title: Acute Inflammatory Response of Patients with Pseudomonas aeruginosa Infections: A Prospective Study.
abstract: The severity of Pseudomonas aeruginosa (PA) infection may be determined by the interaction with the host immune system. We designed a prospective study to assess the relationship between the inflammatory response and the clinical presentation and outcome of PA infection. We also investigated whether there are differences in the inflammatory response depending on the resistance profile of PA. Interleukin-6 (IL-6), IL-10, procalcitonin (PCT), and C-reactive protein (CRP) were measured. Sixty-nine infection episodes were recorded; 40 caused by non-multidrug-resistant (non-MDR) strains [29 (73%) respiratory; 8 (20%) bacteremia], 12 by MDR non-extensively drug-resistant (MDR-non-XDR) [9 (75%) respiratory; 3 (25%) bacteremia], and 17 by XDR strains [9 (53%) respiratory; 7 (41%) bacteremia]. All inflammatory parameters were significantly higher in patients who developed acute organ dysfunction and bacteremia. PCT levels were higher in patients with early mortality [p = 0.050]. Inflammatory biomarkers were higher in patients with XDR than in those with non-MDR PA [IL-6 430 (67-951) vs. 77 (34-216), p = 0.02; IL-10 3.3 (1.5-16.3) vs. 1.3 (0-3.9), p = 0.02; and PCT 1.1 (0.6-5.2) vs. 0.3 (0.1-1.0), p = 0.008]. The intensity of inflammatory response was associated with the severity of PA infection, particularly if bacteremia occurred. Only PCT was documented useful to predict the outcome. XDR infections presented a higher inflammatory response; related in part to the larger number of bloodstream infections in this group.
authors.affiliation: 1 Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Silvia
authors.initials: S
authors.lastname: Gómez-Zorrilla
authors.affiliation: 2 Immunology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Francisco
authors.initials: F
authors.lastname: Morandeira
authors.affiliation: 3 Clinical Biochemistry Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: María José
authors.initials: MJ
authors.lastname: Castro
authors.affiliation: 4 Microbiology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.affiliation: 5 Intensive Care Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Elisabet
authors.initials: E
authors.lastname: Periche
authors.affiliation: 5 Intensive Care Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Rosario
authors.initials: R
authors.lastname: Cañizares
authors.affiliation: 4 Microbiology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Dominguez
authors.affiliation: 1 Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
authors.affiliation: 1 Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona , Barcelona, Spain .
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000401:mortality; D002097:C-Reactive Protein / Q000235:genetics / Q000276:immunology; D002116:Calcitonin / Q000235:genetics / Q000276:immunology*; D003428:Cross Infection / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D005260:Female; D005786:Gene Expression Regulation; D054884:Host-Pathogen Interactions; D006801:Humans; D007113:Immunity, Innate; D016753:Interleukin-10 / Q000235:genetics / Q000276:immunology; D015850:Interleukin-6 / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity; D015398:Signal Transduction; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016753:Interleukin-10; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Pseudomonas aeruginosa; infections; microbial drug resistance; nosocomial infections