A Rojas1, Z R Palacios-Baena2, L E López-Cortés3, J Rodríguez-Baño2. 1. Departamento de Enfermedades Infecciosas del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 2. Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. 3. Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. Electronic address: luiselopezcortes@gmail.com.
Abstract
BACKGROUND: Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional. OBJECTIVES: To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy. DATA SOURCE: A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered. INTERVENTION: Empiric antimicrobial therapy for CO-BSI-PA. METHODS: A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model. RESULTS: Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52-141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12-2.98l p 0.02). CONCLUSIONS: CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions.
BACKGROUND:Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional. OBJECTIVES: To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy. DATA SOURCE: A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered. INTERVENTION: Empiric antimicrobial therapy for CO-BSI-PA. METHODS: A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model. RESULTS: Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52-141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12-2.98l p 0.02). CONCLUSIONS:CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions.
Authors: A R Buonomo; A E Maraolo; R Scotto; M Foggia; E Zappulo; P Congera; S Parente; I Gentile Journal: Infection Date: 2020-01-24 Impact factor: 3.553
Authors: Pedro María Martínez Pérez-Crespo; Álvaro Rojas; Joaquín Felipe Lanz-García; Pilar Retamar-Gentil; José María Reguera-Iglesias; Olalla Lima-Rodríguez; Alfonso Del Arco Jiménez; Jonathan Fernández Suárez; Alfredo Jover-Saenz; Josune Goikoetxea Aguirre; Eva León Jiménez; María Luisa Cantón-Bulnes; Pilar Ortega Lafont; Carlos Armiñanzas Castillo; Juan Sevilla Blanco; Jordi Cuquet Pedragosa; Lucía Boix-Palop; Berta Becerril Carral; Alberto Bahamonde-Carrasco; Teresa Marrodan Ciordia; Clara Natera Kindelán; Isabel María Reche Molina; Carmen Herrero Rodríguez; Inés Pérez Camacho; David Vinuesa García; Fátima Galán-Sánchez; Alejandro Smithson Amat; Esperanza Merino de Lucas; Antonio Sánchez-Porto; Marcos Guzmán García; Inmaculada López-Hernández; Jesús Rodríguez-Baño; Luis Eduardo López-Cortés Journal: Antibiotics (Basel) Date: 2022-05-24