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Pseudomonas aeruginosa bloodstream infections in internal medicine wards: A large Italian multicenter retrospective
Silvia Corcione1,2, Simone Mornese Pinna1, Antonio Vena3,4
1Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
Introduction:
This large, multicenter, Italian retrospective study aimed to describe clinical characteristics and risk factors associated with 30-day mortality in patients with Pseudomonas aeruginosa bloodstream infections (PA-BSI) admitted to internal medicine wards (IMW). To enhance clinical decision-making, we also developed and internally validated a bedside prognostic model to predict the 30-day mortality risk.
Methods:
We conducted a retrospective, multicenter cohort study across 14 public hospitals in Italy, analyzing all adult patients admitted to IMW with PA-BSI between 2021 and 2022.
Results:
Out of 285 eligible patients with PA-BSI, the median age was 73 years, and septic shock occurred in 13.3% of cases. Less than 5% of PA-BSI were caused by difficult-to-treat resistant P. aeruginosa (DTR-PA). Encouragingly, appropriate empiric therapy was administered in 69.8% of patients, yet the overall 30-day mortality remained 22.5%. Cox regression analysis identified age, and urinary catheter use as significant risk factors for mortality. Conversely, adequate source control and targeted therapy emerged as protective factors. Multivariate analysis confirmed septic shock at bloodstream infection onset (HR 6.96; 95% CI, 1.72-28.12) as a strong independent predictor of mortality, whereas effective source control (HR 0.152; 95% CI, 0.039-0.59) significantly improved survival odds. Using these insights, we developed a practical prognostic model capable of estimating the 30-day mortality risk, providing clinicians with a valuable predictive tool at the bedside.
Conclusions:
PA-BSI in IMWs is characterized by a relatively low incidence of septic shock and rate of resistance, alongside high rates of appropriate empiric therapy. Despite these favorable factors, meropenem may represent a valuable therapeutic option for PA-BSI with severe presentations in this setting since mortality remains substantial (22.5%). Our findings underscore the critical importance of early source control and identify septic shock as a key predictor of mortality even in the setting of IMW. The proposed bedside nomogram model could empower clinicians to identify high-risk patients early, facilitating timely interventions and improving outcomes in this vulnerable population.
Insights
Pseudomonas aeruginosa bloodstream infections (PA-BSI) in internal medicine wards have substantial mortality. Septic shock is a key predictor, while source control improves survival, informing a new bedside prognostic model.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Clinical Epidemiology
Background:
- Pseudomonas aeruginosa bloodstream infections (PA-BSI) are a significant concern in hospitalized patients.
- Understanding risk factors for mortality in PA-BSI is crucial for improving patient outcomes.
- Internal Medicine Wards (IMW) represent a common setting for these infections.
Purpose of the Study:
- To describe clinical characteristics and identify risk factors for 30-day mortality in patients with PA-BSI admitted to IMW.
- To develop and internally validate a bedside prognostic model for predicting 30-day mortality risk in PA-BSI patients.
- To evaluate the impact of therapeutic interventions on mortality.
Main Methods:
- A large, multicenter, retrospective cohort study was conducted across 14 Italian hospitals.
- Data from adult patients admitted to IMW with PA-BSI between 2021 and 2022 were analyzed.
- Cox regression and multivariate analyses were used to identify mortality predictors, leading to the development of a prognostic model.
Main Results:
- The study included 285 patients with PA-BSI; median age was 73 years, and 13.3% experienced septic shock.
- Overall 30-day mortality was 22.5%, with difficult-to-treat resistant P. aeruginosa (DTR-PA) in less than 5% of cases.
- Septic shock at onset (HR 6.96) was a strong predictor of mortality, while effective source control (HR 0.152) was protective.
Conclusions:
- PA-BSI in IMWs presents with relatively low resistance rates but substantial mortality.
- Early source control and prompt management of septic shock are critical for improving survival.
- A validated bedside prognostic model can aid clinicians in early risk stratification and timely intervention for PA-BSI patients.
