Pseudomonas aeruginosa bacteraemia: 303 cases
Abstract number: R2446
Ezpeleta C., Alava J., Unzaga J., Cabezas V., Busto C., Gomez E., Atutxa I., Cisterna R.
Objective:P. aeruginosa bacteraemia (PAB) is a serious infection associated with high mortality, being one of the most common nosocomial pathogen. Underlying diseases, source of infection and inappropriate antibiotic therapy are associated with mortality. The aim of this study is to asses clinical epidemiology of PAB in our hospital.
Methods: Prospective study of all patients with PAB. Study period Nov 1993-July 2007. Blood cultures are performed by means of BACTEC 9240. The Infection Control team studies every patient with positive blood cultures. Variables under surveillance are age, sex, underlying illnesses, predisposing conditions, source of bacteraemia, nosocomial/community acquired, antibiotic susceptibility, treatment and outcome. A computer based surveillance system (SEPSIS-DATA) is used.
Results: 303 cases, 203 males (67%). Age: 67.6% >60 years. Underlying illnesses: Neoplasia 42.24%, Diabetes 16.17%, COPD 13.2%, HIV 7.59%. Hospital acquired 48.84%. Source of bacteraemia: Primary 27.0%, Urinary tract 20.13%, Respiratory 21.12%, abdominal 11.22%, skin: 6.60%, Catheter related 5.94%, surgical site 2.64%. Predisposing conditions: mechanical ventilation 9.9%, ICU 11.5%, surgery 13.5%, urinary catheter 25.4%, antibiotic 48 h before bacteraemia: 40.59%, intravascular catheter 49.17%, immunosuppressive therapy 26.73%, neutropenia: 16.17%. Time to positivity of blood cultures 80.2% less than 48 h. Polymicrobial bacteraemia: 20.8%. Treatment and outcome: Inappropriate antibiotic therapy 20.1%. Crude mortality: 32.34%. Sensitivity to antibiotics: Amikacin 94.72%, Imipenem 90.76%, Ceftazidime 88.45%, Gentamicin 87.46%, and Ciprofloxacin 78.88%. Nosocomial bacteraemia: 148 cases, 63.5% males, 55.4% older than 60y. Underlying illnesses: neoplasia 45%, VIH 7.4%. Source of bacteraemia: primary 31.7%, urinary 18.9%, respiratory 18.24%, catheter related 10.14%, surgical site 5.4%, abdominal 8.11%. Crude mortality nosocomial acquired: 37%.
Conclusions: The incidence of Pseudomonas aeruginosa bacteraemia in our hospital remained stable over last years. Neoplasia was the most common underlying disease. The most active antibiotics are Amikacin, Imipenem and Ceftazidime. The rate of multidrug-resistant P. aeruginosa has increased in the last years. For these reasons, patients with Pseudomonas bacteraemia might receive empirical antibiotics that are inactive against Pseudomonas, especially before identification and antibiotic susceptibility results become available.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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