title: [Effect of adequate initial antimicrobial therapy on mortality in critical patients with Pseudomonas aeruginosa bacteremia].
abstract: BACKGROUND
  Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia.
  
  
  OBJECTIVE
  To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients.
  
  
  METHODS
  A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted.
  
  
  RESULTS
  One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33).
  
  
  CONCLUSIONS
  Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.
authors: Grupo de Investigación en Enfermedades Infecciosas, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Andrés Leonardo
authors: AL
authors: González
authors: Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Aura Lucía
authors: AL
authors: Leal
authors: Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Jorge Alberto
authors: JA
authors: Cortés
authors: Grupo para el Control de la Resistencia Bacteriana de Bogotá (GREBO), Bogotá, D.C, Colombia.
authors: Ricardo
authors: R
authors: Sánchez
authors: Grupo de Investigación en Enfermedades Infecciosas, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Liliana Isabel
authors: LI
authors: Barrero
authors: Grupo de Investigación en Enfermedades Infecciosas, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Juan Sebastián
authors: JS
authors: Castillo
authors: Grupo de Investigación en Enfermedades Infecciosas, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors: Carlos Arturo
authors: CA
authors: Álvarez
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D003105:Colombia / Q000453:epidemiology; D016638:Critical Illness / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents