[Risk and prognostic factors of Pseudomonas aeruginosa bacteremia in critically ill patients].
BACKGROUND
To determine risk and prognostic factors in patients admitted to the intensive care unit (ICU) in which an episode of bacteremia caused by Pseudomonas aeruginosa has been diagnosed.


METHODS
Cohort, observational, prospective, multicenter study. Patients admitted to 30 ICUs in Spain in whom one or more pathogens were isolated from blood cultures were included.


RESULTS
In a total of 16,216 patients admitted to the participating ICUs during the study period, 949 episodes of bacteremia were diagnosed In 77 cases (8.11%), P. aeruginosa was the causative pathogen, with an infection rate of 4.7 episodes per 1000 patients. Independent risk factors associated with P. aeruginosa bacteremia were as follows: respiratory infection focus (OR 3.92; 95% IC 2.33-6.59; p </= 0.0001), previous use of antibiotics (OR 2.13; 95% IC 1.18-3.81; p </= 0.0078), arterial catheter (OR 4.09; 95% IC 2.26-7.38; p </= 0.0001), and previous longer ICU stay (days) (OR 1.02; 95% IC 1.003-1.033; p = 0.0274). Crude mortality rate in patients with bacteremia caused by P. aeruginosa was 50.6% (39/77), whereas mortality rate of bacteremia caused by other pathogens was 38.6% (337/872) (p = 0.039). This difference was also found for attributed mortality (31.2% [24/77] vs. 20.4% [178/872], (p = 0.027). In the multivariate analysis adjusted by respiratory infection focus, previous ICU stay, and age, crude mortality (OR 1.55; 95% CI 0.96-2.51; p = 0.071) and attributed mortality (OR 1.63; 95% CI 0.96-2.78; p = 0.0709) of P. aeruginosa bacteremia were higher than in bacteremia caused by other pathogens. In the multivariate analysis, risk factors significantly associated with crude mortality were respiratory infection focus (OR 4.13; 95% IC 1.15-14.76; p = 0.0293) and severe sepsis or septic shock (OR 4.96; 95% IC 1.23-20.09; p = 0.0248).


CONCLUSIONS
Bacteremia caused by P. aeruginosa admitted to the ICU have a higher crude and attributed mortality than bacteremias caused by other pathogens. Prognosis is associated with the presence of severe sepsis or septic shock and respiratory infection focus.
Alvarez-Lerma
F
F
Servicio de Medicina Intensiva, Hospital Universitario del Mar, Barcelona, Spain. FAlvarez@imas.imim.es
Pavesi
M
M
Calizay
M
M
Valles
J
J
Palomar
M
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood* / Q000188:drug therapy / Q000534:rehabilitation; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000097:blood* / Q000188:drug therapy / Q000534:rehabilitation; D012307:Risk Factors
D000900:Anti-Bacterial Agents