Risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

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Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

BioScientia Medicina ◽

10.37275/bsm.v6i1.436 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1292-1299

Author(s):

Muhammad Iqbal ◽

Raflis Rustam ◽

Vendry Rivaldy

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Clinical Manifestations ◽

Bloodstream Infections ◽

Sampling Technique ◽

Exit Site ◽

Double Lumen ◽

Exit Site Infection ◽

Double Lumen Catheter ◽

Lumen Catheter

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang. Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0. Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p<0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin. Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

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Path to Resistance: Risk Factors Associated With Carbapenem-Resistant Pseudomonas aeruginosa

Journal of Patient-Centered Research and Reviews ◽

10.17294/2330-0698.1421 ◽

2016 ◽

Vol 3 (4) ◽

pp. 236

Author(s):

Kushal Patel ◽

Jessica J.F. Kram ◽

Dennis J Baumgardner

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Resistance Risk ◽

Factors Associated ◽

Carbapenem Resistant

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Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: prospective observational study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz245 ◽

2019 ◽

Vol 74 (9) ◽

pp. 2774-2783 ◽

Cited By ~ 3

Author(s):

Eun-Jeong Yoon ◽

Dokyun Kim ◽

Hyukmin Lee ◽

Hye Sun Lee ◽

Jeong Hwan Shin ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Observational Study ◽

Prospective Observational Study ◽

Cox Regression ◽

Bloodstream Infections ◽

Clinical Settings ◽

Kaplan Meier ◽

Steep Decrease

Abstract Background To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality. Methods A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics. Results During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency. Conclusions BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

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Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China

Emerging Infectious Diseases ◽

10.3201/eid2510.181699 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1861-1867 ◽

Cited By ~ 2

Author(s):

Yan-Yan Hu ◽

Jun-Min Cao ◽

Qing Yang ◽

Shi Chen ◽

Huo-Yang Lv ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Zhejiang Province ◽

Carbapenem Resistant

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Carbapenem-Resistant Pseudomonas aeruginosa Bacteremia: Risk Factors for Mortality and Microbiologic Treatment Failure

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01243-16 ◽

2016 ◽

Vol 61 (1) ◽

Cited By ~ 26

Author(s):

Deanna J. Buehrle ◽

Ryan K. Shields ◽

Lloyd G. Clarke ◽

Brian A. Potoski ◽

Cornelius J. Clancy ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Treatment Failure ◽

Antimicrobial Therapy ◽

Multiple Drug ◽

Drug Resistant ◽

Active Therapy ◽

Content Type ◽

Carbapenem Resistant ◽

Multiple Drug Resistant

ABSTRACT We reviewed 37 patients treated for bacteremia due to carbapenem-resistant (CR) Pseudomonas aeruginosa. Although 65% of isolates were multiple-drug resistant, therapeutic options were available, as all were susceptible to ≥1 antibiotic. A total of 92% of patients received active antimicrobial therapy, but only 57% received early active therapy (within 48 h). Fourteen-day mortality was 19%. Microbiologic failure occurred in 29%. The Pitt bacteremia score (P = 0.046) and delayed active therapy (P = 0.027) were predictive of death and microbiologic failure, respectively.

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