This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (123)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Analysis of 189 Episodes

Francesc Vidal, MD; Josep Mensa, MD; Manuel Almela, MD; José-Antonio Martínez, MD; Francesc Marco, MD; Climent Casals, MD; Josep-María Gatell, MD; Eladio Soriano, MD; María-Teresa Jimenez de Anta, MD

Arch Intern Med. 1996;156(18):2121-2126.

Abstract
Objective
To evaluate the trend in incidence of Pseudomonas aeruginosa bacteremia, underlying conditions of patients, mortality rate, and factors associated with poor outcome.

Patients and Methods
Medical charts of 189 consecutive episodes of P aeruginosa bacteremia, detected between January 1, 1991, and December 31, 1994, were prospectively evaluated. Associated risk factors, treatment, and outcome were recorded.

Results
Pseudomonas aeruginosa bacteremia represented 5.7% of the total number of bacteremias, 6.9% of nosocomial bacteremias, and 23.6% of nosocomial gram-negative bacteremias. There were 1.5 episodes per 1000 discharges. These numbers were slightly lower than those recorded at our hospital 10 years earlier. Human immunodeficiency virus infection was the most frequent underlying disease (28/189 [15%]). Overall mortality was 18% (34/189). The presence of fatal underlying disease (P<.001), surgery (P=.001), pneumonia (P=.02), and severe sepsis (P<.001) were associated with poor prognosis, the mortality of the patients with these variables being 28%, 28%, 47%, and 62%, respectively. The presence of inappropriate definitive antimicrobial treatment became an independent factor predictive of death (P=.04) only when the subset of patients with intravenous catheter-associated bacteremia was excluded from the analysis. The survival rate was no greater in patients who received 2 or more antibiotics active in vitro against P aeruginosa than in those who received only 1. Neutropenia was not associated with increased mortality. The use of colony-stimulating factors did not affect the outcome of the neutropenic patients.

Conclusions
The rate of P aeruginosa bacteremia is falling slightly at our hospital. The emergence of the human immunodeficiency virus epidemic has had a considerable impact on both epidemiology and mortality. The presence of severe underlying disease, surgery, pneumonia, and, especially, severe sepsis are associated with a poor outcome. With the exclusion of patients with intravenous catheter—associated P aeruginosa bacteremia, the administration of an appropriate antimicrobial therapy is essential to a good outcome. Treatment with 1 active antibiotic seems to be sufficient.

Arch Intern Med. 1996;156:2121-2126

Author Affiliations
From the Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari de Tarragona JOAN XXIII, and Faculty of Medicine and Health Sciences (Reus), University Rovira i Virgili, Tarragona, Spain (Dr Vidal); and Departments of Infectious Diseases (Drs Mensa, Martínez, Gatell, and Soriano) and Microbiology (Drs Almela, Marco, Casals, and Jimenez de Anta), Hospital Clinic, Barcelona, Spain.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Initiation of Inappropriate Antimicrobial Therapy Results in a Fivefold Reduction of Survival in Human Septic Shock
Kumar et al.
Chest 2009;136:1237-1248.
ABSTRACT | FULL TEXT  

Impact of Reporting Gram Stain Results From Blood Culture Bottles on the Selection of Antimicrobial Agents
Uehara et al.
Am J Clin Pathol 2009;132:18-25.
ABSTRACT | FULL TEXT  

Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis
Scheetz et al.
J Antimicrob Chemother 2009;63:816-825.
ABSTRACT | FULL TEXT  

Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome
Ortega et al.
J Antimicrob Chemother 2009;63:568-574.
ABSTRACT | FULL TEXT  

Clinical implications of antimicrobial resistance for therapy
MacGowan and on behalf of the BSAC Working Parties on Resistanc
J Antimicrob Chemother 2008;62:ii105-ii114.
ABSTRACT | FULL TEXT  

Acid Sphingomyelinase Amplifies Redox Signaling in Pseudomonas aeruginosa-Induced Macrophage Apoptosis
Zhang et al.
J. Immunol. 2008;181:4247-4254.
ABSTRACT | FULL TEXT  

Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic Selection
Lodise et al.
Antimicrob. Agents Chemother. 2007;51:3510-3515.
ABSTRACT | FULL TEXT  

Impact of Empiric Antibiotic Therapy on Outcomes in Patients with Pseudomonas aeruginosa Bacteremia
Osih et al.
Antimicrob. Agents Chemother. 2007;51:839-844.
ABSTRACT | FULL TEXT  

The Impact of an Antibiotic Cycling Program on Empirical Therapy for Gram-Negative Infections
Merz et al.
Chest 2006;130:1672-1678.
ABSTRACT | FULL TEXT  

Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay.
Scarsi et al.
Antimicrob. Agents Chemother. 2006;50:3355-3360.
ABSTRACT | FULL TEXT  

Favourable outcomes in episodes of Pseudomonas bacteraemia when associated with tunnelled cuffed catheters (TCCs) in chronic haemodialysis patients
Golestaneh et al.
Nephrol Dial Transplant 2006;21:1328-1333.
ABSTRACT | FULL TEXT  

Phospholipase A2 Functions in Pseudomonas aeruginosa- Induced Apoptosis
Kirschnek and Gulbins
Infect. Immun. 2006;74:850-860.
ABSTRACT | FULL TEXT  

Evaluating Ciprofloxacin Dosing for Pseudomonas aeruginosa Infection by Using Clinical Outcome-Based Monte Carlo Simulations
Zelenitsky et al.
Antimicrob. Agents Chemother. 2005;49:4009-4014.
ABSTRACT | FULL TEXT  

In vitro selection of resistance in Pseudomonas aeruginosa and Acinetobacter spp. by levofloxacin and ciprofloxacin alone and in combination with {beta}-lactams and amikacin
Drago et al.
J Antimicrob Chemother 2005;56:353-359.
ABSTRACT | FULL TEXT  

Pseudomonas aeruginosa Bloodstream Infection: Importance of Appropriate Initial Antimicrobial Treatment
Micek et al.
Antimicrob. Agents Chemother. 2005;49:1306-1311.
ABSTRACT | FULL TEXT  

Hospital Mortality for Patients With Bacteremia Due to Staphylococcus aureus or Pseudomonas aeruginosa
Osmon et al.
Chest 2004;125:607-616.
ABSTRACT | FULL TEXT  

Single Versus Combined Antibiotic Therapy for Gram-Negative Infections
Klibanov et al.
The Annals of Pharmacotherapy 2004;38:332-337.
ABSTRACT | FULL TEXT  

Treatment and outcome of Pseudomonas aeruginosa bacteraemia: an antibiotic pharmacodynamic analysis
Zelenitsky et al.
J Antimicrob Chemother 2003;52:668-674.
ABSTRACT | FULL TEXT  

Effectiveness of Combination Antimicrobial Therapy for Pseudomonas aeruginosa Bacteremia
Chamot et al.
Antimicrob. Agents Chemother. 2003;47:2756-2764.
ABSTRACT | FULL TEXT  

O-Antigen Serotypes and Type III Secretory Toxins in Clinical Isolates of Pseudomonas aeruginosa
Faure et al.
J. Clin. Microbiol. 2003;41:2158-2160.
ABSTRACT | FULL TEXT  

Bacteraemia in adults due to glucose non-fermentative Gram-negative bacilli other than P. aeruginosa
Vidal et al.
QJM 2003;96:227-234.
ABSTRACT | FULL TEXT  

Clinical Utility of Blood Cultures Drawn From Central Vein Catheters and Peripheral Venipuncture in Critically Ill Medical Patients
Beutz et al.
Chest 2003;123:854-861.
ABSTRACT | FULL TEXT  

A clinical index predicting mortality with Pseudomonas aeruginosa bacteraemia
ALIAGA et al.
J Med Microbiol 2002;51:615-701.
ABSTRACT | FULL TEXT  

Prescribing guidelines for severe Pseudomonas infections
Giamarellou
J Antimicrob Chemother 2002;49:229-233.
FULL TEXT  

Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT | FULL TEXT  

Therapeutic Administration of Anti-PcrV F(ab')2 in Sepsis Associated with Pseudomonas aeruginosa
Shime et al.
J. Immunol. 2001;167:5880-5886.
ABSTRACT | FULL TEXT  

Antibiotic Resistance in the Intensive Care Unit
Kollef and Fraser
ANN INTERN MED 2001;134:298-314.
ABSTRACT | FULL TEXT  

Hospital-Acquired Pneumonia : Risk Factors, Microbiology, and Treatment
Lynch
Chest 2001;119 :373S-384S.
ABSTRACT | FULL TEXT  

Rapid Differentiation of Fermentative from Nonfermentative Gram-Negative Bacilli in Positive Blood Cultures by an Impedance Method
Chang and Huang
J. Clin. Microbiol. 2000;38:3589-3594.
ABSTRACT | FULL TEXT  

The Influence of Inadequate Antimicrobial Treatment of Bloodstream Infections on Patient Outcomes in the ICU Setting
Ibrahim et al.
Chest 2000;118:146-155.
ABSTRACT | FULL TEXT  

Recent Experience With Pseudomonas aeruginosa Bacteremia in Patients With Cancer: Retrospective Analysis of 245 Episodes
Chatzinikolaou et al.
Arch Intern Med 2000;160:501-509.
ABSTRACT | FULL TEXT  

Fluorescent In Situ Hybridization Allows Rapid Identification of Microorganisms in Blood Cultures
Kempf et al.
J. Clin. Microbiol. 2000;38:830-838.
ABSTRACT | FULL TEXT  

Health and Economic Outcomes of Antibiotic Resistance in Pseudomonas aeruginosa
Carmeli et al.
Arch Intern Med 1999;159:1127-1132.
ABSTRACT | FULL TEXT  

Inadequate Antimicrobial Treatment of Infections: A Risk Factor for Hospital Mortality Among Critically Ill Patients
Kollef et al.
Chest 1999;115:462-474.
ABSTRACT | FULL TEXT