Abstract
BackgroundThis study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis.MethodsA retrospective case–control study was designed to identify risk factors for P. aeruginosa bacteremia in cirrhotic patients. The cases were cirrhotic patients with P. aeruginosa bacteremia and the controls were cirrhotic patients with Enterobacteriaceae bacteremia.ResultsSixty-one cases and the same number of controls were enrolled. In a multivariate analysis, younger age {adjusted odds ratio (aOR) per one year: 0.96, 95% confidence interval: 0.93 - 0.99}, nosocomial acquisition (aOR 3.87, 95% confidence interval: 1.50 - 9.94), preexisting biliary disease (aOR 4.79, 95% confidence interval: 1.92 - 10.47), and recent exposure to immunosuppressive agent (aOR 3.10, 95% confidence interval: 1.23 - 7.82) were associated with P. aeruginosa bacteremia. In the case group the frequency of appropriate initial antibiotic regimens was considerably lower than in the control group: 29.5% vs. 65.6% (P <0.01). However, thirty day mortality did not differ significantly between cases and controls (19.7% vs. 24.6%).ConclusionsNosocomial acquisition, preexisting biliary disease, and recent use of immunosuppressive agents are strong predictive factors for P. aeruginosa bacteremia in cirrhotic patients.
Highlights
This study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis
Cases were defined as patients with liver cirrhosis and bacteremia due to P. aeruginosa admitted to Seoul National University Hospital (SNUH) or Seoul National University Bundang Hospital (SNUBH) during the period January 2005 through December 2011
Data collection We reviewed electronic medical records and following data have been collected: age, sex, etiology of liver cirrhosis, liver function measured by Child-Pugh score, severity of bacteremia measured by Pitt bacteremia score, Charlson weighted index of comorbidity, associated diseases or conditions, primary focus of bacteremia, potential risk factors of pseudomonas infection, laboratory data at the time of diagnosis of bacteremia, adequacy of initial antibiotics, and 30-day mortality
Summary
This study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis. It has been reported that inadequate or delayed antibiotic therapy for pseudomonas bacteremia is associated with poor prognosis [6,7,8,9]. Neutropenia following chemotherapy is a well-known risk factor [10], and some clinical predictors of pseudomonas bacteremia have been reported in patients without neutropenia [11,12,13]. Age over 90 years, healthcare-associated infection, indwelling central venous catheter, indwelling urinary device, and antimicrobial therapy within the previous 30 days, have been reported to be clinical predictors of pseudomonas infection
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