Pseudomonas aeruginosa Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival

Japanese Journal of Infectious Diseases

Koichi Izumikawa¹  Kentaro Nagaoka²  Yosuke Harada²  Norihiko Akamatsu²  Shigeru Kohno¹  Yoshitomo Morinaga²  Katsunori Yanagihara²  Hirotsugu Kohrogi³  Norihito Kaku²  Koichi Yamada²  Junichi Matsuda²  Yohei Migiyama² 

[1] Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences;Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences;Department of Respiratory Medicine, Kumamoto University Graduate School of Medical Sciences

关键词: Pseudomonas aeruginosa bacteremia;    immunocompetent patients;    immunocompromised patients;    initial antibiotic therapy;    type III secretion system;   

DOI  :  10.7883/yoken.JJID.2014.573

学科分类：传染病学

来源: National Institute of Infectious Diseases

【 摘 要 】

References(31)Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6%) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8% vs. 30%, P < 0.01; 30-day mortality, 23% vs. 39%, P = 0.053). Multivariate analysis showed that a higher sequential organ failure assessment score (hazard ratio [HR]: 1.27, P < 0.01) and underlying malignancies (HR: 3.33, P < 0.01) were independently associated with 30-day mortality. Initial antibiotic therapy (HR: 0.21, P < 0.01) and patients' immune status (HR: 0.29, P = 0.02) also had a significant impact on survival. However, there was a significant interaction between these 2 variables (P = 0.03 for interaction). A subgroup analysis showed that in immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5% vs. 66.7%, P < 0.01 by log-rank test).

【 授权许可】

Unknown