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Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria.

Publication ,  Journal Article
Thaden, JT; Park, LP; Maskarinec, SA; Ruffin, F; Fowler, VG; van Duin, D
Published in: Antimicrob Agents Chemother
June 2017

The impact of bacterial species on outcome in bloodstream infections (BSI) is incompletely understood. We evaluated the impact of bacterial species on BSI mortality, with adjustment for patient, bacterial, and treatment factors. From 2002 to 2015, all adult inpatients with monomicrobial BSI caused by Staphylococcus aureus or Gram-negative bacteria at Duke University Medical Center were prospectively enrolled. Kaplan-Meier curves and multivariable Cox regression with propensity score models were used to examine species-specific bacterial BSI mortality. Of the 2,659 enrolled patients, 999 (38%) were infected with S. aureus, and 1,660 (62%) were infected with Gram-negative bacteria. Among patients with Gram-negative BSI, Enterobacteriaceae (81% [1,343/1,660]) were most commonly isolated, followed by non-lactose-fermenting Gram-negative bacteria (16% [262/1,660]). Of the 999 S. aureus BSI isolates, 507 (51%) were methicillin resistant. Of the 1,660 Gram-negative BSI isolates, 500 (30%) were multidrug resistant. The unadjusted time-to-mortality among patients with Gram-negative BSI was shorter than that of patients with S. aureus BSI (P = 0.003), due to increased mortality in patients with non-lactose-fermenting Gram-negative BSI generally (P < 0.0001) and Pseudomonas aeruginosa BSI (n = 158) in particular (P < 0.0001). After adjustment for patient demographics, medical comorbidities, bacterial antibiotic resistance, timing of appropriate antibiotic therapy, and source control in patients with line-associated BSI, P. aeruginosa BSI remained significantly associated with increased mortality (hazard ratio = 1.435; 95% confidence interval = 1.043 to 1.933; P = 0.02). P. aeruginosa BSI was associated with increased mortality relative to S. aureus or other Gram-negative BSI. This effect persisted after adjustment for patient, bacterial, and treatment factors.

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Published In

Antimicrob Agents Chemother

DOI

EISSN

1098-6596

Publication Date

June 2017

Volume

61

Issue

6

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Prospective Studies
  • Microbiology
  • Humans
  • Gram-Negative Bacteria
  • Enterobacteriaceae
  • Bacteremia
  • 3214 Pharmacology and pharmaceutical sciences
 

Citation

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Thaden, J. T., Park, L. P., Maskarinec, S. A., Ruffin, F., Fowler, V. G., & van Duin, D. (2017). Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria. Antimicrob Agents Chemother, 61(6). https://doi.org/10.1128/AAC.02671-16
Thaden, Joshua T., Lawrence P. Park, Stacey A. Maskarinec, Felicia Ruffin, Vance G. Fowler, and David van Duin. “Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria.Antimicrob Agents Chemother 61, no. 6 (June 2017). https://doi.org/10.1128/AAC.02671-16.
Thaden, Joshua T., et al. “Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria.Antimicrob Agents Chemother, vol. 61, no. 6, June 2017. Pubmed, doi:10.1128/AAC.02671-16.

Published In

Antimicrob Agents Chemother

DOI

EISSN

1098-6596

Publication Date

June 2017

Volume

61

Issue

6

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Pseudomonas Infections
  • Prospective Studies
  • Microbiology
  • Humans
  • Gram-Negative Bacteria
  • Enterobacteriaceae
  • Bacteremia
  • 3214 Pharmacology and pharmaceutical sciences