Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy.

Autor: Royo-Cebrecos C; Internal Medicine Department, Hospital Nostra Senyora de Meritxell, SAAS, AD700 Escaldes-Engordany, Andorra., Laporte-Amargós J; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain., Peña M; Haematology Department, Institute Català d'Oncologia (ICO)-Hospital Duran i Reynals, IDIBELL, 08908 Barcelona, Spain., Ruiz-Camps I; Infectious Diseases Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain., Garcia-Vidal C; Infectious Diseases Department, Hospital Clínic i Provincial, 08036 Barcelona, Spain., Abdala E; Instituto do Cancer do Estado de São Paulo, Faculty of Medicine, Univesity of São Paulo, Sao Paulo 01246, Brazil., Oltolini C; Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy., Akova M; Department of Infectious Diseases, Hacettepe University School of Medicine, 06100 Ankara, Turkey., Montejo M; Infectious Diseases Unit, Cruces University Hospital, 48903 Bilbao, Spain., Mikulska M; Division of Infectious Diseases, Ospedale Policlinico San Martino, University of Genoa (DISSAL), 16132 Genoa, Italy., Martín-Dávila P; Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain., Herrera F; Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1430EFA, Argentina., Gasch O; Infectious Diseases Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain., Drgona L; Oncohematology Department, National Cancer Institute, Comenius University, 81499 Bratislava, Slovakia., Morales HMP; Infectious Diseases Department, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil., Brunel AS; Infectious Diseases and Medicine Department, Lausanne University Hospital, CHUV, 1011 Lausanne, Switzerland., García E; Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain., Isler B; Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, 34668 Istanbul, Turkey., Kern WV; Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg Medical Center, 79110 Freiburg, Germany., Palacios-Baena ZR; Unit of Infectious Diseases and Clinical Microbiology, Institute of Biomedicine of Seville (IBIS), Virgen Macarena University Hospital, 41013 Seville, Spain., de la Calle GM; Infectious Diseases Unit, Instituto de Investigación Hospital '12 de Octubre' (i + 12), School of Medicine, '12 de Octubre' University Hospital, Universidad Complutense, 28041 Madrid, Spain., Montero MM; Infectious Pathology and Antimicrobials Research Group (IPAR), Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d'Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain., Kanj SS; Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon., Sipahi OR; Faculty of Medicine, Ege University, 35040 Izmir, Turkey., Calik S; Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, 35170 Izmir, Turkey., Márquez-Gómez I; Infectious Diseases Department, Hospital Regional de Málaga, 29010 Málaga, Spain., Marin JI; Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Manizales 170001-17, Colombia., Gomes MZR; Hospital Federal dos Servidores do Estado, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro 20221-161, Brazil., Hemmatii P; Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany., Araos R; Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago de Chile 12461, Chile., Peghin M; Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21100 Varese, Italy., Del Pozo JL; Infectious Diseases and Microbiology Unit, Navarra University Clinic, 31008 Pamplona, Spain., Yáñez L; Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain., Tilley R; Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK., Manzur A; Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina., Novo A; Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain., Carratalà J; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain.; Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain., Gudiol C; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain.; Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain.
Jazyk: angličtina
Zdroj: Microorganisms [Microorganisms] 2024 Mar 30; Vol. 12 (4). Date of Electronic Publication: 2024 Mar 30.
DOI: 10.3390/microorganisms12040705
Abstrakt: This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.
Databáze: MEDLINE