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Inicio Medicina Clínica (English Edition) Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: Mortality a...
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Vol. 152. Issue 3.
Pages 83-89 (February 2019)
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Vol. 152. Issue 3.
Pages 83-89 (February 2019)
Original article
Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: Mortality and prognostic factors
Impacto de la bacteriemia por Pseudomonas aeruginosa en un hospital de tercer nivel: mortalidad y factores pronósticos
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Alejandro Callejas-Díaza,b,
Corresponding author
, Cristina Fernández-Pérezc, Antonio Ramos-Martíneza,b,d, Elena Múñez-Rubioa,b, Isabel Sánchez-Romeroe, Juan Antonio Vargas Núñeza,d
a Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
b Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
c Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Madrid, Spain
d Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
e Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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Tables (5)
Table 1. Baseline characteristics of patients with Pseudomonas aeruginosa bacteraemia (110 cases).
Table 2. Classification of Pseudomonas aeruginosa bacteraemia episodes (110 cases) by place of acquisition, source of origin and severity.
Table 3. Susceptibility pattern of Pseudomonas aeruginosa strains causing bacteraemia (110 cases).
Table 4. Overall and attributable mortality of patients with Pseudomonas aeruginosa bacteraemia (110 cases) Univariate analysis.
Table 5. Independent prognostic factors of overall and attributable mortality and mortality rate of patients with Pseudomonas aeruginosa bacteraemia (110 cases).
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Abstract
Background and objectives

Pseudomonas aeruginosa bacteraemia is associated with a very high mortality, conditioned by comorbidity, source, severity of the episode and lack of adequate treatment. The aim of the study is to know the mortality and prognostic factors of bacteraemia by P. aeruginosa in our hospital.

Patients and methods

We conducted a retrospective study of P. aeruginosa bacteraemia detected between 2009 and 2014. Epidemiological, clinical and microbiological characteristics were described. A risk factor analysis for mortality was performed.

Results

We analysed 110 episodes of bacteraemia, which was more frequent in men of advanced age and with a history of hospitalisation, comorbidity and immunosuppression. Most of the bacteraemias were secondary (mainly of respiratory or urinary source) and led to a significant clinical deterioration. The presence of antibiotic resistance was very high, with 27.3% of multiresistant strains. Empirical treatment was adequate in 60.0% and 92.3% for definite treatment. Overall mortality was 37.3% and attributable mortality was 29.1%. The most important prognostic factors were Charlson index ≥3, history of haematologic malignancy, neutropenia and previous use of corticosteroids, source of bacteraemia, Pitt index ≥4, renal insufficiency, adequate definite treatment, empiric treatment with piperacillin/tazobactam in severe episodes and focus control.

Conclusion

P. aeruginosa bacteraemia is associated with a very high mortality, possibly more related to previous comorbidity and severity of the episode than to the treatment chosen. However, the main goal in management remains to optimise treatment, including focus control.

Keywords:
Pseudomonas aeruginosa
Bacteraemia
Nosocomial infection
Bacterial resistance
Mortality
Resumen
Antecedentes y objetivo

La bacteriemia por Pseudomonas aeruginosa se asocia a una mortalidad muy elevada, condicionada por la comorbilidad, el origen y la gravedad del episodio y la ausencia de un tratamiento adecuado. El objetivo del estudio es conocer la mortalidad y los factores pronósticos de la bacteriemia por P. aeruginosa en nuestro hospital.

Pacientes y métodos

Se realizó un estudio retrospectivo de las bacteriemias por P. aeruginosa detectadas entre 2009 y 2014. Se calculó la incidencia y se describieron las características epidemiológicas, clínicas y microbiológicas, la mortalidad y sus factores pronósticos.

Resultados

Se analizaron 110 episodios de bacteriemia por P. aeruginosa, frecuentemente observadas con antecedentes de hospitalización, comorbilidad e inmunodepresión. La mayoría fue de origen respiratorio o urinario. La presencia de resistencias fue muy elevada. El tratamiento empírico fue adecuado en el 60,0%, y el dirigido, en el 92,3%. La mortalidad global fue del 37,3%, y la atribuible, del 29,1%. Los factores pronósticos más importantes fueron el índice Charlson ≥3, los antecedentes de neoplasia hematológica, neutropenia y uso de corticoides, el origen, el índice de Pitt ≥4, la insuficiencia renal, el tratamiento dirigido adecuado, el tratamiento empírico con piperacilina/tazobactam en pacientes graves y el control del foco.

Conclusiones

La bacteriemia por P. aeruginosa se asocia a una mortalidad muy elevada, posiblemente más relacionada con las condiciones previas del paciente y la gravedad del episodio que con el tratamiento elegido. No obstante, el principal objetivo en el manejo sigue siendo optimizar el tratamiento, incluyendo el control del foco.

Palabras clave:
Pseudomonas aeruginosa
Bacteriemia
Infecciones nosocomiales
Resistencias bacterianas
Mortalidad

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