Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study
Por:
Babich, T, Naucler, P, Valik, JK, Giske, CG, Benito, N, Cardona, R, Rivera, A, Pulcini, C, Fattah, MA, Haquin, J, MacGowan, A, Grier, S, Chazan, B, Yanovskay, A, Ben Ami, R, Landes, M, Nesher, L, Zaidman-Shimshovitz, A, McCarthy, K, Paterson, DL, Tacconelli, E, Buhl, M, Maurer, S, Rodriguez-Bano, J, Morales, I, Oliver, A, de Gopegui, ER, Cano, A, Machuca, I, Gozalo-Marguello, M, Martinez-Martinez, L, Gonzalez-Barbera, EM, Alfaro, IG, Salavert, M, Beovic, B, Saje, A, Mueller-Premru, M, Pagani, L, Vitrat, V, Kofteridis, D, Zacharioudaki, M, Maraki, S, Weissman, Y, Paul, M, Dickstein, Y, Leibovici, L, Yahav, D
Publicada:
1 feb 2020
Resumen:
This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving >= 48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01-1.03); female sex (1.34, 1.03-1.77); bedridden functional capacity (1.99, 1.24-3.21); recent hospitalisation (1.43, 1.07-1.92); concomitant corticosteroids (1.33, 1.02-1.73); and Charlson comorbidity index (1.05, 1.01-1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15-2.1), nonurinary source (2.44, 1.54-3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18-1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49-1.33). Among 2135 patients surviving >= 48 h, hospital-acquired infection (1.59, 1.21-2.09), baseline endotracheal tube (1.63, 1.13-2.36) and ICU admission (1.53, 1.02-2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Filiaciones:
Babich, T:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Naucler, P:
Karolinska Inst, Karolinska Univ Hosp, Dept Infect Dis, Div Infect Dis,Dept Med Solna, Stockholm, Sweden
Valik, JK:
Karolinska Inst, Karolinska Univ Hosp, Dept Infect Dis, Div Infect Dis,Dept Med Solna, Stockholm, Sweden
Giske, CG:
Karolinska Inst, Dept Lab Med, Stockholm, Sweden
Karolinska Univ Hosp, Dept Clin Microbiol, Stockholm, Sweden
Benito, N:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Internal Med, Infect Dis Unit,Inst Invest Biomed St Pau, Barcelona, Spain
Cardona, R:
Hosp Santa Creu & Sant Pau, Dept Internal Med, Barcelona, Spain
Rivera, A:
Hosp Santa Creu & Sant Pau, Dept Microbiol, Inst Invest Biomed St Pau, Barcelona, Spain
Pulcini, C:
Univ Lorraine, APEMAC, F-54000 Nancy, France
Univ Lorraine, Infect Dis Dept, CHRU Nancy, F-54000 Nancy, France
Fattah, MA:
Univ Lorraine, Infect Dis Dept, CHRU Nancy, F-54000 Nancy, France
Haquin, J:
Univ Lorraine, Infect Dis Dept, CHRU Nancy, F-54000 Nancy, France
MacGowan, A:
Southmead Hosp, Dept Infect Sci, Pathol Sci Bldg, Bristol, Avon, England
Grier, S:
Southmead Hosp, Dept Infect Sci, Pathol Sci Bldg, Bristol, Avon, England
Chazan, B:
Emek Med Ctr, Infect Dis Unit, Afula, Israel
Technion, Rappaport Fac Med, Haifa, Israel
Yanovskay, A:
Emek Med Ctr, Infect Dis Unit, Afula, Israel
Technion, Rappaport Fac Med, Haifa, Israel
Ben Ami, R:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Sourasky Med Ctr, Infect Dis Unit, Tel Aviv, Israel
Landes, M:
Sourasky Med Ctr, Infect Dis Unit, Tel Aviv, Israel
Nesher, L:
Ben Gurion Univ Negev, Soroka Med Ctr, Infect Dis Inst, Beer Sheva, Israel
Zaidman-Shimshovitz, A:
Ben Gurion Univ Negev, Soroka Med Ctr, Infect Dis Inst, Beer Sheva, Israel
McCarthy, K:
Univ Queensland, UQ Ctr Clin Res, Brisbane, Qld, Australia
Paterson, DL:
Univ Queensland, UQ Ctr Clin Res, Brisbane, Qld, Australia
Tacconelli, E:
Tubingen Univ Hosp, Div Infect Dis, Tubingen, Germany
Buhl, M:
Tubingen Univ Hosp, Div Infect Dis, Tubingen, Germany
Maurer, S:
Tubingen Univ Hosp, Div Infect Dis, Tubingen, Germany
Rodriguez-Bano, J:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, Inst Biomed Sevilla IBiS,Dept Med, Seville, Spain
Morales, I:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, Inst Biomed Sevilla IBiS,Dept Med, Seville, Spain
Oliver, A:
Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Serv Microbiol, Palma De Mallorca, Spain
Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Unidad Invest, Palma De Mallorca, Spain
de Gopegui, ER:
Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Serv Microbiol, Palma De Mallorca, Spain
Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Unidad Invest, Palma De Mallorca, Spain
Cano, A:
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Infect Dis Unit, Cordoba, Spain
Machuca, I:
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Infect Dis Unit, Cordoba, Spain
Gozalo-Marguello, M:
Univ Hosp Marques Valdecilla IDIVAL, Microbiol Serv, Santander, Spain
Martinez-Martinez, L:
Univ Hosp Marques Valdecilla IDIVAL, Microbiol Serv, Santander, Spain
Gonzalez-Barbera, EM:
La Fe Univ Hosp, Microbiol Dept, Valencia, Spain
Alfaro, IG:
La Fe Univ Hosp, Microbiol Dept, Valencia, Spain
Salavert, M:
Hosp Univ & Politecn La Fe, Infect Dis Unit, Valencia, Spain
Beovic, B:
Univ Med Ctr, Dept Infect Dis, Ljubljana, Slovenia
Univ Ljubljana, Fac Med, Ljubljana, Slovenia
Saje, A:
Univ Med Ctr, Dept Infect Dis, Ljubljana, Slovenia
Univ Ljubljana, Fac Med, Ljubljana, Slovenia
Mueller-Premru, M:
Univ Ljubljana, Fac Med, Inst Microbiol & Immunol, Ljubljana, Slovenia
Pagani, L:
Annecy Genevois Hosp Ctr CHANGE, Infect Dis Unit, Annecy, France
Vitrat, V:
Annecy Genevois Hosp Ctr CHANGE, Infect Dis Unit, Annecy, France
Kofteridis, D:
Univ Hosp Heraklion, Dept Internal Med, Infect Dis Unit, Iraklion, Greece
Zacharioudaki, M:
Univ Hosp Heraklion, Dept Internal Med, Infect Dis Unit, Iraklion, Greece
Maraki, S:
Univ Hosp Heraklion, Dept Internal Med, Infect Dis Unit, Iraklion, Greece
Weissman, Y:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Paul, M:
Rambam Hlth Care Campus, Infect Dis Unit, Haifa, Israel
Dickstein, Y:
Rambam Hlth Care Campus, Infect Dis Unit, Haifa, Israel
Leibovici, L:
Beilinson Med Ctr, Rabin Med Ctr, Med E, 39 Jabotinsky Rd, IL-49100 Petah Tiqwa, Israel
Yahav, D:
Beilinson Med Ctr, Rabin Med Ctr, Infect Dis Unit, 39 Jabotinsky Rd, IL-49100 Petah Tiqwa, Israel
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