Andrés Leonardo González1, Aura Lucía Leal2, Jorge Alberto Cortés3, Ricardo Sánchez4, Liliana Isabel Barrero1, Juan Sebastián Castillo1, Carlos Arturo Álvarez1. 1. Grupo de Investigación en Enfermedades Infecciosas, Universidad Nacional de Colombia, Bogotá, D.C, Colombia. 2. Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia. 3. Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia. 4. Grupo para el Control de la Resistencia Bacteriana de Bogotá (GREBO), Bogotá, D.C, Colombia.
Abstract
INTRODUCTION: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. OBJECTIVE: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. MATERIALS AND METHODS: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. RESULTS: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). CONCLUSION: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.
INTRODUCTION: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. OBJECTIVE: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. MATERIALS AND METHODS: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. RESULTS: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). CONCLUSION: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.
Authors: Jose Luis Lamas Ferreiro; Judith Álvarez Otero; Lucía González González; Luis Novoa Lamazares; Alexandra Arca Blanco; Jose Ramón Bermúdez Sanjurjo; Irene Rodríguez Conde; María Fernández Soneira; Javier de la Fuente Aguado Journal: PLoS One Date: 2017-05-26 Impact factor: 3.240
Authors: Marjolein C Persoon; Anne F Voor In't Holt; Cornelia C H Wielders; Diederik Gommers; Margreet C Vos; Juliëtte A Severin Journal: Antimicrob Resist Infect Control Date: 2020-02-03 Impact factor: 4.887