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. 2023 Jun 21:13:1156651.
doi: 10.3389/fcimb.2023.1156651. eCollection 2023.

Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa in patients with hematological diseases

Sisi Zhen  1   2 , Yuanqi Zhao  3 , Zhangjie Chen  1   2 , Tingting Zhang  1   2 , Jieru Wang  1   2 , Erlie Jiang  1   2 , Fengkui Zhang  1   2 , Yingchang Mi  1   2 , Xiaofan Zhu  1   2 , Mingzhe Han  1   2 , Zhijian Xiao  1   2 , Jianxiang Wang  1   2 , Sizhou Feng  1   2
Affiliations

Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa in patients with hematological diseases

Sisi Zhen et al. Front Cell Infect Microbiol. .

Abstract

Background: Infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are related to higher mortality. The objective of this study was to explore clinical outcomes of CRPA bacteremia, identify risk factors and also, compare the efficacy of traditional and novel antibiotic regimens.

Methods: This retrospective study was conducted at a blood diseases hospital in China. The study included hematological patients who were diagnosed with CRPA bacteremia between January 2014 and August 2022. The primary endpoint was all-cause mortality at day 30. Secondary endpoints included 7-day and 30-day clinical cure. Multivariable Cox regression analysis was employed to identify mortality-related risk factors.

Results: 100 patients infected with CRPA bacteremia were included and 29 patients accepted allogenic-hematopoietic stem cell transplantation. 24 received ceftazidime-avibactam (CAZ-AVI)-based therapy and 76 received other traditional antibiotics. 30-day mortality was 21.0%. Multivariable cox regression analysis showed neutropenia >7 days after bloodstream infections (BSI) (P=0.030, HR: 4.068, 95%CI: 1.146~14.434), higher Pitt bacteremia score (P<0.001, HR:1.824, 95%CI: 1.322~2.517), higher Charlson comorbidity index (P=0.01, HR: 1.613, 95%CI: 1.124~2.315) and bacteremia due to multidrug-resistant Pseudomonas aeruginosa (MDR-PA) (P=0.024, HR:3.086, 95%CI: 1.163~8.197) were identified as independent risk factors of 30-day mortality. After controlling for confounders, an additional multivariable cox regression analysis revealed definitive regimens containing CAZ-AVI were associated with lower mortality in CRPA bacteremia (P=0.016, HR: 0.150, 95%CI: 0.032~0.702), as well as in MDR-PA bacteremia (P=0.019, HR: 0.119, 95%CI: 0.020~0.709).

Conclusions: For patients with hematological diseases and CRPA bacteremia, 30-day mortality rate was 21.0% (21/100). Neutropenia >7 days after BSI, higher Pitt bacteremia score, higher Charlson comorbidity index and bacteremia due to MDR-PA increased 30-day mortality. CAZ-AVI-based regimens were effective alternatives for bacteremia due to CRPA or MDR-PA.

Keywords: bacteremia; carbapenem-resistant Pseudomonas aeruginosa; ceftazidime-avibactam; hematological diseases; multidrug-resistant Pseudomonas aeruginosa.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study Flow Chart. CRPA, carbapenem-resistant Pseudomonas aeruginosa; BSI, bloodstream infections; MDR-PA, multidrug-resistant Pseudomonas aeruginosa; DTR-PA, difficult to treat Pseudomonas aeruginosa.
Figure 2
Figure 2
Susceptibility of CRPA to Antimicrobial Agents. CRPA, carbapenem-resistant Pseudomonas aeruginosa; CAZ-AVI, ceftazidime-avibactam.
Figure 3
Figure 3
Survival Rates of CRPA BSI Patients (n=100). CRPA, carbapenem-resistant Pseudomonas aeruginosa; BSI, bloodstream infections; MDR-PA, multidrug-resistant Pseudomonas aeruginosa; CAZ-AVI, ceftazidime-avibactam.
Figure 4
Figure 4
Survival Rates of MDR-PA BSI Patients (n=45). MDR-PA, multidrug-resistant Pseudomonas aeruginosa; BSI, bloodstream infections; CAZ-AVI, ceftazidime-avibactam.
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