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Multicenter Study
. 2012 Mar;56(3):1265-72.
doi: 10.1128/AAC.05991-11. Epub 2011 Dec 12.

Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections

Carmen Peña  1 , Cristina Suarez, Mónica Gozalo, Javier Murillas, Benito Almirante, Virginia Pomar, Manuela Aguilar, Ana Granados, Esther Calbo, Jesús Rodríguez-Baño, Fernando Rodríguez, Fe Tubau, Luis Martínez-Martínez, Antonio Oliver; Spanish Network for Research in Infectious Diseases REIPI
Collaborators, Affiliations
Multicenter Study

Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections

Carmen Peña et al. Antimicrob Agents Chemother. 2012 Mar.

Abstract

The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.

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Figures

Fig 1
Fig 1
Episodes of bacteremia due to P. aeruginosa at participating hospitals.
Fig 2
Fig 2
Kaplan-Meier survival curves of carbapenem-resistant and carbapenem-susceptible P. aeruginosa bacteremias (P = 0.10 by log rank test).
See this image and copyright information in PMC

References

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