Prognosis and influencing factors of bloodstream infection caused by carbapenem-resistant <i>Pseudomonas aeruginosa</i>: a cohort study_West China Medical Journal

Authors：

LI Lin ^1,2 , HUANG Wenzhi ¹ ,  QIAO Fu ¹

1. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

QIAO Fu, Email: qiaofu2005@scu.edu.cn

Keywords：

Carbapenem-resistant Pseudomonas aeruginosa; bloodstream infection; prognosis; influencing factor

DOI：

10.7507/1002-0179.202302016

Video：

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Objective To explore the overall outcome and its factors of patients with carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI). Methods A single-center, retrospective cohort study was carried out. The demographic and clinical data of all emergency patients and inpatients in West China Hospital of Sichuan University from 2017 to 2021 were collected. Firstly, the prognosis of patients with CRPA-BSI was compared with those with carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection (CSPA-BSI). Then Cox regression was used to analyze the factors affecting the prognosis of CRPA-BSI patients. Results A total of 53 patients with CRPA-BSI and 175 patients with CSPA-BSI were enrolled, and they were 1∶1 matched according to the age-adjusted Charlson Comorbidity Index (aCCI) to control for confounding factors. When aCCI was similar, the incidence of poor prognosis in CRPA-BSI patients was significantly higher than that in CSPA-BSI patients [41.5% vs. 18.9%; relative risk=2.20, 95% confidence interval (CI) (1.16, 4.19), P=0.011]. The median length of hospital stay in the CRPA-BSI group was 3 d longer than that in the CSPA-BSI group but the difference was not statistically significant (29 vs. 26 d, P=0.388). With regard to prognostic factors, univariate Cox regression analyses showed that the highest temperature ≤39℃ (P=0.014), hepatobiliary and pancreatic diseases (P=0.011), days of central venous catheterization (P=0.025), days of indwelling urinary catheters (P=0.037), adjustment of medication duration according to drug sensitivity results (P=0.015) and Pitt bacteremia score (P=0.007) were related to the poor prognosis of CRPA-BSI patients. Multiple Cox regression analysis showed that hepatobiliary and pancreatic disease [hazard ratio (HR)=3.434, 95%CI (1.271, 9.276), P=0.015] and Pitt bacteremia score [HR=1.264, 95%CI (1.057, 1.510), P=0.010] were independently associated with poor outcome in CRPA-BSI patients. Conclusions The prognosis of CRPA-BSI patients is worsen than that of CSPA-BSI patients. Hepatobiliary and pancreatic diseases significantly increase the risk of poor outcome in CRPA-BSI patients. Pitt bacteremia score is a predictor of prognosis in patients with CRPA-BSI.

Citation： LI Lin, HUANG Wenzhi, QIAO Fu. Prognosis and influencing factors of bloodstream infection caused by carbapenem-resistant Pseudomonas aeruginosa: a cohort study. West China Medical Journal, 2023, 38(3): 352-357. doi: 10.7507/1002-0179.202302016 Copy

1.	Brink AJ. Epidemiology of carbapenem-resistant Gram-negative infections globally. Curr Opin Infect Dis, 2019, 32(6): 609-616.
2.	Rojas A, Palacios-Baena ZR, López-Cortés LE, et al. Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis. Clin Microbiol Infect, 2019, 25(8): 964-970.
3.	Ababneh MA, Rababa’h AM, Almomani BA, et al. A ten-year surveillance of P aeruginosa bloodstream infections in a tertiary care hospital: trends and risk factors for mortality. Int J Clin Pract, 2021, 75(9): e14409.
4.	Suárez C, Peña C, Gavaldà L, et al. Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection. Int J Infect Dis, 2010, 14(Suppl 3): e73-78.
5.	Horino T, Chiba A, Kawano S, et al. Clinical characteristics and risk factors for mortality in patients with bacteremia caused by Pseudomonas aeruginosa. Intern Med, 2012, 51(1): 59-64.
6.	Callejas-Díaz A, Fernández-Pérez C, Ramos-Martínez A, et al. Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: mortality and prognostic factors. Med Clin (Barc), 2019, 152(3): 83-89.
7.	Joo EJ, Kang CI, Ha YE, et al. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome. Microb Drug Resist, 2011, 17(2): 305-312.
8.	Tuon FF, Gortz LW, Rocha JL. Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy. Braz J Infect Dis, 2012, 16(4): 351-356.
9.	Diekema DJ, Hsueh PR, Mendes RE, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother, 2019, 63(7): e00355-319.
10.	Huttunen R, Åttman E, Aittoniemi J, et al. Nosocomial bloodstream infections in a Finnish tertiary care hospital: a retrospective cohort study of 2175 episodes during the years 1999-2001 and 2005-2010. Infect Dis (Lond), 2015, 47(1): 20-26.
11.	Zavascki AP, Cruz RP, Goldani LZ. Risk factors for imipenem-resistant Pseudomonas aeruginosa: a comparative analysis of two case-control studies in hospitalized patients. J Hosp Infect, 2005, 59(2): 96-101.
12.	Lautenbach E, Synnestvedt M, Weiner MG, et al. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect Control Hosp Epidemiol, 2010, 31(1): 47-53.
13.	施清怡. 碳青霉烯类不敏感铜绿假单胞菌血流感染危险因素及预后分析. 杭州: 浙江大学, 2019.
14.	Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
15.	Cassini A, Högberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.
16.	World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. Geneva: World Health Organization, 2017.
17.	Hu H, Zhang Y, Zhang P, et al. Bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing P. aeruginosa sequence type 463, associated with high mortality rates in China:a retrospective cohort study. Front Cell Infect Microbiol, 2021, 11: 756782.
18.	Jeong SJ, Yoon SS, Bae IK, et al. Risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome. Diagn Microbiol Infect Dis, 2014, 80(2): 130-135.
19.	Peña C, Suarez C, Gozalo M, et al. Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections. Antimicrob Agents Chemother, 2012, 56(3): 1265-1272.
20.	Buehrle DJ, Shields RK, Clarke LG, et al. Carbapenem-resistant Pseudomonas aeruginosa bacteremia: risk factors for mortality and microbiologic treatment failure. Antimicrob Agents Chemother, 2016, 61(1): e01243-1216.
21.	Suárez C, Peña C, Tubau F, et al. Clinical impact of imipenem-resistant Pseudomonas aeruginosa bloodstream infections. J Infect, 2009, 58(4): 285-290.
22.	Aviv T, Lazarovitch T, Katz D, et al. The epidemiological impact and significance of carbapenem resistance in Pseudomonas aeruginosa bloodstream infections: a matched case-case-control analysis. Infect Control Hosp Epidemiol, 2018, 39(10): 1262-1265.
23.	Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control, 1988, 16(3): 128-140.
24.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
25.	Kang CI, Kim SH, Park WB, et al. Bloodstream infections caused by antibiotic-resistant Gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother, 2005, 49(2): 760-766.
26.	Chow JW, Yu VL. Combination antibiotic therapy versus monotherapy for Gram-negative bacteraemia: a commentary. Int J Antimicrob Agents, 1999, 11(1): 7-12.
27.	Doi Y. Treatment options for carbapenem-resistant Gram-negative bacterial infections. Clin Infect Dis, 2019, 69(Suppl 7): S565-S575.
28.	Yang K, Xiao T, Shi Q, et al. Socioeconomic burden of bloodstream infections caused by carbapenem-resistant and carbapenem-susceptible Pseudomonas aeruginosa in China. J Glob Antimicrob Resist, 2021, 26: 101-107.
29.	Morata L, Cobos-Trigueros N, Martínez JA, et al. Influence of multidrug resistance and appropriate empirical therapy on the 30-day mortality rate of Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2012, 56(9): 4833-4837.
30.	Aliaga L, Mediavilla JD, Cobo F. A clinical index predicting mortality with Pseudomonas aeruginosa bacteraemia. J Med Microbiol, 2002, 51(7): 615-701.
31.	苏冬梅, 赵雷, 董琳, 等. 铜绿假单胞菌血流感染 67 例临床及预后危险因素分析. 安徽医药, 2021, 25(1): 201-204.
32.	王小雨, 任立军, 沈建飞, 等. 血流感染脓毒症患者炎症因子变化、病原菌分布特征及预后影响因素分析. 中国病原生物学杂志, 2020, 15(5): 587-591.
33.	李瑛, 吕宇, 杨陵. 耐碳青霉烯类革兰阴性菌检出患者 30d 病死风险影响因素. 中华医院感染学杂志, 2020, 30(18): 2749-2753.
34.	Tang PC, Lee CC, Li CW, et al. Time-to-positivity of blood culture: an independent prognostic factor of monomicrobial Pseudomonas aeruginosa bacteremia. J Microbiol Immunol Infect, 2017, 50(4): 486-493.
35.	Lee CH, Su TY, Ye JJ, et al. Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems. J Microbiol Immunol Infect, 2017, 50(5): 677-683.

1. Brink AJ. Epidemiology of carbapenem-resistant Gram-negative infections globally. Curr Opin Infect Dis, 2019, 32(6): 609-616.
2. Rojas A, Palacios-Baena ZR, López-Cortés LE, et al. Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis. Clin Microbiol Infect, 2019, 25(8): 964-970.
3. Ababneh MA, Rababa’h AM, Almomani BA, et al. A ten-year surveillance of P aeruginosa bloodstream infections in a tertiary care hospital: trends and risk factors for mortality. Int J Clin Pract, 2021, 75(9): e14409.
4. Suárez C, Peña C, Gavaldà L, et al. Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection. Int J Infect Dis, 2010, 14(Suppl 3): e73-78.
5. Horino T, Chiba A, Kawano S, et al. Clinical characteristics and risk factors for mortality in patients with bacteremia caused by Pseudomonas aeruginosa. Intern Med, 2012, 51(1): 59-64.
6. Callejas-Díaz A, Fernández-Pérez C, Ramos-Martínez A, et al. Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: mortality and prognostic factors. Med Clin (Barc), 2019, 152(3): 83-89.
7. Joo EJ, Kang CI, Ha YE, et al. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome. Microb Drug Resist, 2011, 17(2): 305-312.
8. Tuon FF, Gortz LW, Rocha JL. Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy. Braz J Infect Dis, 2012, 16(4): 351-356.
9. Diekema DJ, Hsueh PR, Mendes RE, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother, 2019, 63(7): e00355-319.
10. Huttunen R, Åttman E, Aittoniemi J, et al. Nosocomial bloodstream infections in a Finnish tertiary care hospital: a retrospective cohort study of 2175 episodes during the years 1999-2001 and 2005-2010. Infect Dis (Lond), 2015, 47(1): 20-26.
11. Zavascki AP, Cruz RP, Goldani LZ. Risk factors for imipenem-resistant Pseudomonas aeruginosa: a comparative analysis of two case-control studies in hospitalized patients. J Hosp Infect, 2005, 59(2): 96-101.
12. Lautenbach E, Synnestvedt M, Weiner MG, et al. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect Control Hosp Epidemiol, 2010, 31(1): 47-53.
13. 施清怡. 碳青霉烯类不敏感铜绿假单胞菌血流感染危险因素及预后分析. 杭州: 浙江大学, 2019.
14. Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
15. Cassini A, Högberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.
16. World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. Geneva: World Health Organization, 2017.
17. Hu H, Zhang Y, Zhang P, et al. Bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing P. aeruginosa sequence type 463, associated with high mortality rates in China:a retrospective cohort study. Front Cell Infect Microbiol, 2021, 11: 756782.
18. Jeong SJ, Yoon SS, Bae IK, et al. Risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome. Diagn Microbiol Infect Dis, 2014, 80(2): 130-135.
19. Peña C, Suarez C, Gozalo M, et al. Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections. Antimicrob Agents Chemother, 2012, 56(3): 1265-1272.
20. Buehrle DJ, Shields RK, Clarke LG, et al. Carbapenem-resistant Pseudomonas aeruginosa bacteremia: risk factors for mortality and microbiologic treatment failure. Antimicrob Agents Chemother, 2016, 61(1): e01243-1216.
21. Suárez C, Peña C, Tubau F, et al. Clinical impact of imipenem-resistant Pseudomonas aeruginosa bloodstream infections. J Infect, 2009, 58(4): 285-290.
22. Aviv T, Lazarovitch T, Katz D, et al. The epidemiological impact and significance of carbapenem resistance in Pseudomonas aeruginosa bloodstream infections: a matched case-case-control analysis. Infect Control Hosp Epidemiol, 2018, 39(10): 1262-1265.
23. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control, 1988, 16(3): 128-140.
24. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
25. Kang CI, Kim SH, Park WB, et al. Bloodstream infections caused by antibiotic-resistant Gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother, 2005, 49(2): 760-766.
26. Chow JW, Yu VL. Combination antibiotic therapy versus monotherapy for Gram-negative bacteraemia: a commentary. Int J Antimicrob Agents, 1999, 11(1): 7-12.
27. Doi Y. Treatment options for carbapenem-resistant Gram-negative bacterial infections. Clin Infect Dis, 2019, 69(Suppl 7): S565-S575.
28. Yang K, Xiao T, Shi Q, et al. Socioeconomic burden of bloodstream infections caused by carbapenem-resistant and carbapenem-susceptible Pseudomonas aeruginosa in China. J Glob Antimicrob Resist, 2021, 26: 101-107.
29. Morata L, Cobos-Trigueros N, Martínez JA, et al. Influence of multidrug resistance and appropriate empirical therapy on the 30-day mortality rate of Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2012, 56(9): 4833-4837.
30. Aliaga L, Mediavilla JD, Cobo F. A clinical index predicting mortality with Pseudomonas aeruginosa bacteraemia. J Med Microbiol, 2002, 51(7): 615-701.
31. 苏冬梅, 赵雷, 董琳, 等. 铜绿假单胞菌血流感染 67 例临床及预后危险因素分析. 安徽医药, 2021, 25(1): 201-204.
32. 王小雨, 任立军, 沈建飞, 等. 血流感染脓毒症患者炎症因子变化、病原菌分布特征及预后影响因素分析. 中国病原生物学杂志, 2020, 15(5): 587-591.
33. 李瑛, 吕宇, 杨陵. 耐碳青霉烯类革兰阴性菌检出患者 30d 病死风险影响因素. 中华医院感染学杂志, 2020, 30(18): 2749-2753.
34. Tang PC, Lee CC, Li CW, et al. Time-to-positivity of blood culture: an independent prognostic factor of monomicrobial Pseudomonas aeruginosa bacteremia. J Microbiol Immunol Infect, 2017, 50(4): 486-493.
35. Lee CH, Su TY, Ye JJ, et al. Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems. J Microbiol Immunol Infect, 2017, 50(5): 677-683.

West China Medical Journal

Prognosis and influencing factors of bloodstream infection caused by carbapenem-resistant Pseudomonas aeruginosa: a cohort study

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