title: Pseudomonas aeruginosa bacteremia upon hospital admission: risk factors for mortality and influence of inadequate empirical antimicrobial therapy.
abstract: Pseudomonas aeruginosa is an uncommon cause of bacteremia upon hospital admission (UHA) and the chosen empirical antimicrobial therapy may not cover it appropriately. In a multicenter prospective study conducted in Israel, we evaluated risk factors for in-hospital mortality in patients with P. aeruginosa bacteremia UHA and determined the influence of delay in adequate empirical antimicrobial therapy on patients' outcome. Seventy-six adult patients with P. aeruginosa bacteremia within 72 h of hospital admission were included. Demographic, clinical, and treatment data were collected. Microbiological adequacy of empirical therapy was determined. Severe sepsis or septic shock at admission (OR, 21.9; P < 0.001), respiratory or unknown sources of bacteremia (OR, 11.5; P = 0.003), recent hospitalization (OR, 6.2; P = 0.032), and poor functional status (OR, 5.8; P = 0.029) were identified as independent predictors of mortality. Inadequate empirical antimicrobial therapy was marginally associated with increased mortality only among patients who presented with severe sepsis or septic shock (P = 0.051).
authors.affiliation: Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. vereds@tasmc.health.gov.il
authors.forename: Vered
authors.initials: V
authors.lastname: Schechner
authors.forename: Tamar
authors.initials: T
authors.lastname: Gottesman
authors.forename: Orna
authors.initials: O
authors.lastname: Schwartz
authors.forename: Maya
authors.initials: M
authors.lastname: Korem
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Rivka
authors.initials: R
authors.lastname: Karplus
authors.forename: Tsipora
authors.initials: T
authors.lastname: Lazarovitch
authors.forename: Eyal
authors.initials: E
authors.lastname: Braun
authors.forename: Renato
authors.initials: R
authors.lastname: Finkelstein
authors.forename: Tamar
authors.initials: T
authors.lastname: Lachish
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wiener-Well
authors.forename: Danny
authors.initials: D
authors.lastname: Alon
authors.forename: Michal
authors.initials: M
authors.lastname: Chowers
authors.forename: Rita
authors.initials: R
authors.lastname: Bardenstein
authors.forename: Oren
authors.initials: O
authors.lastname: Zimhony
authors.forename: Alona
authors.initials: A
authors.lastname: Paz
authors.forename: Israel
authors.initials: I
authors.lastname: Potasman
authors.forename: Michael
authors.initials: M
authors.lastname: Giladi
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Shiri
authors.initials: S
authors.lastname: Klarfeld-Lidji
authors.forename: Meirav
authors.initials: M
authors.lastname: Hochman
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents