title: Extensively drug-resistant Pseudomonas aeruginosa bacteremia in solid organ transplant recipients.
abstract: BACKGROUND
  We sought to determine the risk factors, molecular epidemiology, antibiotic therapy, and outcomes of bacteremia because of extensively drug-resistant (XDR) Pseudomonas aeruginosa in solid organ transplant (SOT) recipients.
  
  
  METHODS
  All episodes of bacteremia occurring in SOT recipients were prospectively documented from 2007 to 2013.
  
  
  RESULTS
  Of 318 episodes of bacteremia, 49 were caused by P. aeruginosa. Thirty-one strains (63%) were XDR defined by nonsusceptibility to at least one agent in all but two or fewer antipseudomonal antimicrobial categories. Time from transplantation to bacteremia was shorter in XDR P. aeruginosa group comparing to other etiologies (median days 66 vs. 278; P=0.03). Factors independently associated with XDR P. aeruginosa bacteremia were prior transplantation, nosocomial acquisition, and septic shock at onset. XDR P. aeruginosa isolates belonged to a single clone (ST-175). Comparing to other etiologies, patients with bacteremia because of XDR P. aeruginosa more often received inadequate empirical antibiotic therapy. Persistence of bacteremia, shock, respiratory failure and intensive care unit admission were more frequent in patients with XDR P. aeruginosa. The overall case-fatality rate was higher among patients with XDR P. aeruginosa bacteremia than in the others (38% vs. 16%; P=0.009).
  
  
  CONCLUSIONS
  Bacteremia because of XDR P. aeruginosa should be carefully considered when selecting empirical antibiotic therapy for hospitalized SOT recipients with prior transplantation presenting with septic shock.
authors.affiliation: 1 Infectious Disease Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. Hospitalet de Llobregat, Barcelona, Spain. 2 Microbiology Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. Hospitalet de Llobregat, Barcelona, Spain. 3 Liver Transplant Unit, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. Hospitalet de Llobregat, Barcelona, Spain. 4 Cardiology Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. Hospitalet de Llobregat, Barcelona, Spain. 5 Nephrology Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Bodro
authors.forename: Núria
authors.initials: N
authors.lastname: Sabé
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.forename: Carme
authors.initials: C
authors.lastname: Baliellas
authors.forename: José
authors.initials: J
authors.lastname: González-Costello
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cruzado
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000473:pathology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents