D Viasus1, P Puerta-Alcalde2, C Cardozo2, M Suárez-Lledó3, O Rodríguez-Núñez2, L Morata2, C Fehér2, F Marco4, M Chumbita2, E Moreno-García2, F Fernández-Avilés3, G Gutiérrez-Garcia5, J A Martínez6, J Mensa2, M Rovira5, J Esteve5, A Soriano6, C Garcia-Vidal7. 1. Health Sciences Division, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia. 2. Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain. 3. Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain. 4. ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain. 5. Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain. 6. Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain. 7. Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain. Electronic address: cgarciav@clinic.cat.
Abstract
OBJECTIVES: To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS: Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS: Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS: A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.
OBJECTIVES: To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenicpatients. METHODS: Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS: Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS: A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.
Authors: C Gudiol; A Albasanz-Puig; J Laporte-Amargós; N Pallarès; A Mussetti; I Ruiz-Camps; P Puerta-Alcalde; E Abdala; C Oltolini; M Akova; M Montejo; M Mikulska; P Martín-Dávila; F Herrera; O Gasch; L Drgona; H Paz Morales; A-S Brunel; E García; B Isler; W V Kern; I Morales; G Maestro-de la Calle; M Montero; S S Kanj; O R Sipahi; S Calik; I Márquez-Gómez; J I Marin; M Z R Gomes; P Hemmatti; R Araos; M Peghin; J L Del Pozo; L Yáñez; R Tilley; A Manzur; A Novo; J Carratalà Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191
Authors: José M Miró; Carolina Garcia-Vidal; Pedro Puerta-Alcalde; Juan Ambrosioni; Mariana Chumbita; Marta Hernández-Meneses; Nicole Garcia-Pouton; Celia Cardozo; Estela Moreno-García; Francesc Marco; Josep Mensa; Montserrat Rovira; Jordi Esteve; Jose A Martínez; Felipe García; Josep Mallolas; Alex Soriano Journal: Infect Dis Ther Date: 2021-04-11
Authors: Mohamed F El-Badawy; Emad M Eed; Asmaa S Sleem; Azza A K El-Sheikh; Ibrahim A Maghrabi; Sayed F Abdelwahab Journal: Infect Drug Resist Date: 2022-07-16 Impact factor: 4.177