Pseudomonas aeruginosa bacteraemia in burns patients: Risk factors and outcomes.
BACKGROUND
We aimed to identify the risk factors for, and outcomes of Pseudomonas aeruginosa bacteraemia in adult burns patients.


METHODS
All adult burns patients who developed a Gram-negative bacteraemia over a period of 7 years were included. Retrospective data analysed included patient demographics, organisms cultured, antibiotic susceptibility patterns, isolation of P. aeruginosa in non-blood isolates, treatment, length of stay and mortality.


RESULTS
Forty-three patients developed a Gram-negative bacteraemia over the study period, 12 of whom had Pseudomonas bacteraemia during the course of their admission. In eight patients (18.6%) P. aeruginosa was the first Gram-negative isolated. The only factor predicting P. aeruginosa bacteraemia as a first episode (compared to another Gram-negative) was prior isolation of Pseudomonas at other sites (wound sites, urine or sputum). Overall length of stay was less in patients who developed P. aeruginosa as a first episode, mainly because of increased mortality in this group. Prior non-blood isolates of P. aeruginosa could have correctly predicted the sensitivity pattern of the strain of P. aeruginosa organism in 75% of patients who did not receive appropriate initial antibiotics.


CONCLUSIONS
Prior colonisation with P. aeruginosa predicts P. aeruginosa in blood cultures, as opposed to other Gram-negative bacteria. Clinicians should have a high index of suspicion for P. aeruginosa bacteraemia where a septic burns patient has a prior history of non-blood P. aeruginosa cultures. Empirical antibiotic regimes based on the antibiotic-sensitivity patterns of previous non-blood P. aeruginosa isolates in each patient should be given at the time blood cultures are taken.
Mahar
Patrick
P
Victorian Adult Burns Service, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia.
Padiglione
Alexander A
AA
Cleland
Heather
H
Paul
Eldho
E
Hinrichs
Melissa
M
Wasiak
Jason
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology*; D002056:Burns / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents