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Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality

M Tumbarello1, E Repetto, E M Trecarichi

  • 1Institute of Infectious Diseases, Catholic University of the Sacred Heart, Roma, Italy.

Epidemiology and Infection
|January 14, 2011
PubMed

Insights

Multidrug-resistant Pseudomonas aeruginosa bloodstream infections (BSIs) are linked to central venous catheters, prior antibiotics, and corticosteroids. Inadequate initial therapy and septic shock increase mortality risk in patients with P. aeruginosa BSI.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Epidemiology

Background:

  • Pseudomonas aeruginosa bloodstream infections (BSIs) pose a significant clinical challenge.
  • Understanding risk factors for multidrug-resistant (MDR) P. aeruginosa is crucial for effective management.
  • Clinical outcomes associated with MDR versus non-MDR P. aeruginosa BSIs require further investigation.

Purpose of the Study:

  • To identify risk factors associated with the isolation of multidrug-resistant (MDR) or non-MDR P. aeruginosa.
  • To evaluate the clinical outcomes, including 21-day mortality, of P. aeruginosa BSIs.
  • To compare risk factors and outcomes between MDR and non-MDR P. aeruginosa bloodstream infections.

Main Methods:

  • Retrospective case-case-control and cohort study design.
  • Inclusion of 106 patients with P. aeruginosa BSI from two Italian university hospitals over a 2-year period.
  • Statistical analysis to identify independent risk factors for MDR/non-MDR P. aeruginosa isolation and 21-day mortality.

Main Results:

  • Independent risk factors for MDR P. aeruginosa included central venous catheter (CVC) use, previous antibiotic therapy, and corticosteroid therapy.
  • Independent risk factors for non-MDR P. aeruginosa included previous BSI, low neutrophil count (<500/mm3), urinary catheterization, and CVC.
  • The overall 21-day mortality rate was 33.9%. Septic shock, MDR P. aeruginosa infection, and inadequate initial antimicrobial therapy were independently associated with increased mortality.

Conclusions:

  • Specific risk factors are associated with the isolation of MDR versus non-MDR P. aeruginosa.
  • MDR P. aeruginosa, septic shock, and inappropriate initial treatment significantly increase the risk of mortality in patients with P. aeruginosa BSI.
  • These findings highlight the importance of targeted antimicrobial strategies and prompt management for P. aeruginosa bloodstream infections.

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