Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa.
OBJECTIVE
To evaluate relationships between the inflammatory response, clinical course, and outcome of nosocomial BSI due to Pseudomonas aeruginosa.


METHODS
We performed a historical cohort study on 77 adults with P. aeruginosa (Pa) nBSI to define the associated systemic inflammatory response syndrome (SIRS). We examined SIRS scores 2 days prior through 14 days after the first positive blood culture. Imipenem resistant--IRPa (n=20) and susceptible infections--ISPa (n=57) were compared. Variables significant in univariate analysis were entered into a logistic regression model.


RESULTS
Seventy-four percent of BSI were ISPa and 26.0% by IRPa. Septic shock occurred in 39.0%. Crude mortality was 48.1%. There was no difference in APACHE II (AP2) scores on days -2, -1 and 0 between the ISPa and IRPa groups. Multivariate analysis revealed that AP2> or =20 at BSI onset (P<0.001) and hematologic failure (P=0.001) independently predicted death.


CONCLUSIONS
In patients with P. aeruginosa nBSI, the incidence of septic shock and organ failure is high; patients with IRPa BSI are not more acutely ill prior to infection than those with ISPa BSI and outcome is not significantly different; AP2> or =20 at BSI onset and the development of hematologic failure are independent predictors of death.
Marra
Alexandre R
AR
Division of Infectious Diseases, Brazil (UNIFESP-EPM)/Hospital São Paulo (HSP), Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
Bar
Katharine
K
Bearman
Gonzalo M L
GM
Wenzel
Richard P
RP
Edmond
Michael B
MB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000401:mortality; D013997:Time Factors
D000900:Anti-Bacterial Agents; D015378:Imipenem