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)
1
Sackler Faculty of Medicine
2 Karolinska Institutet [Stockholm]
3 Instituto de Investigaciones Biomédicas Sant Pau [Barcelona, Spain]
4 Hospital de la Santa Creu i Sant Pau
5 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
6 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
7 Southmead Hospital [Bristol, UK]
8 Rappaport faculty of Medicine
9 Tel Aviv Sourasky Medical Center [Te Aviv]
10 Soroka University Medical Center [Beer Sheva, Israel]
11 University of Queensland [Brisbane]
12 Tübingen University Hospital [Germany]
13 University Hospital Virgen Macarena
14 Hospital Son Dureta
15 Hospital Universitario Son Espases
16 Reina Sofía University Hospital
17 Marqués de Valdecilla University Hospital
18 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
19 University of Ljubljana
20 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
21 University General Hospital of Heraklion
22 Rambam Health Care Campus
23 Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
2 Karolinska Institutet [Stockholm]
3 Instituto de Investigaciones Biomédicas Sant Pau [Barcelona, Spain]
4 Hospital de la Santa Creu i Sant Pau
5 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
6 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
7 Southmead Hospital [Bristol, UK]
8 Rappaport faculty of Medicine
9 Tel Aviv Sourasky Medical Center [Te Aviv]
10 Soroka University Medical Center [Beer Sheva, Israel]
11 University of Queensland [Brisbane]
12 Tübingen University Hospital [Germany]
13 University Hospital Virgen Macarena
14 Hospital Son Dureta
15 Hospital Universitario Son Espases
16 Reina Sofía University Hospital
17 Marqués de Valdecilla University Hospital
18 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
19 University of Ljubljana
20 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
21 University General Hospital of Heraklion
22 Rambam Health Care Campus
23 Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
Natividad Benito
- Function : Author
- PersonId : 762350
- ORCID : 0000-0001-6410-013X
Céline Pulcini
- Function : Author
- PersonId : 981495
Eva Gonzalez-Barbera
- Function : Author
- PersonId : 796723
- ORCID : 0000-0003-1674-1391
Leonardo Pagani
- Function : Author
- PersonId : 781948
- ORCID : 0000-0002-2553-9147
Diamantis Kofteridis
- Function : Author
- PersonId : 797153
- ORCID : 0000-0001-7603-2592
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.