Poh-Chang Tang1, Ching-Chi Lee2, Chia-Wen Li2, Ming-Chi Li2, Wen-Chien Ko3, Nan-Yao Lee4. 1. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan. 2. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. 3. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com. 4. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: nanyao@mail.ncku.edu.tw.
Abstract
BACKGROUND/ PURPOSE: Pseudomonas aeruginosa bacteremia is an important cause of nosocomial infections with high morbidity and mortality. Time-to-positivity (TTP) of blood cultures is considered to be a predictor of the clinical outcome for bacteremia. The aim of the study is to investigate the relationship between TTP and clinical outcomes in patients with monomicrobial P. aeruginosa bacteremia. METHODS: From January 2013 to June 2014, a retrospective cohort study was conducted in a 1200-bed tertiary care hospital. The cases of monomicrobial P. aeruginosa bacteremia were studied. TTP and clinical parameters were determined and analyzed. RESULTS: In 139 cases of P. aeruginosa bacteremia, TTP ≤ 13 hours was associated with higher Pitt bacteremia scores (5.3 ± 4.2 vs. 2.3 ± 2.8, p < 0.001), severe sepsis (66.1% vs. 35.0%, p < 0.001), higher 30-day mortality rate (54.2% vs. 15.0%, p < 0.001), longer hospitalization in the survivors (25.6 ± 48.5 days vs. 16.3 ± 15.3 days, p = 0.16), and more admission to intensive care unit (27.2% vs. 16.3%, p = 0.14). Risk factors for 30-day mortality in the univariate analysis included corticosteroid exposure, primary bacteremia, concurrent pneumonia, a high Pitt bacteremia score, severe sepsis, and TTP ≤ 13 hours. In the multivariate analysis, primary bacteremia, a pulmonary origin of bacteremia, severe sepsis, and TTP ≤ 13 hours were independent risk factors for 30-day mortality. CONCLUSION: In cases of monomicrobial P. aeruginosa bacteremia, a short TTP (≤ 13 hours) provides prognostic information, in addition to clinical parameters.
BACKGROUND/ PURPOSE: Pseudomonas aeruginosa bacteremia is an important cause of nosocomial infections with high morbidity and mortality. Time-to-positivity (TTP) of blood cultures is considered to be a predictor of the clinical outcome for bacteremia. The aim of the study is to investigate the relationship between TTP and clinical outcomes in patients with monomicrobial P. aeruginosa bacteremia. METHODS: From January 2013 to June 2014, a retrospective cohort study was conducted in a 1200-bed tertiary care hospital. The cases of monomicrobial P. aeruginosa bacteremia were studied. TTP and clinical parameters were determined and analyzed. RESULTS: In 139 cases of P. aeruginosa bacteremia, TTP ≤ 13 hours was associated with higher Pitt bacteremia scores (5.3 ± 4.2 vs. 2.3 ± 2.8, p < 0.001), severe sepsis (66.1% vs. 35.0%, p < 0.001), higher 30-day mortality rate (54.2% vs. 15.0%, p < 0.001), longer hospitalization in the survivors (25.6 ± 48.5 days vs. 16.3 ± 15.3 days, p = 0.16), and more admission to intensive care unit (27.2% vs. 16.3%, p = 0.14). Risk factors for 30-day mortality in the univariate analysis included corticosteroid exposure, primary bacteremia, concurrent pneumonia, a high Pitt bacteremia score, severe sepsis, and TTP ≤ 13 hours. In the multivariate analysis, primary bacteremia, a pulmonary origin of bacteremia, severe sepsis, and TTP ≤ 13 hours were independent risk factors for 30-day mortality. CONCLUSION: In cases of monomicrobial P. aeruginosa bacteremia, a short TTP (≤ 13 hours) provides prognostic information, in addition to clinical parameters.
Authors: Paul Ríos; Claudio Rocha; William Castro; Maria Vidal; Enrique Canal; Manuela Bernal; Nathanael D Reynolds; Drake H Tilley; Mark P Simons Journal: JMM Case Rep Date: 2018-06-21