Bacterial and Clinical Characteristics of Health Care- and Community-Acquired Bloodstream Infections Due to Pseudomonas aeruginosa
Bacterial and Clinical Characteristics of Health Care- and Community-Acquired Bloodstream Infections Due to Pseudomonas aeruginosa
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DOI：
10.1128/aac.02467-12
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发表时间：
2013-08-01
影响因子：
4.9
通讯作者：
El-Solh, Ali A.
中科院分区：
文献类型：
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作者：
Hattemer, Angela;Hauser, Alan;El-Solh, Ali A.
医疗保健相关感染，包括铜绿假单胞菌血流感染，与适当抗生素治疗的延迟和死亡率增加有关。本研究的目的是评估医疗保健相关血流感染 (HCABSI) 与铜绿假单胞菌引起的社区获得性血流感染 (CABSIs) 的内在毒力、细菌耐药性和临床结果。我们对两所大学附属医院的连续铜绿假单胞菌菌血症患者进行了回顾性多中心研究。收集人口统计、临床和治疗数据。微生物学分析包括体外敏感性概况和 III 型分泌 (TTS) 表型。分析了 60 次 CACSI 和 90 次 HCABSI 发作。与 CABSIs 患者相比，HCABSIs 患者在菌血症时有更多器官功能障碍 (P = 0.05)，并且更有可能接受抗菌治疗 (P < 0.001)。 92% 的耐碳青霉烯类铜绿假单胞菌感染被定性为 HCABSIs。 CABSIs 的 30 天死亡率为 26%，而 HCABSIs 的 30 天死亡率为 36%（P = 0.38）。菌血症时的序贯器官衰竭评估评分（风险比 [HR]，1.2；95% 置信区间 [CI]，1.1 至 1.3）和 TTS 表型（HR 2.1；95% CI，1.1 至 3.9）被发现是 30 天死亡率的独立预测因子。由铜绿假单胞菌引起的 CABSI 和 HCABSI 之间没有观察到死亡率差异。疾病的严重程度和 TTS 蛋白的表达是铜绿假单胞菌菌血症导致的 30 天死亡率的最强预测因子。未来旨在中和 TTS 蛋白的铜绿假单胞菌菌血症试验是有必要的。
Health care-associated infections, including Pseudomonas aeruginosa bloodstream infection, have been linked to delays in appropriate antibiotic therapy and an increased mortality rate. The objective of this study was to evaluate intrinsic virulence, bacterial resistance, and clinical outcomes of health care-associated bloodstream infections (HCABSIs) in comparison with those of community-acquired bloodstream infections (CABSIs) caused by P. aeruginosa. We conducted a retrospective multicenter study of consecutive P. aeruginosa bacteremia patients at two university-affiliated hospitals. Demographic, clinical, and treatment data were collected. Microbiologic analyses included in vitro susceptibility profiles and type III secretory (TTS) phenotypes. Sixty CABSI and 90 HCABSI episodes were analyzed. Patients with HCABSIs had more organ dysfunction at the time of bacteremia (P = 0.05) and were more likely to have been exposed to antimicrobial therapy (P < 0.001) than those with CABSIs. Ninety-two percent of the carbapenem-resistant P. aeruginosa infections were characterized as HCABSIs. The 30-day mortality rate for CABSIs was 26% versus 36% for HCABSIs (P = 0.38). The sequential organ failure assessment score at the time of bacteremia (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1 to 1.3) and the TTS phenotype (HR 2.1; 95% CI, 1.1 to 3.9) were found to be independent predictors of the 30-day mortality rate. No mortality rate difference was observed between CABSIs and HCABSIs caused by P. aeruginosa. Severity of illness and expression of TTS proteins were the strongest predictors of the 30-day mortality rate due to P. aeruginosa bacteremia. Future P. aeruginosa bacteremia trials designed to neutralize TTS proteins are warranted.