Overview :

Kang et al identified risk factors associated with mortality in patients with bacteremia caused by Pseudomonas aeruginosa. This can help identify patients who may benefit from more aggressive management. The authors are from the Seoul National University School of Medicine in South Korea.

Age range of patients: 15-85 years (adolescent and adult)

Site of acquisition: 21% community, 79% nosocomial

Patient features:

(1) two thirds had solid or hematologic neoplasms

(2) about 30% were neutropenic

(3) 7% were receiving immunosuppressive therapy and 24% corticosteroids

Endpoint: 30 day mortality rate

Risk factors identified on multivariate analysis (Table 3, page 749):

(1) clinically severe sepsis (presentation in septic shock)

(2) presence of pneumonia

(3) receipt ineffective initial (empirical) antibiotic therapy

(4) receipt  ineffective definitive therapy

(5) increasing APACHE II score (risk increasing for each point increase)

An additional risk factor was a delay in instituting effective antibiotic therapy once the susceptibility results were available.

where:

• Patients were started on an empiric regimen that was modified after 48-72 hours depending on the clinical response of the patient and/or the susceptibility pattern for the blood culture isolate.

• Effective initial antimicrobial therapy was a regimen with antibiotics that later shown to be active against the blood culture isolate.

• Effective definitive antimicrobial therapy was a regimen with antipseudomonal antibiotics active against the blood culture isolate.

• The mortality rate for patients treated in the ICU was 71%.

• I could not find whether the APACHE II scores given in the table above (from Table 2, page 748) were on admission or maximum for the admission.

Kang C-I, Kim S-H, et al. Pseudomonas aeruginosa bacteremia: Risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis. 2003; 37: 745-751.