Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa.
OBJECTIVE
To evaluate the relationship between hospital mortality and bloodstream infections due to Staphylococcus aureus or Pseudomonas aeruginosa.


METHODS
Prospective cohort study.


METHODS
A 1,400-bed, university-affiliated urban teaching hospital.


METHODS
Between December 2001 and September 2002, 314 patients with bacteremia due to S aureus or P aeruginosa were prospectively evaluated.


METHODS
Prospective patient surveillance and data collection.


RESULTS
Thirteen patients (4.1%) received inadequate initial antibiotic treatment. Fifty-four patients (17.2%) died during hospitalization. Hospital mortality was statistically greater for patients with bloodstream infections due to P aeruginosa (n = 49) compared to methicillin-sensitive S aureus (MSSA) [n = 117; 30.6% vs 16.2%, p = 0.036] and methicillin-resistant S aureus (MRSA) [n = 148; 30.6% vs 13.5%, p = 0.007]. Multiple logistic regression analysis identified the lack of response to initial medical treatment (adjusted odds ratio [AOR], 2.69; 95% confidence interval [CI], 1.83 to 3.94; p = 0.010) and endocarditis (AOR, 4.62; 95% CI, 2.45 to 8.73; p = 0.016) as independent determinants of hospital mortality. Patients with bloodstream infections due to P aeruginosa were statistically more likely to be nonresponders to early medical treatment compared to patients with MSSA (73.5% vs 11.1%, p < 0.001) and MRSA (73.5% vs 16.9%, p < 0.001) bloodstream infections.


CONCLUSIONS
These data suggest that bloodstream infections due to P aeruginosa have a greater risk of hospital mortality compared to bloodstream infections due to S aureus despite adequate antibiotic treatment.
Osmon
Stephen
S
Pulmonary and Critical Care Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Ward
Suzanne
S
Fraser
Victoria J
VJ
Kollef
Marin H
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D016019:Survival Analysis
D000900:Anti-Bacterial Agents