Pilar (Hospital Ramon y Cajal)
Herrera, Fabián (Centro de Educación Médica e Investigaciones Clínicas (CEMIC))
Gasch Blasi, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Drgona, Lubos (Comenius University)
Morales, Hugo Manuel Paz (Hospital Erasto Gaertner)
Brunel, Anne-Sophie (Lausanne University Hospital)
García, Estefanía (Hospital Universitario Reina Sofía)
Isler, Burcu (Istanbul Education and Research Hospital)
Kern, Winfried V. (University of Freiburg Medical Center)
Palacios-Baena, Zaira R. (Hospital Universitario Virgen Macarena)
de la Calle, Guillermo Maestr (Instituto de Investigación Hospital "12 de Octubre" (i + 12))
Montero, María Milagro (Institut Hospital del Mar d'Investigacions Mèdiques)
Kanj, Souha (American University of Beirut Medical Center)
Sipahi, Oguz R. (Ege University)
Calik, Sebnem (University of Health Science Izmir Bozyaka Training and Research Hospital)
Márquez-Gómez, Ignacio (Hospital Regional de Málaga)
Marin, Jorge I. (Clínica Maraya)
Gomes, Marisa Z. R. (Instituto Oswaldo Cruz)
Hemmatii, Philipp (DeparKlinikum Ernst von Bergmann)
Araos, Rafael (Clínica Alemana Universidad del Desarrollo)
Peghin, Maddalena (University of Insubria-ASST-Sette Laghi)
Del Pozo, Jose Luis (Clínica Universitaria de Navarra)
Yáñez, Lucrecia (Hospital Universitario Marqués de Valdecilla)
Tilley, Robert (University Hospitals Plymouth NHS Trust)
Manzur, Adriana (Hospital Rawson)
Novo, Andrés (Hospital Universitari Son Espases)
Carratalà, Jordi (Hospital Universitari de Bellvitge)
Gudiol, Carlota (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33. 3% vs. 20. 2%, p < 0. 001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92. 6% vs. 57. 4%; p < 0. 001), pneumonia (38% vs. 19. 2% p < 0. 001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33. 8% vs. 21. 1%, p < 0. 001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21. 7% vs. 16. 2%, p = 0. 020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10. 5%; p < 0. 001), mechanical ventilation (49. 1% vs. 5. 6%; p < 0. 001), and higher 7-day and 30-day case fatality rates (58. 2% vs. 12%, p < 0. 001, and 74% vs. 23. 1%, p < 0. 001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.
Drets:	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.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Bacteremia ; Bloodstream infection ; Cancer ; Neutropenia ; Pseudomonas aeruginosa ; Septic shock
Publicat a:	Microorganisms, Vol. 12 (march 2024) , ISSN 2076-2607

DOI: 10.3390/microorganisms12040705
PMID: 38674650

13 p, 298.6 KB

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