Abstract
Background
P. aeruginosa bacteremia is a common and severe infection carrying high mortality in older adults. We aimed to evaluate outcomes of P. aeruginosa bacteremia among old adults (≥ 80 years).
Methods
We included the 464/2394 (19%) older adults from a retrospective multinational (9 countries, 25 centers) cohort study of individuals hospitalized with P. aeruginosa bacteremia. Bivariate and multivariable logistic regression models were used to evaluate risk factors for 30-day mortality among older adults.
Results
Among 464 adults aged ≥ 80 years, the mean age was 84.61 (SD 3.98) years, and 274 (59%) were men. Compared to younger patients, ≥ 80 years adults had lower Charlson score; were less likely to have nosocomial acquisition; and more likely to have urinary source. Thirty-day mortality was 30%, versus 27% among patients 65–79 years (n = 894) and 25% among patients < 65 years (n = 1036). Multivariate analysis for predictors of mortality among patients ≥ 80 years, demonstrated higher SOFA score (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.23–1.51, p < 0.001), corticosteroid therapy (OR 3.15, 95% CI: 1.24–8.01, p = 0.016) and hospital acquired P. aeruginosa bacteremia (OR 2.30, 95% CI: 1.33–3.98, p = 0.003) as predictors. Appropriate empirical therapy within 24 h, type of definitive anti-pseudomonal drug, and type of regimen (monotherapy or combination) were not associated with 30-day mortality.
Conclusions
In older adults with P. aeruginosa bacteremia, background conditions, place of acquisition, and disease severity are associated with mortality, rather than the antimicrobial regimen. In this regard, preventive efforts and early diagnosis before organ failure develops might be beneficial for improving outcomes.
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Data availability statement
Data are available.
Change history
19 January 2023
In this article the title was incorrectly given as ‘Outcomes of octogenarians and nonactogenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study’ but should have been ‘Outcomes of octogenarians and nonagenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study’.
References
Gransden WR, Eykyn SJ, Phillips I. Septicaemia in the newborn and elderly. J Antimicrob Chemother. 1994;34:101–19.
Meyers BR, Sherman E, Mendelson MH, et al. Bloodstream infections in the elderly. Am J Med. 1989;86:379–84.
Muder RR, Brennen C, Wagener MM, Goetz AM. Bacteremia in a long-term-care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis. 1992;14:647–54.
Rudman D, Hontanosas A, Cohen Z, Mattson DE. Clinical correlates of bacteremia in a Veterans Administration extended care facility. J Am Geriatr Soc. 1988;36:726–32.
Kang CI, Kim SH, Kim HB, Park SW, Choe YJ, Oh MD, 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;37:745–51.
Horino T, Chiba A, Kawano S, Kato T, Sato F, Maruyama Y, et al. Clinical characteristics and risk factors for mortality in patients with bacteremia caused by Pseudomonas aeruginosa. Intern Med. 2012;51:59–64.
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17.
Leibovici L, Samra Z, Konigsberger H, Drucker M, Ashkenazi S, Pitlik SD. Long-term survival following bacteremia or fungemia. JAMA. 1995;274:807–12.
Ammerlaan HS, Harbarth S, Buiting AG, Crook DW, Fitzpatrick F, Hanberger H, et al. Secular trends in nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection. Clin Infect Dis. 2013;56:798–805.
Aliaga L, Mediavilla JD, Cobo F. A clinical index predicting mortality with Pseudomonas aeruginosa bacteraemia. J Med Microbiol. 2002;51:615–701.
Lee CC, Lee CH, Hong MY. Risk factors and outcome of Pseudomonas aeruginosa bacteremia among adults visiting the ED. Am J Emerg Med. 2012;30:852–60.
Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother. 2005;49:1306–11.
Vidal F, Mensa J, Almela M, Martínez JA, Marco F, Casals C, et al. Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes. Arch Intern Med. 1996;156:2121–6.
Cheong HS, Kang CI, Wi YM, Ko KS, Chung DR, Lee NY, et al. Inappropriate initial antimicrobial therapy as a risk factor for mortality in patients with community-onset Pseudomonas aeruginosa bacteraemia. Eur J Clin Microbiol Infect Dis. 2008;27:1219–25.
Joo EJ, Kang CI, Ha YE, Kang SJ, Park SY, Chung DR, et al. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome. Microb Drug Resist. 2011;17:305–12.
Kim YJ, Jun YH, Kim YR, Park KG, Park YJ, Kang JY, et al. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy. BMC Infect Dis. 2014;14:161.
Schechner V, Gottesman T, Schwartz O, Korem M, Maor Y, Rahav G, et al. Pseudomonas aeruginosa bacteremia upon hospital admission: risk factors for mortality and influence of inadequate empirical antimicrobial therapy. Diagn Microbiol Infect Dis. 2011;71:38–45.
Su TY, Ye JJ, Hsu PC, Wu HF, Chia JH, Lee MH. Clinical characteristics and risk factors for mortality in cefepime-resistant Pseudomonas aeruginosa bacteremia. J Microbiol Immunol Infect. 2015;48:175–82.
Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007;23:633–47. https://doi.org/10.1016/j.cger.2007.05.003.
Richardson JP. Bacteremia in the elderly. J Gen Intern Med. 1993;8:89–92.
Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, et al. Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection: a multisite retrospective study. Clin Infect Dis. 2020;70:2270–80.
Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, et al. Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study. J Antimicrob Chemother. 2021;76:2172–81.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:762–74.
Tschudin-Sutter S, Fosse N, Frei R, Widmer AF. Combination therapy for treatment of Pseudomonas aeruginosa bloodstream infections. PLoS ONE. 2018;3:e0203295.
Shi Q, Huang C, Xiao T, et al. A retrospective analysis of Pseudomonas aeruginosa bloodstreaminfections: prevalence, risk factors, and outcome in carbapenem- susceptible and -non-susceptible infections. Antimicrob Resist Infect Control. 2019;8:68.
Pena C, Suarez C, Ocampo-Sosa A, et al. Effect of adequate single-drug vs combination antimicrobial therapy on mortality in Pseudomonas aeruginosa blood stream infections: a post hoc analysis of a prospective cohort. Clin Infect Dis. 2013;57:208–16.
Obodozie-Ofoegbu OO, Teng C, Mortensen EM, Frei CR. Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study. Am J Infect Control. 2019;47:1053–8.
Garrouste-Orgeas M, Timsit JF, Tafflet M, et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis. 2006;42:1118–26.
Leibovici L, Shraga I, Drucker M, et al. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med. 1998;244:379–86.
Osih RB, McGregor JC, Rich SE, Moore AC, Furuno JP, Perencevich EN, et al. Impact of empiric antibiotic therapy on outcomes in patients with Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother. 2007;51:839–44.
Lin MY, Weinstein RA, Hota B. Delay of active antimicrobial therapy and mortality among patients with bacteremia: impact of severe neutropenia. Antimicrob Agents Chemother. 2008;52:3188–94.
Babich T, Zusman O, Elbaz M, Ben-Zvi H, Paul M, Leibovici L, Avni T. Empirical antibiotic treatment does not improve outcomes in catheter-associated urinary tract infection: prospective cohort study. Clin Infect Dis. 2017;65:1799–805.
Schuttevaer R, Alsma J, Brink A, van Dijk W, de Steenwinkel JEM, Lingsma HF, et al. Appropriate empirical antibiotic therapy and mortality: conflicting data explained by residual confounding. PLoS ONE. 2019;14: e0225478.
Migiyama Y, Yanagihara K, Kaku N, Harada Y, Yamada K, Nagaoka K, et al. Pseudomonas aeruginosa bacteremia among immunocompetent and immunocompromised patients: relation to initial antibiotic therapy and survival. Jpn J Infect Dis. 2016;69:91–6.
Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, Pilcher DV, Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE). Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317:290–300.
Thomas TP. The complications of systemic corticosteroid therapy in the elderly. A retrospective study. Gerontology. 1984;30:60–5.
Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703. https://doi.org/10.1016/s0895-4356(97)00015-2.
Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis. 2019;38:743–6.
Saedi AA, Feehan J, Phu S, Duque G. Current and emerging biomarkers of frailty in the elderly. Clin Interv Aging. 2019;19:389–98.
Joseph JT, Roy SS, Shams N, Visintainer P, Wormser GP. A Collaborative approach intended to reduce the duration of short term urinary catheters in adult patients at a tertiary care medical center also significantly reduced the duration of hospitalization. Am J Infect Control. 2021;50:954–9.
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Study concept and design were done by AA, IM, and DY. Acquisition, analysis, and interpretation of data were done by all authors. Drafting the manuscript was done by AA and IM. Critical revision of the manuscript for important intellectual content was done by all authors.
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Atamna, A., Margalit, I., Ayada, G. et al. Outcomes of octogenarians and nonagenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study. Infection 51, 1003–1012 (2023). https://doi.org/10.1007/s15010-022-01973-x
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DOI: https://doi.org/10.1007/s15010-022-01973-x