title: Risk factors associated with unfavorable short-term treatment outcome in patients with documented Pseudomonas aeruginosa infection.
abstract: BACKGROUND
  Invasive infections with Pseudomonas aeruginosa (PA) are associated with significant morbidity and mortality. While risk factors for mortality have been identified, their influence on short-term outcomes impacting treatment selection has not been reported.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the relationship between select patient- and treatment-related factors and short-term outcomes in patients with PA pneumonia and/or bacteremia.
  
  
  METHODS
  Large academic medical center in the United States.
  
  
  METHODS
  This IRB-approved single-center, retrospective case-cohort study included patients >18 years of age with culture-confirmed PA bacteremia and/or pneumonia receiving antimicrobial agent(s) active against PA.
  
  
  METHODS
  Risk of unfavorable short-term treatment result.
  
  
  RESULTS
  The population consisted of 117 patients (40 [34 %] and 77 [66 %] in the unfavorable and not-unfavorable groups, respectively). Baseline characteristics including age (mean of 63 years), gender (55 % male), Charlson score, creatinine clearance, and body mass index were comparable between groups. Piperacillin/tazobactam was the most common monotherapy antibiotic (46 and 33 % in unfavorable and not-unfavorable groups, respectively). Combination therapy primarily consisted of a beta-lactam plus ciprofloxacin in both unfavorable (10 %) and not-unfavorable (20 %) outcome groups. The preliminary regression model indicated that SIRS, direct ICU admission, and vasopressor therapy were associated with an unfavorable outcome. In addition, patients who received more than two active antimicrobials had a reduced risk of an unfavorable outcome. The final regression model revealed that vasopressor therapy (odds ratio [OR] 6.0; 95 % confidence interval [95 % CI] 2.3, 17) was associated with an unfavorable outcome, while receipt of greater than two active antibiotics was associated with a reduced risk of an unfavorable outcome (OR 0.26; 95 % CI 0.07, 0.83).
  
  
  CONCLUSIONS
  Treatment with more than two agents with activity against PA was associated with a reduced risk of an unfavorable short-term treatment outcome in patients with bacteremia and/or pneumonia.
authors: Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, P.O. Box 1090, Buies Creek, NC, 27506, USA, vpdimondi@gmail.com.
authors: V Paul
authors: VP
authors: DiMondi
authors: Mary L
authors: ML
authors: Townsend
authors: Richard H
authors: RH
authors: Drew
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
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