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[Pseudomonas aeruginosa septicemia. Host-related risk factors in 82 episodes]
O Roche1, F Beuhorry-Sassus, A Boillot
1Laboratoire de Bactériologie, Faculté de Médecine et Centre hospitalier universitaire, Besançon.
Objectives:
The prognosis of septicaemia due to Pseudomonas aeruginosa is severe with mortality ranging from 32 to 73%. We retrospectively studied 82 episodes in order to determine whether risk factors could be identified.
Methods:
Eighty-two episodes of Pseudomonas aeruginosa septicaemia, observed between 1986 and 1991, were analyzed. Risk of death within 2 days of the first positive blood culture (mortality = 19.5%) were assessed with univariate and multivariate analyses.
Results:
Patient age ranged from 1 to 92 years. Most had been hospitalized in medical wards (49%) or intensive care units (28%) (NS). The type of septicaemia (several bacteria in 21%), the source of the infection (nosocomial in 78%), portal, predisposing factors (cancer, haematologic disease: 54%) and MacCabe index were not significantly correlated with risk of death at two days following first positive blood culture. With univariate analysis body temperature below 38,5 degrees C was significant (p = 0.007) for death at day 2 and appropriate antibiotic treatment after diagnosis was significant (p < 0.001) for absence of death on day 2. For multivariate analysis, chemotherapy and shock syndrome were significant (p = 0.005 and 0.09 respectively) for death at day 2 and appropriate antibiotic treatment was significant (p = 0.005) for absence of death on day 2.
Conclusion:
Antibiotic prescription appears to be the most easily controlled significant factor predictive of outcome in Pseudomonas aeruginosa septicaemia.
Insights
Prompt antibiotic treatment is crucial for improving outcomes in Pseudomonas aeruginosa sepsis. Early and appropriate antibiotic therapy significantly reduces mortality risk in patients with this severe infection.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Bacteriology
Context:
- Pseudomonas aeruginosa sepsis presents a severe clinical challenge with high mortality rates.
- Identifying predictive risk factors is essential for optimizing patient management.
- Nosocomial infections and underlying conditions like cancer significantly impact sepsis outcomes.
Purpose:
- To retrospectively analyze risk factors associated with mortality in Pseudomonas aeruginosa sepsis.
- To determine the impact of early and appropriate antibiotic treatment on patient survival.
- To identify controllable factors for improving the prognosis of Pseudomonas aeruginosa sepsis.
Summary:
- A retrospective analysis of 82 Pseudomonas aeruginosa sepsis episodes identified key predictors of mortality.
- While factors like age, comorbidities, and infection source were not significant, low body temperature and shock syndrome were associated with increased risk of death.
- Appropriate antibiotic treatment demonstrated a significant protective effect, reducing the risk of death within two days of diagnosis.
Impact:
- Findings highlight the critical role of timely and appropriate antibiotic administration in managing Pseudomonas aeruginosa sepsis.
- This research provides evidence-based insights for clinicians to improve treatment strategies and patient outcomes.
- The study underscores the importance of antibiotic stewardship in combating severe bacterial infections.