Clinical characteristics and risk factors for mortality in patients with bacteremia caused by Pseudomonas aeruginosa.
ABSTRACT The mortality rates for bacteremia due to Pseudomonas aeruginosa remain high. In our hospital, we performed retrospective analyses to determine risk factors for mortality among patients with bacteremia caused by P. aeruginosa.
This retrospective cohort study was conducted among adult patients with bacteremia due to P. aeruginosa at Jikei University Hospital. We analyzed factors, such as age, gender, underlying disease, initial antimicrobial treatment, and primary site of infection to determine which of these were predictive of mortality in patients with P. aeruginosa bacteremia.
One hundred and thirty-four patients with P. aeruginosa bacteremia were identified between April 2003 and March 2010. The 30-day mortality rate among all patients with P. aeruginosa bacteremia was 20.9%. The most common underlying disease was leukemia (20.9%), and the most common primary site of infection was the urinary tract (24.6%). Seventy-one patients (65.7%) were treated with an appropriate initial antimicrobial regimen for P. aeruginosa bacteremia. However, these patients had similar 30-day mortality to that observed in patients not administered appropriate antibiotics. This study revealed that risk factors for the 30-day mortality were thrombocytopenia and polymicrobial P. aeruginosa bacteremia (p<0.01).
Thrombocytopenia and polymicrobial bacteremia were associated with a greater incidence of 30-day mortality among patients with P. aeruginosa bacteremia. On the other hand, age, underlying disease, and inappropriate initial empirical antimicrobial treatment did not affect mortality.
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ABSTRACT: Objective: To study the incidence and prognosis of thrombocytopenia in adult intensive care unit (ICU) patients. Design: Prospective observational cohort study. Setting: The medical ICU of a university hospital and the combined medical-surgical ICU of a regional hospital. Patients: All patients consecutively admitted during a 5-month period. Interventions: Patient surveillance and data collection. Measurements and Main Results: The primary outcome measure was ICU mortality. Data of 329 patients were analyzed. Overall ICU mortality rate was 19.5%. A total of 136 patients (41.3%) had at least one platelet count <150 × 109/L. These patients had higher Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score (SAPS) II, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at admission, longer ICU stay (8 [4-16] days vs. 5 [2-9] days) (median [interquartile range]), and higher ICU mortality (crude odds ratio [OR], 5.0; 95% confidence interval [CI], 2.7-9.1) and hospital mortality than patients with daily platelet counts >150 × 109/L (p < .0005 for all comparisons). Bleeding incidence rose from 4.1% in nonthrombocytopenic patients to 21.4% in patients with minimal platelet counts between 101 × 109/L and 149 × 109/L (p = .0002) and to 52.6% in patients with minimal platelet counts <100 × 109/L (p < .0001). In all quartiles of admission APACHE II and SAPS II scores, a nadir platelet count <150 × 109/L was related with a substantially poorer vital prognosis. Similarly, a drop in platelet count to ≤50% of admission was associated with higher death rates (OR, 6.0; 95% CI, 3.0-12.0;p < .0001). In a logistic regression analysis with ICU mortality as the dependent variable, the occurrence of thrombocytopenia had more explanatory power than admission variables, including APACHE II, SAPS II, and MODS scores (adjusted OR, 4.2; 95% CI, 1.8-10.2). Conclusions: Thrombocytopenia is common in ICUs and constitutes a simple and readily available risk marker for mortality, independent of and complementary to established severity of disease indices. Both a low nadir platelet count and a large fall of platelet count predict a poor vital outcome in adult ICU patients. Thrombocytopenia is one of the most common laboratory abnormalities in intensive care unit (ICU) patients. Thrombocytopenia can be a result of increased (nonimmune or immune) platelet destruction, hemodilution, platelet sequestration (as in hypersplenism), or decreased platelet production (1). The cause of a low platelet count in ICU may be difficult to determine and is often multifactorial. A hemorrhagic diathesis secondary to severe thrombocytopenia may adversely affect patient care and outcome. Earlier studies suggest that thrombocytopenia in the ICU is associated with prolonged hospital stay and reduced survival (2-4). However, these studies were mainly retrospective chart reviews, primarily focused on determinants of thrombocytopenia and generally did not control for the severity of disease (2-7). It is conceivable that thrombocytopenia preferentially presents or develops in patients who are judged at ICU admission to have a poor chance of survival. In this view, thrombocytopenia in itself would contribute little prognostic information to the baseline severity of illness. To assess the severity of illness of ICU patients, several classification and prognostic systems have been introduced and validated (8), such as the Acute Physiology and Chronic Health Evaluation (APACHE) II (9) and the New Simplified Acute Physiology Score (SAPS II) (10). Scores that quantify organ dysfunction among ICU patients, including the Multiple Organ Dysfunction Score (MODS) (11), also correlate with ICU mortality rate (11-13). The present study was intended to determine prospectively the incidence, causes and complications of thrombocytopenia among adult, predominantly nonsurgical, ICU patients. More specifically, we investigated whether thrombocytopenia in ICU patients would constitute a prognostic marker independent of established prognostic indices.Critical Care Medicine 05/2000; 28(6):1871-1876. · 6.12 Impact Factor
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ABSTRACT: To clarify the clinical characteristics and risk factors for mortality of patients with Morganella morganii bacteremia. Retrospective analyses were undertaken of patients with M. morganii bacteremia treated at Chang Gung Memorial Hospital-Kaohsiung, between 2002 and 2003. Seventy three patients (39 male, 34 female; mean age, 64.43 +/- 16.58 years) were included for analyses. At least 1 underlying disease was found in 91.7% of patients. Solid tumors (34.2%) was most frequently encountered. The leading portals of entry of M. morganii bacteremia were the urinary tract (37%) and hepatobiliary tract (22%). Of all included cases, 69.9% were community-acquired and 45.2% were of polymicrobial bacteremia. Urinary tract (47.5%) and hepatobiliary tract (30.3%) were the major portals of entry among patients with monomicrobial and polymicrobial M. morganii bacteremia, respectively. The overall mortality rate was 38.3%. Susceptibility testing of M. morganii isolates showed universal resistance to cephalothin, and high resistance rates to cefuroxime (90.5%) and amoxicillin-clavulanate (95.9%). In contrast to 95.8% of the M. morganii isolates being ceftazidime-susceptible, 19.4% were imipenem-resistant. Univariate analyses showed that fatal cases had significantly higher rates of diabetes mellitus (50% vs 20%, p=0.010), polymicrobial bacteremia (64.2% vs 33.3%, p=0.015) and inappropriate antibiotic treatment (67.8% vs 26.6%, p=0.001). Multivariate analysis indicated that inappropriate antibiotic treatment (odds ratio, 4.8, p=0.002) was the only independent risk factor for mortality. M. morganii bacteremia frequently occurred secondary to urinary tract or hepatobiliary tract infection, and was associated with a high mortality rate, especially for those not receiving appropriate antibiotic therapy.Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 09/2006; 39(4):328-34. · 1.63 Impact Factor
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ABSTRACT: Stenotrophomonas maltophilia is an important nosocomial pathogen with intrinsic multi-drug resistance. This retrospective study reviewed 84 episodes of S. maltophilia bacteremia over a 4-year period from July 1999 to September 2003. Stenotrophomonas maltophilia bacteremia was hospital-acquired in 64 patients (76%), and developed after prolonged hospitalization in 48 (57%). Seventy patients (83%) had a central venous catheter (CVC), 64 (76%) had prior antibiotic therapy, 55 (65%) had underlying malignancy, and 43 (51%) were receiving immunosuppressive therapy. Twenty seven percent of the episodes of bacteremia had polymicrobial isolates. The overall and bacteremia-related mortality rates were 44% and 33%, respectively. Forty six percent of the bacteremia-related mortality occurred within 3 days after onset of symptoms. The most common sources of bacteremia were respiratory tract (33%) and CVC (31%), while the source of the bacteremia was unknown in 26% of episodes. The most effective antibiotics in vitro were trimethoprim-sulfamethoxazole, ciprofloxacin, chloramphenicol, and ceftazidime; however, a trend of increasing drug resistance in these agents was identified over the study period. On univariate analysis, nosocomial bacteremia, long-lasting neutropnenia (>10 days), bacteremia originating from the respiratory tract, shock, low serum albumin level (<3 g/dL), and thrombocytopenia (platelet count <100,000/mm3) were significantly related to mortality (p<0.05). Among these variables, shock and thrombocytopenia were independent factors associated with mortality. In contrast, patients with CVC-related bacteremia had a lower mortality rate (odds ratio, 0.04; p<0.001). Patients treated with appropriate antibiotics had a lower mortality rate, but this difference was not significant (p=0.477). In S. maltophilia bacteremia, careful evaluation of CVC was important for identifying the source of bacteremia and predicting prognosis. The source of bacteremia and condition of patients at presentation were the major factors influencing prognosis.Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2004; 37(6):350-8. · 1.63 Impact Factor