Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality.
The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine.


METHODS
All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients' risk factors and mortality caused by P. aeruginosa bacteremia.


RESULTS
A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P=0.002). Timely and appropriate treatment and surgery were significant protective factors for 30-day mortality (11.1 and 5.26 times, respectively; P=0.001). Meropenem-resistant Pseudomonas aeruginosa strains caused bacteremia more frequently in patients older than 65 years than meropenem-sensitive strains (57.9%, n=11). All 19 patients with meropenem-resistant Pseudomonas aeruginosa bacteremia received inappropriate empirical antibiotic therapy.


CONCLUSIONS
Treatment at the intensive care unit, mechanical ventilation, acute respiratory failure, source of infection in respiratory tract, and central vein catheter are the major risk factors associated with an increased mortality rate in patients with Pseudomonas aeruginosa bacteremia. The patients older than 65 years are at increased risk for bacteremia caused by carbapenem-resistant Pseudomonas aeruginosa strains. Carbapenems are not antibiotics of the choice of treatment for Pseudomonas aeruginosa bacteremia at the Hospital of Kaunas University of Medicine.
Department of Laboratory Medicine, Kaunas University of Medicine, Eivenių 2, 50028 Kaunas, Lithuania. astravitka@hotmail.com
Astra
A
Vitkauskienė
Erika
E
Skrodenienė
Asta
A
Dambrauskienė
Andrius
A
Macas
Raimundas
R
Sakalauskas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality; D003627:Data Interpretation, Statistical; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008097:Lithuania; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D016017:Odds Ratio; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013845:Thienamycins / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015378:Imipenem; D000077731:Meropenem