title: Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes.
abstract: OBJECTIVE
  To evaluate the trend in incidence of Pseudomonas aeruginosa bacteremia, underlying conditions of patients, mortality rate, and factors associated with poor outcome.
  
  
  METHODS
  Medical charts of 189 consecutive episodes of P aeruginosa bacteremia, detected between January 1, 1991, and December 31, 1994, were prospectively evaluated. Associated risk factors, treatment, and outcome were recorded.
  
  
  RESULTS
  Pseudomonas aeruginosa bacteremia represented 5.7% of the total number of bacteremias, 6.9% of nosocomial bacteremias, and 23.6% of nosocomial gram-negative bacteremias. There were 1.5 episodes per 1000 discharges. These numbers were slightly lower than those recorded at our hospital 10 years earlier. Human immunodeficiency virus infection was the most frequent underlying disease (28/189 [15%]). Overall mortality was 18% (34/189). The presence of fatal underlying disease (P < .001), surgery (P = .001), pneumonia (P = .02), and severe sepsis (P < .001) were associated with poor prognosis, the mortality of the patients with these variables being 28%, 28%, 47%, and 62%, respectively. The presence of inappropriate definitive antimicrobial treatment became an independent factor predictive of death (P = .04) only when the subset of patients with intravenous catheter-associated bacteremia was excluded from the analysis. The survival rate was no greater in patients who received 2 or more antibiotics active in vitro against P aeruginosa than in those who received only 1. Neutropenia was not associated with increased mortality. The use of colony-stimulating factors did not affect the outcome of the neutropenic patients.
  
  
  CONCLUSIONS
  The rate of P aeruginosa bacteremia is falling slightly at our hospital. The emergence of the human immunodeficiency virus epidemic has had a considerable impact on both epidemiology and mortality. The presence of severe underlying disease, surgery, pneumonia, and, especially, severe sepsis are associated with a poor outcome. With the exclusion of patients with intravenous catheter-associated P aeruginosa bacteremia, the administration of an appropriate antimicrobial therapy is essential to a good outcome. Treatment with 1 active antibiotic seems to be sufficient.
authors.affiliation: Department of Internal Medicine, Hospital Universitari de Tarragona JOAN XXIII, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Vidal
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.forename: C
authors.initials: C
authors.lastname: Casals
authors.forename: J M
authors.initials: JM
authors.lastname: Gatell
authors.forename: E
authors.initials: E
authors.lastname: Soriano
authors.forename: M T
authors.initials: MT
authors.lastname: Jimenez de Anta
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy