A Retrospective Analysis Of Carbapenem Non-susceptible Pseudomonas Aeruginosa Bloodstream Infections:Risk Factors And Outcome

BackgroundPseudomonas aeruginosa(PA),as an opportunistic pathogen,often causes nosocomial infections and plays an important role in nosocomial infection control.And the incidence of PA infection is increasing.Although the prevalence of its resistance to most of abtibiotics tends to decrease,increasing use of carbapenems has increased the prevalence of carbapenem-non-susceptible(CnS)PA in hospitals.CnSPA is associated with an worsening patient prognosis.It is important to identify risk factors for CnSPA BSIs and evaluate clinical treatment responses and factors associated with mortality in patients with PA BSIs or CnSPA BSIs.MethodA single center,retrospective comparative analysis of carbapenem-non-susceptible PA(CnSPA)and carbapenem-susceptible PA(CSPA)bloodstream infections(BSIs)was conducted with patients between January 1,2007,and December 31,2016.A three-part analysis was conducted to identify risk factors associated with CnSPA,explore prognosis,and evaluate treatments.All statistical analyses were executed by using the SPSS version 24.0.ResultsThe study enrolled 340 patients(225 male and 115 female)with PA BSIs and the average age of the patients was 58±17 years;30.0%(N=101)of patients had CnSPA.Steady incidence of PA BSIs,which has fluctuated from 0.027/1000 patient-days to 0.062/1000 patient-days,and increased prevalence of CnSPA BSIs were observed during the study period.The mean length of hospital stay before onset of PA BSI was 20.4 days,and 41.8%of patients resided in the ICU within the 90 days prior to onset of BSI.The respiratory tract(35%)was the most common probable source of infection.Multivariate analysis revealed that respiratory disease and exposure to carbapenems within the previous 90 days to onset of BSI were independent risk factors for acquisition of CnSPA BSIs.High APACHE II scores(?15),arterial catheterization,and delayed application of appropriate definitive therapy were independently associated with higher risk of mortality in PA BSIs.Overall all-cause 30-day mortality associated with PA BSIs was 26.8%(91/340).In addition,mortality was higher in patients with CnSPA than in those with CSPA(37.6%vs.22.2%,respectively;P=0.003).Beta-lactam/beta-lactamase inhibitor combinations(BLBLIs)were as effective as carbapenems for the treatment of PA BSIs.Combination therapy was no better than monotherapy at reducing mortality in patients with PA BSIs,which was similar for CnSPA BSIs.Corticosteroid exposure and delayed receipt of effective definitive therapy were independent risk factors for death from CnSPA BSIs.ConclusionSteady incidence of PA BSIs and increased prevalence of CnSPA BSIs were observed during the study period,with higher mortality seeing in patients with CnSPA BSIs.Respiratory disease and exposure to carbapenems were independent risk factors for development of CnSPA BSIs.Appropriate and prompt therapy reduced mortality rates in PA BSIs.Combination therapy was no better than monotherapy at reducing mortality in patients with PA BSIs,which was similar for CnSPA BSIs.BLBLIs were as effective as carbapenems for the treatment of PA BSIs.Prompt therapy improved prognosis in CnSPA BSIs.Corticosteroid exposure was independent risk factors for CnSPA BSIs...