title: Clinical impact of imipenem-resistant Pseudomonas aeruginosa bloodstream infections.
abstract: OBJECTIVE
  To describe the incidence and clinical characteristics of imipenem-resistant (IR) Pseudomonas aeruginosa bacteraemia.
  
  
  METHODS
  We performed a retrospective study including all episodes of IR P. aeruginosa bacteraemia seen from January 2003 to December 2005 in a tertiary teaching hospital.
  
  
  RESULTS
  There were 108 episodes of IR P. aeruginosa bacteraemia, which represented an incidence of 0.14 episodes per 1000 patient-days in 2003 and 0.11 episodes per 1000 patient-days in 2005. 83 of the episodes (77%) were nosocomially acquired. Most of patients had at least one underlying disease and had previously received antimicrobial treatment. The most frequent source was the urinary tract (31%), followed by unknown origin (22%). A total of 23 (21%) episodes were polymicrobial and 51 (47%) were caused by multidrug-resistant strains. The independent risk factors for mortality from IR P. aeruginosa bloodstream infection were a high-risk source of the bacteraemia (OR: 4.6; 95% CI 1.7-12.4; p=0.01), and presentation with severe sepsis (OR: 2.8; 95% CI 1-7.8; p=0.05).
  
  
  CONCLUSIONS
  Our study shows that the rates of IR P. aeruginosa bacteraemia remained stable throughout the study period. The source of bacteraemia and the clinical presentation with severe sepsis were the main determinants of the prognosis.
authors.affiliation: IDIBELL, Infectious Diseases Service, Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. csuarez@bellvitgehospital.cat
authors.forename: Cristina
authors.initials: C
authors.lastname: Suárez
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.forename: Laura
authors.initials: L
authors.lastname: Gavaldà
authors.forename: Adriana
authors.initials: A
authors.lastname: Manzur
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Dominguez
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
authors.forename: Francisco
authors.initials: F
authors.lastname: Gudiol
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies
chemical_list: D015378:Imipenem