Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection.
OBJECTIVE
We aimed to study the influence of carbapenem resistance on attributable mortality in a cohort of patients with Pseudomonas aeruginosa bacteremia.


METHODS
Data on 121 episodes of P. aeruginosa bacteremia occurring between January and December 2005 were retrospectively analyzed.


RESULTS
Thirty-three episodes were caused by carbapenem-resistant P. aeruginosa (CRPA) strains and 88 by carbapenem-susceptible P. aeruginosa (CSPA) strains. There was no significant difference in mortality between the groups (33% in CRPA vs. 30% in CSPA; p = 0.69). However, a Kaplan-Meier survival analysis showed that in the first 48h after the onset of bacteremia, there was a lower cumulative mortality proportion in the CRPA group than in the CSPA group (13% vs. 50%; p = 0.026). The independent risk factors associated with death in P. aeruginosa bacteremia were clinical presentation with severe sepsis (odds ratio (OR) 38, 95% confidence interval (CI) 10.2-142.2) and bacteremia of high-risk origin (OR 6.6, 95% CI 1.6-26.9).


CONCLUSIONS
According to our data, carbapenem resistance was not associated with higher mortality in patients with P. aeruginosa bacteremia. The slower initial mortality in the CRPA group might have implications in the design of the optimal antibiotic policy strategy.
Suárez
Cristina
C
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain. csuarez@bellvitgehospital.cat
Peña
Carmen
C
Gavaldà
Laura
L
Tubau
Fe
F
Manzur
Adriana
A
Dominguez
M Angeles
MA
Pujol
Miquel
M
Gudiol
Francesc
F
Ariza
Javier
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D015780:Carbapenems / Q000627:therapeutic use*; D005260:Female; D006291:Health Policy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems