title: Impact of hyperglycemia on outcomes of patients with Pseudomonas aeruginosa bacteremia.
abstract: Bacteremia caused by Pseudomonas aeruginosa is associated with significant morbidity and mortality. In other bacterial infections, hyperglycemia has been identified as a risk factor for mortality in nondiabetic patients. The objective of this study was to determine the impact of early hyperglycemia on outcomes in diabetic and nondiabetic patients with P. aeruginosa bacteremia. A retrospective cohort study was performed in adult patients (≥18 years old) with P. aeruginosa bacteremia. Patients received at least 1 drug empirically to which the isolate was susceptible in vitro. Classification and regression tree analysis was used to determine the threshold breakpoint for average blood glucose concentration within 48 hours of positive blood culture (BG48). Logistic regression was used to explore independent risk factors for 30-day mortality. A total of 176 bacteremia episodes were identified; patients in 66 episodes were diabetic. Diabetic patients had higher BG48 (165.2±64.8 mg/dL versus 123.7±31.5 mg/dL, P<0.001) and lower 30-day mortality (10.7% versus 22.7%, P=0.046) than nondiabetic patients. Multivariate regression revealed 30-day mortality in nondiabetic patients was associated with Acute Physiology and Chronic Health Evaluation II score (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0-1.2) and BG48 >168 mg/dL (OR 6.3; 95% CI 1.7-23.3). However, blood glucose concentration was not identified as an independent risk factor for mortality in diabetic patients by multivariate regression analysis. Hyperglycemia did not appear to affect outcomes in diabetic patients, whereas nondiabetic patients had a higher risk of mortality from P. aeruginosa bacteremia. Prospective studies evaluating the impact of glycemic control in these patients are needed.
authors.affiliation: University of Houston College of Pharmacy, Houston, TX, USA.
authors.forename: Twisha S
authors.initials: TS
authors.lastname: Patel
authors.affiliation: University of Houston College of Pharmacy, Houston, TX, USA; St. Luke's Medical Center, Houston, TX, USA. Electronic address: jessica.cottreau@rosalindfranklin.edu.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Cottreau
authors.affiliation: University of Houston College of Pharmacy, Houston, TX, USA; St. Luke's Medical Center, Houston, TX, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Hirsch
authors.affiliation: University of Houston College of Pharmacy, Houston, TX, USA; St. Luke's Medical Center, Houston, TX, USA.
authors.forename: Vincent H
authors.initials: VH
authors.lastname: Tam
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Pseudomonas aeruginosa; bacteremia; hyperglycemia