4cbda964bce413198a3b00a9271bbef0 pmc_32074947.pdf b73947bac2577fa2bea98fe44a7b84ceb368712f pmc_32074947.pdf ea1798dc6b71455a34a29e1e915d27b32abc7c994ec8748be4b157fb7e2517ed pmc_32074947.pdf Title: Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes? Subject: 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. Keywords: extensively drug-resistant Pseudomonas aeruginosa; multidrug resistance; high-risk clones; combined antimicrobial therapy; bacteremia; outcome Author: María Milagro Montero, Inmaculada López Montesinos, Hernando Knobel, Ema Molas, Luisa Sorlí, Ana Siverio-Parés, Nuria Prim, Concepción Segura, Xavier Duran-Jordà, Santiago Grau and Juan Pablo Horcajada Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Fri Feb 14 05:01:58 2020 CET ModDate: Fri Feb 14 05:01:58 2020 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 642072 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GZHAQA+URWPalladioL-Ital Type 1 Custom yes yes no 84 0 CDHXCM+URWPalladioL-Bold Type 1 Custom yes yes no 85 0 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FOOAOF+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 197 0 FOOAOG+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 198 0 FOOAPG+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 199 0 FOOAKD+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 240 0 FOOBNF+TimesNewRomanPSMT CID TrueType Identity-H yes yes yes 241 0 FOOAMD+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 242 0 FOOANE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 243 0 FOOAOF+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 244 0 FOOAOG+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 245 0 FOOAPG+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 246 0 FOOBAH+PalatinoLinotype-BoldItalic CID TrueType Identity-H yes yes yes 247 0 FOOBBI+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 248 0 VUPETJ+Rpxb Type 1 Builtin yes yes no 291 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 04:14:47 CEST RepresentationInformation: pmc_32074947.pdf ReportingModule: PDF-hul, Rel. 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