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Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study

Tanya Babich 1 Pontus Naucler 2 John Karlsson Valik 2 Christian Giske 2 Natividad Benito 3 Ruben Cardona 4 Alba Rivera 4 Céline Pulcini 5, 6 Manal Abdel Fattah 6 Justine Haquin 6 Alasdair Macgowan 7 Sally Grier 7 Bibiana Chazan 8 Anna Yanovskay 8 Ronen Ben Ami 1 Michal Landes 9 Lior Nesher 10 Adi Zaidman-Shimshovitz 10 Kate Mccarthy 11 David Paterson 11 Evelina Tacconelli 12 Michael Buhl 12 Susanna Mauer 12 Jesús Rodríguez-Baño 13 Isabel Morales 13 Antonio Oliver 14 Enrique Ruiz de Gopegui 15 Angela Cano 16 Isabel Machuca 16 Monica Gozalo-Marguello 17 Luis Martínez-Martínez 17 Eva Gonzalez-Barbera 18 Iris Gomez Alfaro 18 Miguel Salavert 18 Bojana Beovic 19 Andreja Saje 19 Manica Mueller-Premru 19 Leonardo Pagani 20 Virginie Vitrat 20 Diamantis Kofteridis 21 Maria Zacharioudaki 21 Sofia Maraki 21 Yulia Weissman 1 Mical Paul 22 Yaakov Dickstein 22 Leonard Leibovici 23 Dafna Yahav 23
Abstract : This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01-1.03); female sex (1.34, 1.03-1.77); bedridden functional capacity (1.99, 1.24-3.21); recent hospitalisation (1.43, 1.07-1.92); concomitant corticosteroids (1.33, 1.02-1.73); and Charlson comorbidity index (1.05, 1.01-1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15-2.1), non-urinary source (2.44, 1.54-3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18-1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49-1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21-2.09), baseline endotracheal tube (1.63, 1.13-2.36) and ICU admission (1.53, 1.02-2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection.
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https://hal.univ-lorraine.fr/hal-02440501
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Submitted on : Wednesday, January 15, 2020 - 11:14:17 AM
Last modification on : Friday, February 21, 2020 - 11:11:19 AM

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Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, et al.. Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study. International Journal of Antimicrobial Agents, Elsevier, 2020, 55 (2), pp.105847. ⟨10.1016/j.ijantimicag.2019.11.004⟩. ⟨hal-02440501⟩

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