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Inappropriate initial antimicrobial therapy as a risk factor for mortality in patients with community-onset Pseudomonas aeruginosa bacteraemia

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Abstract

This study was performed to identify the risk factors for mortality and evaluate the effect of inappropriate initial antimicrobial therapy on the outcomes of patients with community-onset Pseudomonas aeruginosa bacteraemia in an emergency department (ER) setting. All cases with P. aeruginosa bacteraemia occurring within 48 h after ER visit from January 2000 to December 2005 were retrospectively analysed. A total of 106 community-onset P. aeruginosa bacteraemia cases in the ER were included (mean age, 57.61 ± 14.44 years old; M:F, 58:48). Although P. aeruginosa bacteraemia was diagnosed in the ER, most of the cases of P. aeruginosa bacteraemia were healthcare-associated (88.7%). Malignancy (n = 83, 78.3%) was the most common underlying disorder. Fifty patients (47.2%) were neutropaenic and 56 patients (52.8%) had septic shock. The overall 30-day mortality rate was 26.4% (28/106). In the univariate analysis, underlying malignancy, high Charlson’s weighted index of comorbidity (≥3), high Pitt bacteraemia score (≥4), indwelling central venous catheter and inappropriate initial therapy were significantly associated with 30-day mortality (all P < 0.05). In the multivariate analysis, high Pitt bacteraemia score (OR, 17.03; 95% CI, 4.60–63.15; P < 0.001) and inappropriate initial antimicrobial therapy (OR, 4.29; 95% CI, 1.39–13.24; P = 0.011) were found to be significant risk factors for 30-day mortality. The 30-day mortality rate was significantly higher in the inappropriate therapy group (18/51, 35.3%) than in the appropriate therapy group (10/55, 18.2%) (P = 0.046). This study demonstrated that inappropriate initial antimicrobial therapy was significantly associated with unfavourable outcomes in patients with community-onset P. aeruginosa bacteraemia. As P. aeruginosa bacteraemia can be a fatal infection, even when community-onset, inappropriate antimicrobial therapy should be avoided in suspected cases of P. aeruginosa bacteraemia.

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References

  1. Zelenitsky SA, Harding GK, Sun S, Ubhi K, Ariano RE (2003) Treatment and outcome of Pseudomonas aeruginosa bacteraemia: an antibiotic pharmacodynamic analysis. J Antimicrob Chemother 52(4):668–674. doi:10.1093/jac/dkg403

    Article  PubMed  CAS  Google Scholar 

  2. Huang YC, Lin TY, Wang CH (2002) Community-acquired Pseudomonas aeruginosa sepsis in previously healthy infants and children: analysis of forty-three episodes. Pediatr Infect Dis J 21(11):1049–1052. doi:10.1097/00006454-200211000-00015

    Article  PubMed  Google Scholar 

  3. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW (2005) Clinical features and outcome of patients with community-acquired Pseudomonas aeruginosa bacteraemia. Clin Microbiol Infect 11(5):415–418. doi:10.1111/j.1469-0691.2005.01102.x

    Article  PubMed  Google Scholar 

  4. Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH (2005) Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother 49(4):1306–1311. doi:10.1128/AAC.49.4.1306-1311.2005

    Article  PubMed  CAS  Google Scholar 

  5. Chatzinikolaou I, Abi-Said D, Bodey GP, Rolston KV, Tarrand JJ, Samonis G (2000) Recent experience with Pseudomonas aeruginosa bacteremia in patients with cancer: retrospective analysis of 245 episodes. Arch Intern Med 160(4):501–509. doi:10.1001/archinte.160.4.501

    Article  PubMed  CAS  Google Scholar 

  6. Vidal F, Mensa J, Almela M, Martínez JA, Marco F, Casals C, Gatell JM, Soriano E, Jimenez de Anta MT (1996) Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes. Arch Intern Med 156(18):2121–2126. doi:10.1001/archinte.156.18.2121

    Article  PubMed  CAS  Google Scholar 

  7. Grisaru-Soen G, Lerner-Geva L, Keller N, Berger H, Passwell JH, Barzilai A (2000) Pseudomonas aeruginosa bacteremia in children: analysis of trends in prevalence, antibiotic resistance and prognostic factors. Pediatr Infect Dis J 19(10):959–963. doi:10.1097/00006454-200010000-00003

    Article  PubMed  CAS  Google Scholar 

  8. Chamot E, Boffi El Amari E, Rohner P, Van Delden C (2003) Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother 47(9):2756–2764. doi:10.1128/AAC.47.9.2756-2764.2003

    Article  PubMed  CAS  Google Scholar 

  9. Kang CI, Kim SH, Kim HB, Park SW, Choe YJ, Oh MD, Kim EC, Choe KW (2003) Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis 37(6):745–751. doi:10.1086/377200

    Article  PubMed  Google Scholar 

  10. Chow JW, Yu VL (1999) Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 11(1):7–12. doi:10.1016/S0924-8579(98)00060-0

    Article  PubMed  CAS  Google Scholar 

  11. Lesens O, Methlin C, Hansmann Y, Remy V, Martinot M, Bergin C, Meyer P, Christmann D (2003) Role of comorbidity in mortality related to Staphylococcus aureus bacteremia: a prospective study using the Charlson weighted index of comorbidity. Infect Control Hosp Epidemiol 24(12):890–896. doi:10.1086/502156

    Article  PubMed  Google Scholar 

  12. Balk RA (2000) Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations. Crit Care Clin 16(2):179–192. doi:10.1016/S0749-0704(05)70106-8

    Article  PubMed  CAS  Google Scholar 

  13. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 137(10):791–797

    PubMed  Google Scholar 

  14. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW (2005) Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 49(2):760–766. doi:10.1128/AAC.49.2.760-766.2005

    Article  PubMed  CAS  Google Scholar 

  15. Clinical and Laboratory Standards Institute (CLSI) (2005) Performance standards for antimicrobial susceptibility testing: 15th informational supplement. CLSI/NCCLS document M100-S15. CLSI, Wayne, PA, USA

  16. Zaragoza R, Artero A, Camarena JJ, Sancho S, González R, Nogueira JM (2003) The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit. Clin Microbiol Infect 9(5):412–418. doi:10.1046/j.1469-0691.2003.00656.x

    Article  PubMed  CAS  Google Scholar 

  17. Vallés J, Rello J, Ochagavía A, Garnacho J, Alcalá MA (2003) Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest 123(5):1615–1624. doi:10.1378/chest.123.5.1615

    Article  PubMed  Google Scholar 

  18. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31(12):2742–2751. doi:10.1097/01.CCM.0000098031.24329.10

    Article  PubMed  Google Scholar 

  19. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB (1997) The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 24(4):584–602

    PubMed  CAS  Google Scholar 

  20. Yeung CK, Lee KH (1998) Community acquired fulminant Pseudomonas infection of the gastrointestinal tract in previously healthy infants. J Paediatr Child Health 34(6):584–587. doi:10.1046/j.1440-1754.1998.00290.x

    Article  PubMed  CAS  Google Scholar 

  21. Calza L, Manfredi R, Marinacci G, Fortunato L, Chiodo F (2002) Community-acquired Pseudomonas aeruginosa sacro-iliitis in a previously healthy patient. J Med Microbiol 51(7):620–622

    PubMed  CAS  Google Scholar 

  22. Arancibia F, Bauer TT, Ewig S, Mensa J, González J, Niederman MS, Torres A (2002) Community-acquired pneumonia due to gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med 162(16):1849–1858. doi:10.1001/archinte.162.16.1849

    Article  PubMed  Google Scholar 

  23. Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):S131–S138. doi:10.1086/314079

    Article  PubMed  Google Scholar 

  24. Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, Kim SW, Ryu SY, Heo ST, Jung DS, Rhee JY, Shin SY, Ko KS, Peck KR, Lee NY (2007) Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother 59(3):525–530. doi:10.1093/jac/dkl499

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    H. S. Cheong, C.-I. Kang, Y. M. Wi, D. R. Chung, J.-H. Song & K. R. Peck

  2. Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    N. Y. Lee

  3. Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    K. S. Ko

  4. Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Seoul, Republic of Korea

    K. S. Ko & J.-H. Song

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  1. H. S. Cheong
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  2. C.-I. Kang
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Correspondence to K. R. Peck.

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Cheong, H.S., Kang, CI., Wi, Y.M. et al. Inappropriate initial antimicrobial therapy as a risk factor for mortality in patients with community-onset Pseudomonas aeruginosa bacteraemia. Eur J Clin Microbiol Infect Dis 27, 1219–1225 (2008). https://doi.org/10.1007/s10096-008-0568-5

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  • DOI: https://doi.org/10.1007/s10096-008-0568-5

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