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Published on: May 4, 2018
Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections
Sabina Herrera1, Marta Bodro, Alex Soriano
1Infectious Diseases Department, Hospital Clinic, Barcelona, Spain.
Purpose Of Review:
In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%.
Recent Findings:
It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are among the most vulnerable for the worst outcomes. Environmental exposure, integrity of the microbiota, and host immunity are the key determinants for the initial colonization and expansion on mucosal surfaces and potential invasion afterwards by MDR P. aeruginosa.
Summary:
Available data suggest that high colonization pressure (settings with high prevalence like intensive care units), disruption of healthy microbiota (prior use of antibiotics, in particular fluoroquinolones), immunosuppression (neutropenia) and breaking natural barriers (venous or urine catheters), are the main risk factors for MDR P. aeruginosa BSI.
Insights
Identifying patients at high risk for multidrug-resistant Pseudomonas aeruginosa bloodstream infections (BSI) is crucial for effective empirical treatment. Key risk factors include immunosuppression and disruption of the natural host barriers.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- The global prevalence of multidrug-resistant (MDR) Pseudomonas aeruginosa is a significant concern, complicating infection treatment.
- Pseudomonas aeruginosa bloodstream infections (BSI) are severe, with mortality rates between 20-40%.
Purpose of the Study:
- To identify key risk factors for MDR P. aeruginosa BSI.
- To improve empirical therapy and patient survival by understanding high-risk patient groups.
Main Methods:
- Review of available data on MDR P. aeruginosa risk factors.
- Analysis of factors influencing colonization, mucosal expansion, and invasion.
Main Results:
- High colonization pressure (e.g., intensive care units) is a major risk factor.
- Disruption of microbiota (e.g., fluoroquinolone use), immunosuppression (neutropenia), and compromised barriers (catheters) increase BSI risk.
- Immunocompromised patients face worse outcomes.
Conclusions:
- Understanding patient risk factors is essential for targeted empirical treatment of MDR P. aeruginosa BSI.
- Early identification of vulnerable patients can improve outcomes and survival rates.
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