BACTERIAL AND CLINICAL CHARACTERISTICS OF HEALTHCARE- AND COMMUNITY-ACQUIRED BLOOD STREAM INFECTIONS DUE TO PSEUDOMONAS AERUGINOSA.
Antimicrob Agents Chemother. 2013 Jun 3;
Authors: Hattemer A, Hauser A, Diaz M, Scheetz M, Shah N, Allen JP, Porhomayon J, El-Solh AA
Abstract
Healthcare associated infections have been linked to delay in appropriate antibiotics and an increased mortality including P. aeruginosa bloodstream infection. The objective of this study is to evaluate intrinsic virulence, bacterial resistance, and clinical outcomes of healthcare-associated blood stream infection (HCABSI) in comparison to community-acquired blood stream infection (CABSI) caused by P. aeruginosa. We conducted a retrospective, multicenter study of consecutive bacteremic patients with P. aeruginosa at two university-affiliated hospitals. Demographic, clinical and treatment data were collected. Microbiologic analysis included in vitro susceptibility profile and type III secretion (TTS) phenotype. A total of 60 CABSI and 90 HCABSI episodes were analyzed. Patients with HCABSI had higher organ dysfunction at the time of bacteremia (p=0.05) and were more likely to have been exposed to antimicrobial therapy (p<0.001) compared to those with CABSI. Ninety two percent of the carbapenem-resistant P. aeruginosa were characterized as HCABSI. The 30-day mortality rate for CABSI was 26% compared to 36% for HCABSI (p=0.38). The SOFA score at the time of bacteremia (HR 1.2, 95% CI 1.1-1.3) and TTS phenotype (HR 2.1, 95% CI 1.1-3.9) were found to be independent predictors of 30-day mortality. No mortality difference was observed between CABSI and HCABSI caused by P. aeruginosa. Severity of illness and expression of TTS proteins were the strongest predictors of 30-day mortality from P. aeruginosa bacteremia. Future P. aeruginosa bacteremia trials designed to neutralize type III secretory proteins are warranted.
PMID: 23733476 [PubMed - as supplied by publisher]