期刊
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
卷 52, 期 2, 页码 172-179出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.ijantimicag.2018.03.018
关键词
Pseudomonas aeruginosa; Multidrug-resistant; High-risk clones; Virulence; Bacteraemia; Mortality
资金
- Plan Nacional de I + D + i
- Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia y Competitividad (Spanish Network for Research in Infectious Diseases) [REIPI RD 16/0016]
- European Development Regional Fund (ERDF)
- Rio Hortega fellowship grant (Instituto de Salud Carlos III)
Predictors of mortality and the impact of multidrug resistance and virulence on patients with Pseudomonas aeruginosa (PA) bacteraemia were evaluated. Patients with PA bacteraemia in a 12-month period were retrospectively analysed. Carbapenemase production, molecular typing and identification of virulence factor ExoU were carried out. The activity of ceftolozane-tazobactam and ceftazidime-avibactam was also investigated. The primary endpoint was 30-day crude mortality. Of 64 patients with bacteraemia, 24 (37.5%) were caused by extensively drug-resistant PA (XDR-PA): 10 (41.7%) cases involved the VIM-2 carbapenemase-producing ST175 clone, 11 (45.8%) the GES-5 carbapenemase-producing ST235 clone, and 3 (12.5%) were non-carbapenemase producers. The exoU genotype was detected in all ST235 strains and in 6 (15%) of the non-XDR isolates. Ceftazidime-avibactam (58.3%) showed greater activity than ceftolozane-tazobactam (12.5%) against XDR-PA isolates, particularly in GES-5 producers (100%). The 30-day crude mortality rate in patients with XDR-PA bacteraemia was higher than in cases caused by susceptible strains (62.5% vs. 30%; P = 0.02). Multivariate analysis showed that independent risk factors associated with 30-day crude mortality were Pitt score >= 2 (OR, 42.31; 95% CI, 4.88-366.7; P = 0.001) and respiratory source of bacteraemia (OR, 49.13; 95% CI 3.89-620.5; P = 0.003). Stratified analysis adjusting for respiratory source revealed a non-significant trend towards higher mortality in patients with bacteraemia caused by the ST235 clone and exo U-producing isolates. These data support the notion that the XDR phenotype associated with the GES-5 carbapenemase-producing ST235 clone and the exoU-positive genotype adversely affects the outcome of patients with PA bacteraemia, particularly those with respiratory tract infections and a severe clinical presentation. (c) 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
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