title: P. aeruginosa bloodstream infections among hematological patients: an old or new question?
abstract: Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections among hematological patients. A prospective epidemiological surveillance program ongoing at our Hematology Unit revealed an increase over time of P. aeruginosa bloodstream infections (BSI). Their impact on outcome and antibiotic susceptibility was analyzed. BSI which consecutively occurred at our institution during a 70-month period were evaluated and correlated with type of pathogen, status of underlying disease, neutropenia, previous antibiotic therapy, resistance to antibiotics, and outcome. During the observation period, 441 BSI were recorded. Frequency of Gram-negative BSI was higher than that of other pathogens (57.3%). Overall, 66 P. aeruginosa BSI were recorded; 22 out of 66 were multiresistant (MR P. aeruginosa). Thirty-day mortality for all BSI was 11.3%; it was 27.3% for P. aeruginosa BSI and 36.4% for MR P. aeruginosa. At multivariate analysis, only active hematological disease and P. aeruginosa BSI were associated to an increased risk of death. For MR P. aeruginosa, BSI mortality was 83.3% vs. 18.8% when empiric therapy included or not an antibiotic with in vitro activity against P. aeruginosa (p=0.011). Together with active disease, the emergence of P. aeruginosa BSI, particularly if multiresistant, was responsible for an increased risk of death among hematological patients at our institution. In this scenario, reconsidering the type of combination antibiotic therapy to be used as empiric treatment of neutropenic fever was worthwhile.
authors.affiliation: Dept. of Haematology, Spedali Civili, Piazza Spedali Civili, 25100 Brescia, Italy. chiara.cattaneo@libero.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.forename: F
authors.initials: F
authors.lastname: Antoniazzi
authors.forename: S
authors.initials: S
authors.lastname: Casari
authors.forename: G
authors.initials: G
authors.lastname: Ravizzola
authors.forename: M
authors.initials: M
authors.lastname: Gelmi
authors.forename: C
authors.initials: C
authors.lastname: Pagani
authors.forename: M
authors.initials: M
authors.lastname: D'Adda
authors.forename: E
authors.initials: E
authors.lastname: Morello
authors.forename: A
authors.initials: A
authors.lastname: Re
authors.forename: E
authors.initials: E
authors.lastname: Borlenghi
authors.forename: N
authors.initials: N
authors.lastname: Manca
authors.forename: G
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death; D003141:Communicable Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006402:Hematologic Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006405:Hematology / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D011379:Prognosis; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents