Skip to main content

Advertisement

SpringerLink
Log in

Risk factors associated with unfavorable short-term treatment outcome in patients with documented Pseudomonas aeruginosa infection

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Invasive infections with Pseudomonas aeruginosa (PA) are associated with significant morbidity and mortality. While risk factors for mortality have been identified, their influence on short-term outcomes impacting treatment selection has not been reported. Objectives The objective of this study was to evaluate the relationship between select patient- and treatment-related factors and short-term outcomes in patients with PA pneumonia and/or bacteremia. Setting Large academic medical center in the United States. Methods This IRB-approved single-center, retrospective case-cohort study included patients >18 years of age with culture-confirmed PA bacteremia and/or pneumonia receiving antimicrobial agent(s) active against PA. Main Outcome Measure Risk of unfavorable short-term treatment result. Results The population consisted of 117 patients (40 [34 %] and 77 [66 %] in the unfavorable and not-unfavorable groups, respectively). Baseline characteristics including age (mean of 63 years), gender (55 % male), Charlson score, creatinine clearance, and body mass index were comparable between groups. Piperacillin/tazobactam was the most common monotherapy antibiotic (46 and 33 % in unfavorable and not-unfavorable groups, respectively). Combination therapy primarily consisted of a beta-lactam plus ciprofloxacin in both unfavorable (10 %) and not-unfavorable (20 %) outcome groups. The preliminary regression model indicated that SIRS, direct ICU admission, and vasopressor therapy were associated with an unfavorable outcome. In addition, patients who received more than two active antimicrobials had a reduced risk of an unfavorable outcome. The final regression model revealed that vasopressor therapy (odds ratio [OR] 6.0; 95 % confidence interval [95 % CI] 2.3, 17) was associated with an unfavorable outcome, while receipt of greater than two active antibiotics was associated with a reduced risk of an unfavorable outcome (OR 0.26; 95 % CI 0.07, 0.83). Conclusions Treatment with more than two agents with activity against PA was associated with a reduced risk of an unfavorable short-term treatment outcome in patients with bacteremia and/or pneumonia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Crit Care Med. 2007;35:1888–95.

    Article  CAS  PubMed  Google Scholar 

  2. 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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Morata L, Cobos-Trigueros N, Martínez JA, et al. Influence of multidrug resistance and appropriate empirical therapy on the 30-day mortality rate of Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother. 2012;56:4833–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.

  5. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Master RN, Clark RB, Karlowsky JA, Ramirez J, Bordon JM. Analysis of resistance, cross-resistance and antimicrobial combinations for Pseudomonas aeruginosa isolates from 1997 to 2009. Int J Antimicrob Agents. 2011;38:291–5.

    Article  CAS  PubMed  Google Scholar 

  7. Kang C-I, Kim S-H, Kim H-B, 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.

    Article  PubMed  Google Scholar 

  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  9. Peña C, Suarez C, Ocampo-Sosa A, et al. Effect of adequate single-drug vs combination antimicrobial therapy on mortality in Pseudomonas aeruginosa bloodstream infections: a post hoc analysis of a prospective cohort. Clin Infect Dis. 2013;57:208–16.

    Article  PubMed  Google Scholar 

  10. Petros AJ, Marshall JC, van Saene HKF. Should morbidity replace mortality as an endpoint for clinical trials in intensive care? Lancet. 1995;345:369–71.

    Article  CAS  PubMed  Google Scholar 

  11. Scheetz MH, Hoffman M, Bolon MK, et al. Morbidity associated with Pseudomonas aeruginosa bloodstream infections. Diagn Microbiol Infect Dis. 2009;64:311–9.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Tam VH, Rogers CA, Chang K-T, Weston JS, Caeiro J-P, Garey KW. Impact of multidrug-resistant Pseudomonas aeruginosa bacteremia on patient outcomes. Antimicrob Agents Chemother. 2010;54:3717–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Giamarellou H. Prescribing guidelines for severe Pseudomonas infections. J Antimicrob Chemother. 2002;49:229–33.

    Article  CAS  PubMed  Google Scholar 

  14. Kumar A, Ellis P, Arabi Y, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–48.

    PubMed  Google Scholar 

  15. Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum β-lactamase–producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc. 2011;86:250–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Chamot E, Boffi El Amari E, Rohner P, Van Delden C. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother. 2003;47:2756–64.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Brunkhorst FM, Oppert M, Marx G, et al. Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial. JAMA. 2012;307:2390–9.

    Article  CAS  PubMed  Google Scholar 

  18. Dundar D, Otkun M. In-vitro efficacy of synergistic antibiotic combinations in multidrug resistant Pseudomonas aeruginosa strains. Yonsei Med J. 2010;51:111–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Dubois V, Arpin C, Melon M, et al. Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12: efficacy of cefepime–amikacin therapy and analysis of β-lactam resistance. J Clin Microbiol. 2001;39:2072–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Louie A, Grasso C, Bahniuk N, et al. The combination of meropenem and levofloxacin is synergistic with respect to both Pseudomonas aeruginosa kill rate and resistance suppression. Antimicrob Agents Chemother. 2010;54:2646–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Christoff J, Tolentino J, Mawdsley E, Matushek S, Pitrak D, Weber SG. Optimizing empirical antimicrobial therapy for infection due to gram-negative pathogens in the intensive care unit: utility of a combination antibiogram. Infect Control Hosp Epidemiol. 2010;31:256–61.

    Article  PubMed  Google Scholar 

  22. Vincent J-L, Ince C, Bakker J. Clinical review: circulatory shock—an update: a tribute to professor Max Harry Weil. Crit Care. 2012;16:239.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Melissa Johnson, PharmD, AAHIVP for her contribution regarding the statistical analysis used for this project.

Funding

This research was conducted without special funding.

Conflicts of interest

Authors of this manuscript have no relevant disclosers concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this publication.

Author information

Authors and Affiliations

  1. Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, P.O. Box 1090, Buies Creek, NC, 27506, USA

    V. Paul DiMondi & Mary L. Townsend

  2. Department of Pharmacy, Durham VA Medical Center, 508 Fulton Street, Durham, NC, 27705, USA

    Mary L. Townsend

  3. Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, 27506, USA

    Richard H. Drew

  4. Duke University School of Medicine, Duke Medical Center, 169 Hanes House, Box 102359, Durham, NC, 27710, USA

    Richard H. Drew

Authors
  1. V. Paul DiMondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary L. Townsend
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard H. Drew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Paul DiMondi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DiMondi, V.P., Townsend, M.L. & Drew, R.H. Risk factors associated with unfavorable short-term treatment outcome in patients with documented Pseudomonas aeruginosa infection. Int J Clin Pharm 37, 348–354 (2015). https://doi.org/10.1007/s11096-015-0067-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-015-0067-6

Keywords

Search

Navigation