A Retrospective Analysis Of Prognosis And Risk Factors Of Patients With Pseudomonas Aeruginosa Bloodstream Infection

Objective:The present study aimed to investigate the clinical characteristics and risk factors of bloodstream infection(BSI)caused by Pseudomonas aeruginosa(PA).Methods:A single-center retrospective study was conducted to collect the laboratory data and clinical data of PA BSI at the Second Affiliated Hospital of Nanchang University between January 2012 to December 2021.The clinical characteristics and outcomes of patients who received a sequential organ function assessment(SOFA)score < 4 were compared with those of patients who received a SOFA score ≥4.The risk factors for 14-day treatment failure in both groups and 30-day mortality in patients with PA bloodstream infection were investigated by multivariate analysis.Result:Over a 10-year period,174 eligible patients with PA BSI were included in the study,95 of whom had a SOFA score < 4.Among the PA infected patients,the number of middle-aged patients was higher,accounting for 82.8%.Patients were widely distributed in various departments within hospitals,among which the number of patients in the Department of hepatobiliary surgery and the ICU was high,each accounting for 14.4%.PA isolates were all above 80% susceptible to multiple antibiotics.Among them,the highest sensitivity rate(97.1%)was observed for amikacin,96.2% for tobramycin,and 93.1% for gentamicin.Multivariate analysis revealed that empirical imipenem treatment [P=0.042,OR(95% CI): 3.727(1.048-13.252)],adjusted Charlson comorbidity index(a CCI)> 6 points [P=0.031,OR(95% CI): 4.995(1.163–21.462)],and Pitt score [P=0.016,OR(95% CI): 1.461(1.074–1.987)] were independent risk factors for 14-day treatment failure in patients with PA BSI having a SOFA score≥points.Empirical imipenem treatment [P=0.005,OR(95% CI): 10.439(2.022–53.878)] and ICU admission [P=0.004,OR(95% CI):15.024(2.378–94.910)] were independent risk factors for 14-day treatment failure in patients with PA BSI having a SOFA score < 4.Previous antibiotic exposure within 1 month [P=0.020,OR(95% CI): 11.938(1.469-96.987)] and SOFA score [P=0.005,OR(95% CI): 1.284(1.080-1.526)] were independent risk factors for 30-day mortality in patients with PA BSI.Using Kaplan Meier survival analysis,we found no significant difference in clinical outcomes between patients receiving definitiveβ-lactam/β-lactamase inhibitor combinations(BLICs),and carbapenems(P=0.874).Conclusions:Patients with PA BSI are mainly middle-aged and elderly males,who are widely distributed in various departments in hospitals,among which the number of patients in the Department of hepatobiliary surgery and the ICU is high.Aeruginosa isolates were all less resistant to multiple antibiotics.The empirical imipenem treatment was an independent risk factor for 14-day treatment failure in patients in the sofa ≥ 4 and sofa ≥ 4 subgroups.Previous antibiotic exposure within 1 month and SOFA score were risk factors for 30-day mortality of PA BSI.There was no significant difference in the efficacy of the BLICs or carbapenems used alone.Our results suggest that clinicians individualize treatment to patients based on a combination of their condition,history of antibiotic exposure,and the likelihood of drug susceptibility to the most likely pathogens.