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. 2024 Jan 17;13(1):90.
doi: 10.3390/antibiotics13010090.

Registry-Based Retrospective Cohort Study of Mortality among Adults Admitted to Intensive Care Units in Istanbul with Hospital Acquired Pseudomonas aeruginosa Bloodstream-Infection between 2014-2021

Okan Derin  1   2 , Meyha Şahin  3 , Rıdvan Dumlu  4 , Sedef Başgönül  5 , Ahmet Doğukan Bayrak  2   6 , Şevval Arduç  6   7 , Sümeyye Bayram  4   6 , Nurlana Mikaliyova  3 , Arzu Kantürk  4 , Ahsen Öncül  2 , Dilek Yıldız Sevgi  2   6 , Serap Gençer  5 , Banu Bayraktar  6   7 , İlyas Dökmetaş  2   6 , Ali Mert  8
Affiliations

Registry-Based Retrospective Cohort Study of Mortality among Adults Admitted to Intensive Care Units in Istanbul with Hospital Acquired Pseudomonas aeruginosa Bloodstream-Infection between 2014-2021

Okan Derin et al. Antibiotics (Basel). .

Abstract

Background: Managing Pseudomonas aeruginosa bloodstream infections (BSIs) is challenging due to increasing antimicrobial resistance, limited therapeutic options, and high mortality rates. In this study, we aimed to identify 30-day mortality risk factors and assess infectious diseases consultants' preferences for combination or monotherapy.

Methods: The study was conducted in four hospitals in Istanbul, Turkey, involving 140 adult ICU beds and 336,780 ICU-bed-days between 1 January 2014, and 31 December 2021. A total of 157 patients were included in the study. Cox proportional hazard regression was performed to assess the factors on 30-day mortality.

Results: The 30-day mortality rate was 44.6% (70/157). Higher Charlson Comorbidity Index (CCI) score, severe sepsis, primary bloodstream infection, being in COVID-19 pandemic period, and infection caused by MDR strain were associated with higher hazard of 30-day mortality. Combination therapy was more commonly used in patients with BSIs with MDR or DTR (difficult-to-treat) strains but did not significantly improve the hazard of 30-day mortality.

Conclusions: Targeted interventions and vigilant management strategies are crucial for patients with defined risk factors. While infectious disease consultants tended to favor combination therapy, particularly for drug-resistant strains, our analysis revealed no significant impact on 30-day mortality hazard. The increased incidence of P. aeruginosa BSIs during the pandemic emphasizes the need for infection control measures and appropriate antibiotic prescribing practices.

Keywords: Pseudomonas; bloodstream infections; intensive-care units.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
Pseudomonas aeruginosa bloodstream infection total incidence (dots) in study centers between 2014–2021. Trend has been presented as dashed lines.
Figure 2
Figure 2
Resistance patterns of Pseudomonas aeruginosa isolated bloodstream infections in study centers. Note: Recently defined DTR pattern reflected backwards.
Figure 3
Figure 3
Kaplan–Meier survival analysis monotherapy vs. combination therapy stratified by MDR pattern. The dashed line in the ‘MDR’ group marks the median survival time.
Figure 4
Figure 4
The patient inclusion scheme.
See this image and copyright information in PMC

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