Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development-Results from the PRO-BAC Cohort
Por:
Perez-Crespo, P, Rojas, A, Lanz-Garcia, J, Retamar-Gentil, P, Reguera-Iglesias, J, Lima-Rodriguez, O, Jimenez, A, Suarez, J, Jover-Saenz, A, Aguirre, J, Jimenez, E, Canton-Bulnes, M, Lafont, P, Castillo, C, Blanco, J, Pedragosa, J, Boix-Palop, L, Carral, B, Bahamonde-Carrasco, A, Ciordia, T, Kindelan, C, Molina, I, Rodriguez, C, Camacho, I, Garcia, D, Galan-Sanchez, F, Amat, A, de Lucas, E, Sanchez-Porto, A, Garcia, M, Lopez-Hernandez, I, Rodriguez-Bano, J and Lopez-Cortes, L
Publicada:
1 jun 2022
Ahead of Print:
24 may 2022
Resumen:
Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60-79), 68.8% were male, median Charlson score was 5 (IQR 3-7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14-3.12)], haematological malignancy [2.45 (1.20-4.99)], obstructive uropathy [2.86 (1.13-3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10-10.92)] and healthcare-associated BSI [1.85 (1.13-3.02)]. Anindex predictive of CO-BSI-PA was developed; scores >= 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.
Filiaciones:
Perez-Crespo, P:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
Hosp Univ Nuestra Senora de Valme, Unidad Enfermedades Infecciosas & Microbiol, Seville 41014, Spain
Rojas, A:
Pontificia Univ Catolica Chile, Fac Med, Dept Enfermedades Infecciosas Adulto, Santiago 8331150, Chile
Lanz-Garcia, J:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
Retamar-Gentil, P:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
Reguera-Iglesias, J:
Hosp Reg Univ Malaga, Serv Enfermedades Infecciosas, IBIMA Malaga, Malaga 29010, Spain
Lima-Rodriguez, O:
Hosp Alvaro Cunqueiro, Unidad Enfermedades Infecciosas, Serv Med Interna, Vigo 36312, Spain
Jimenez, A:
Hosp Costa del Sol, Grp Enfermedades Infecciosas, Serv Med Interna, Marbella 29603, Spain
Suarez, J:
Hosp Univ Cent Asturias, Unidad Microbiol, Inst Invest Sanitaria Principado Asturias ISPA, Oviedo 33011, Spain
Jover-Saenz, A:
Hosp Arnau Vilanova, Unidad Func Infecc Nosocomiales, Lerida 25198, Spain
Aguirre, J:
Hosp Univ Cruces, Unidad Enfermedades Infecciosas, Bizkaia 48903, Spain
Jimenez, E:
Hosp Univ Nuestra Senora de Valme, Unidad Enfermedades Infecciosas & Microbiol, Seville 41014, Spain
Canton-Bulnes, M:
Hosp Univ Virgen Macarena, Unidad Cuidados Intens, Seville 41009, Spain
Lafont, P:
Hosp Univ Burgos, Unidad Gest Clin Enfermedades Infecciosas, Burgos 09006, Spain
Castillo, C:
Univ Cantabria, Hosp Univ Marques de Valdecilla, IDIVAL, Unidad Enfermedades Infecciosas, Santander 39008, Spain
Blanco, J:
Hosp Univ Jerez de la Frontera, Unidad Gest Clin Enfermedades Infecciosas & Micro, Jerez de la Frontera 11407, Spain
Pedragosa, J:
Hosp Univ Granollers, Dept Med Interna, Granollers 08402, Spain
Boix-Palop, L:
Hosp Univ Mutua Terrassa, Unidad Enfermedades Infecciosas, Barcelona 08221, Spain
Carral, B:
Area Sanitaria Campo Gibraltar, Unidad Clin Gest Enfermedades Infecciosas & Micro, Cadiz 11207, Spain
Bahamonde-Carrasco, A:
Hosp El Bierzo, Dept Med Interna, Ponferrada 24404, Spain
Ciordia, T:
Complejo Asistencial Univ Leon CAULE, Dept Microbiol Clin, Leon 24071, Spain
Kindelan, C:
Hosp Univ Reina Sofia, Unidad Clin Enfermedades Infecciosas, Cordoba 14004, Spain
Molina, I:
Hosp Univ Torrecardenas, Unidad Enfermedades Infecciosas, Almeria 04009, Spain
Rodriguez, C:
Complejo Hosp Jaen, Unidad Gest Clin Enfermedades Infecciosas & Micro, Jaen 23007, Spain
Camacho, I:
Hosp Gen Poniente, Unidad Med Trop, El Ejido 04700, Spain
Garcia, D:
Hosp Univ Clin San Cecilio, Unidad Gest Clin Enfermedades Infecciosas, Granada 18016, Spain
Galan-Sanchez, F:
Hosp Univ Puerta del Mar, Unidad Gest Clin Microbiol, Cadiz 11009, Spain
Amat, A:
Fundacio Hosp Esperit St, Unidad Med Interna, Santa Coloma De Gramenet 08923, Spain
:
Hosp Univ Gen Alicante, Unidad Enfermedades Infecciosas, Alicante 03010, Spain
Sanchez-Porto, A:
Hosp Linea de La Concepcion, Unidad Enfermedades Infecciosas & Microbiol, La Linea De Concepcion 11300, Spain
Garcia, M:
Hosp San Juan de la Cruz, Serv Med Interna, Ubeda 23400, Spain
Lopez-Hernandez, I:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
Rodriguez-Bano, J:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
Lopez-Cortes, L:
Univ Seville, Biomed Inst Sevilla, Hosp Univ Virgen Macarena, Infect Dis & Microbiol Unit, Seville 41009, Spain
Univ Seville, Biomed Inst Sevilla, Dept Med, Seville 41009, Spain
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