Influence of Virulence Genotype and Resistance Profile in the Mortality of Pseudomonas aeruginosa Bloodstream Infections
Por:
Pena, C, Cabot, G, Gomez-Zorrilla, S, Zamorano, L, Ocampo-Sosa, A, Murillas, J, Almirante, B, Pomar, V, Aguilar, M, Granados, A, Calbo, E, Rodriguez-Bano, J, Rodriguez-Lopez, F, Tubau, F, Martinez-Martinez, L, Oliver, A
Publicada:
15 feb 2015
Resumen:
Background. The type III secretion system (TTSS) is a major virulence determinant of Pseudomonas aeruginosa. The objective of this study was to determine whether the TTSS genotype is a useful prognostic marker of P. aeruginosa bacteremia mortality. We also studied the potential association between TTSS genotypes and multidrugresistant (MDR) profiles, and how this interaction impacts the outcome of bloodstream infections.
Methods. We performed a post hoc analysis of a published prospective multicenter cohort of P. aeruginosa bloodstream infections. The impact in mortality of TTSS genotypes (exoS, exoT, exoU, and exoY genes) and resistance profiles was investigated. Cox regression analysis was used to control for confounding variables.
Results. Among 590 patients, the 30-day mortality rate was 30% (175 patients), and 53% of them died in the first 5 days (early mortality). The unadjusted probabilities of survival until 5 days was 31.4% (95% confidence interval [CI], 17.4%-49.4%) for the patients with exoU-positive isolates and 53.2% (95% CI, 44.6%-61.5%) for exoU-negative isolates (log rank P = .005). After adjustment for confounders, exoU genotype (adjusted hazard ratio [aHR], 1.90 [95% CI, 1.15-3.14]; P = .01) showed association with early mortality. In contrast, late (30-day) mortality was not influenced by TTSS genotype but was independently associated with MDR profiles (aHR, 1.40 [95% CI, 1.01-1.94]; P = .04). Moreover, the exoU genotype (21% of all isolates) was significantly less frequent (13%) among MDR strains (particularly among extensively drug-resistant isolates, 5%), but was positively linked to moderately resistant (1-2 antipseudomonals) phenotypes (34%).
Conclusions. Our results indicate that the exoU genotype, which is associated with specific susceptibility profiles, is a relevant independent marker of early mortality in P. aeruginosa bacteremia.
Filiaciones:
Pena, C:
Hosp Univ Bellvitge IDIBELL, Serv Enfermedades Infecciosas, Barcelona, Spain
Cabot, G:
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Microbiol, Unidad Invest, Palma De Mallorca 07010, Spain
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Med Interna, Palma De Mallorca 07010, Spain
Gomez-Zorrilla, S:
Hosp Univ Bellvitge IDIBELL, Serv Enfermedades Infecciosas, Barcelona, Spain
Zamorano, L:
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Microbiol, Unidad Invest, Palma De Mallorca 07010, Spain
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Med Interna, Palma De Mallorca 07010, Spain
Ocampo-Sosa, A:
Hosp Univ Marques de Valdecilla IFIMAV, Serv Microbiol, Santander, Spain
Murillas, J:
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Microbiol, Unidad Invest, Palma De Mallorca 07010, Spain
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Med Interna, Palma De Mallorca 07010, Spain
Almirante, B:
Hosp Univ Vall dHebron, Serv Enfermedades Infecciosas, Barcelona, Spain
Pomar, V:
Hosp Santa Creu & Sant Pau, Unidad Enfermedades Infecciosas, Barcelona, Spain
Aguilar, M:
Hosp Univ Virgen del Rocio, Serv Enfermedades Infecciosas, Seville, Spain
Granados, A:
Consorci Hosp Parc Tauli, Secc Enfermedades Infecciosas, Sabadell, Spain
Calbo, E:
Hosp Mutua de Terrasa, Secc Enfermedades Infecciosas, Seville, Spain
Rodriguez-Bano, J:
Hosp Univ Virgen Macarena, Secc Enfermedades Infecciosas, Seville, Spain
Rodriguez-Lopez, F:
Hosp Univ Reina Sofia IMIBIC, Serv Microbiol Infecciosas, Cordoba, Spain
Tubau, F:
Hosp Univ Bellvitge IDIBELL, Serv Enfermedades Infecciosas, Barcelona, Spain
Martinez-Martinez, L:
Hosp Univ Marques de Valdecilla IFIMAV, Serv Microbiol, Santander, Spain
Univ Cantabria, Dept Biol Mol, E-39005 Santander, Spain
Oliver, A:
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Microbiol, Unidad Invest, Palma De Mallorca 07010, Spain
Hosp Son Espases, Inst Invest Sanitaria Palma, Serv Med Interna, Palma De Mallorca 07010, Spain
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