Abstract
BackgroundPseudomonas aeruginosa (PA) is a leading cause of nosocomial infections, and carbapenem non-susceptible strains are a major threat to patient safety.MethodsA single center, retrospective comparative analysis of carbapenem-non-susceptible PA (CnSPA) and carbapenem-susceptible PA (CSPA) bloodstream infections (BSIs) was conducted between January 1, 2007, and December 31, 2016. Prevalence and risk factors associated with CnSPA BSIs were examined.ResultsThe study enrolled 340 patients with PA BSIs; 30.0% (N = 101) of patients had CnSPA. High APACHE II scores (≥15), central venous catheterization, and delayed application of appropriate definitive therapy were independently associated with higher risk of mortality in PA BSIs. Multivariate analysis revealed that respiratory disease and exposure to carbapenems within the previous 90 days to onset of BSI were independent risk factors for acquisition of CnSPA BSIs. Overall all-cause 30-day mortality associated with PA BSIs was 26.8% (91/340). In addition, mortality was higher in patients with CnSPA than in those with CSPA (37.6% vs. 22.2%, respectively; P = 0.003). Corticosteroid therapy and delayed receipt of effective definitive therapy were independent risk factors for death from CnSPA BSIs.ConclusionIncreased incidence of CnSPA BSIs was observed during the study period, with higher mortality seen in patients with these infections. Respiratory disease and exposure to carbapenems were independent risk factors for development of CnSPA BSIs. Appropriate definitive therapy reduced mortality rates. BLBLIs were as effective as carbapenems as a treatment for PA BSIs.
Highlights
Pseudomonas aeruginosa (PA) is responsible for 10–15% of nosocomial infections worldwide [1]
Over the past 10 years, the incidence of PA Bloodstream infection (BSI) has fluctuated from 0.027/1000 patient-days to 0.062/1000 patient-days, with the highest incidence occurring in the intensive care unit (ICU) (1.85/1000 patient-days); this proportion neither rose nor declined year on year (P = 0.180) (Additional file 2: Figure S2)
Before PA BSI, 20.9% of thoracic or abdominal drainage fluid or sputum samples were positive for PA, whereas 25.6% patients had a BSI caused by other pathogens
Summary
Pseudomonas aeruginosa (PA) is responsible for 10–15% of nosocomial infections worldwide [1]. Infections caused by PA isolates are typically difficult to treat due to intrinsic antibiotic resistance and a remarkable ability to acquire resistance to multiple groups of antimicrobial agents [2]. Such infections are associated with high mortality rates, which range from 18 to 61% [3]. Increasing use of carbapenems has increased the prevalence of carbapenem-non-susceptible (CnS) PA strains. Such strains are often resistant to other drugs such as β-lactams and quinolones [4]. Pseudomonas aeruginosa (PA) is a leading cause of nosocomial infections, and carbapenem nonsusceptible strains are a major threat to patient safety
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