Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections. A Prospective Multicenter Study.

Link to article at PubMed

Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections. A Prospective Multicenter Study.

Antimicrob Agents Chemother. 2011 Dec 12;

Authors: Peña C, Suarez C, Gozalo M, Murillas J, Almirante B, Pomar V, Aguilar M, Granados A, Calbo E, Rodríguez-Baño J, Rodríguez F, Tubau F, Martínez-Martínez L, Oliver A,

Abstract
The impact of antimicrobial resistance on clinical outcome is the subject of ongoing investigation, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa (PA) bacteremia in a prospective multicenter (ten teaching hospitals) observational study of patients with monomicrobial bacteremia followed up 30 days after bacteremia onset. The adjusted influence of carbapenem resistance on mortality was studied using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible isolates (CSPA), and 145 (23%) by carbapenem-resistant (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95%CI 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality, as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the 5(th) day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratios [95% confidence intervals] Charlson 0 at day 30 = 9.9 [3.3 - 29.4]; Charlson 5 at day 30 = 2.6 [0.8 - 8]). This study clarifies the relationship between carbapenem resistance and mortality of patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may be not as great during the first days of the bacteremia or in the presence of comorbidities.

PMID: 22155832 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *