title: Pseudomonas aeruginosa Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival.
abstract: Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6%) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8% vs. 30%, P < 0.01; 30-day mortality, 23% vs. 39%, P = 0.053). Multivariate analysis showed that a higher sequential organ failure assessment score (hazard ratio [HR]: 1.27, P < 0.01) and underlying malignancies (HR: 3.33, P < 0.01) were independently associated with 30-day mortality. Initial antibiotic therapy (HR: 0.21, P < 0.01) and patients' immune status (HR: 0.29, P = 0.02) also had a significant impact on survival. However, there was a significant interaction between these 2 variables (P = 0.03 for interaction). A subgroup analysis showed that in immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5% vs. 66.7%, P < 0.01 by log-rank test).
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Migiyama
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Norihito
authors.initials: N
authors.lastname: Kaku
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Harada
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nagaoka
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Morinaga
authors.forename: Norihiko
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Junichi
authors.initials: J
authors.lastname: Matsuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kohrogi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents