Effect of metallo-β-lactamase production and multidrug resistance on clinical outcomes in patients with Pseudomonas aeruginosa bloodstream infection: a retrospective cohort study

BMC Infectious Diseases

Silke Peter⁴  Florian Hölzl⁴  Ingo B Autenrieth⁴  Uwe Markert²  Ingo Flesch¹  Wichard Vogel³  Klaus Schröppel⁴  Matthias Marschal⁴  Ines Kuebart⁴  Matthias Willmann⁴ 

[1] BG Trauma Center, University of Tübingen, Tübingen, Germany;Clinic for General, Visceral and Vascular Surgery, Zollernalb Hospital, Albstadt, Germany;Medical Center, Department of Hematology, Oncology, Immunology, Rheumatology & Pulmonology, University of Tübingen, Tübingen, Germany;Institute of Medical Microbiology and Hygiene, University of Tübingen, Elfriede-Aulhorn-Str. 6, 72076 Tübingen, Germany

关键词: MBL;    Length of stay;    Prognosis;    Mortality;    Antimicrobial therapy;    Bacteremia;   

Others  :  1145613
DOI  :  10.1186/1471-2334-13-515

 received in 2013-07-24, accepted in 2013-10-29,  发布年份 2013

【 摘 要 】

Background

Blood stream infections (BSI) with Pseudomonas aeruginosa lead to poor clinical outcomes. The worldwide emergence and spread of metallo-β-lactamase (MBL) producing, often multidrug-resistant organisms may further aggravate this problem. Our study aimed to investigate the effect of MBL-producing P. aeruginosa (MBL-PA) and various other resistance phenotypes on clinical outcomes.

Methods

A retrospective cohort study was conducted in three German hospitals. Medical files from 2006 until 2012 were studied, and a number of 113 patients with P. aeruginosa BSI were included. The presence of VIM, IMP and NDM genes was detected using molecular techniques. Genetic relatedness was assessed through multilocus sequence typing (MLST). The effect of resistance patterns or MBL production on clinical outcomes was investigated by using multivariate Cox regression models.

Results

In-hospital mortality was significantly higher in patients with MBL-PA and multidrug-resistant P. aeruginosa. However, neither BSI with MBL-PA nor BSI with various resistance phenotypes of P. aeruginosa were independently associated with mortality or length of hospital stay. In multivariate models, the SAPS II score (HR 1.046), appropriate definitive treatment (HR range 0.25-0.26), and cardiovascular disease (HR range 0.44-0.46) were independent predictors of mortality. Concomitant infections were associated with an excess length of stay (HR < 1).

Conclusions

Medication with appropriate antimicrobial agents at any time during the course of infection remains the key for improving clinical outcomes in patients with P. aeruginosa BSI and should be combined with a strict implementation of routine infection control measures.

【 授权许可】

   
2013 Willmann et al.; licensee BioMed Central Ltd.

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