title: Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Brazil (UNIFESP-EPM)/Hospital São Paulo (HSP), Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Katharine
authors.initials: K
authors.lastname: Bar
authors.forename: Gonzalo M L
authors.initials: GM
authors.lastname: Bearman
authors.forename: Richard P
authors.initials: RP
authors.lastname: Wenzel
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem