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Derin O, Şahin M, Dumlu R, Başgönül S, Bayrak AD, Arduç Ş, Bayram S, Mikaliyova N, Kantürk A, Öncül A, Yıldız Sevgi D, Gençer S, Bayraktar B, Dökmetaş İ, Mert A. 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. Antibiotics (Basel) 2024; 13:90. [PMID: 38247649 PMCID: PMC10812563 DOI: 10.3390/antibiotics13010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
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.
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Affiliation(s)
- Okan Derin
- Graduate School of Health Sciences, Epidemiology Doctorate Program, Istanbul Medipol University, 34815 Istanbul, Turkey
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Infectious Diseases and Clinical Microbiology, 34396 Istanbul, Turkey; (A.D.B.); (A.Ö.); (D.Y.S.); (İ.D.)
| | - Meyha Şahin
- Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, 34214 Istanbul, Turkey; (M.Ş.); (N.M.)
| | - Rıdvan Dumlu
- Istanbul Prof. Dr. Cemil Taşçıoğlu Training and Research Hospital, Infectious Diseases and Clinical Microbiology, 34384 Istanbul, Turkey; (R.D.); (S.B.); (A.K.)
| | - Sedef Başgönül
- Department of Infectious Diseases and Clinical Microbiology, Acıbadem Mehmet Ali Aydınlar University, 34752 Istanbul, Turkey; (S.B.); (S.G.)
| | - Ahmet Doğukan Bayrak
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Infectious Diseases and Clinical Microbiology, 34396 Istanbul, Turkey; (A.D.B.); (A.Ö.); (D.Y.S.); (İ.D.)
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
| | - Şevval Arduç
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Microbiology and Clinical Microbiology, 34396 Istanbul, Turkey
| | - Sümeyye Bayram
- Istanbul Prof. Dr. Cemil Taşçıoğlu Training and Research Hospital, Infectious Diseases and Clinical Microbiology, 34384 Istanbul, Turkey; (R.D.); (S.B.); (A.K.)
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
| | - Nurlana Mikaliyova
- Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, 34214 Istanbul, Turkey; (M.Ş.); (N.M.)
| | - Arzu Kantürk
- Istanbul Prof. Dr. Cemil Taşçıoğlu Training and Research Hospital, Infectious Diseases and Clinical Microbiology, 34384 Istanbul, Turkey; (R.D.); (S.B.); (A.K.)
| | - Ahsen Öncül
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Infectious Diseases and Clinical Microbiology, 34396 Istanbul, Turkey; (A.D.B.); (A.Ö.); (D.Y.S.); (İ.D.)
| | - Dilek Yıldız Sevgi
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Infectious Diseases and Clinical Microbiology, 34396 Istanbul, Turkey; (A.D.B.); (A.Ö.); (D.Y.S.); (İ.D.)
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
| | - Serap Gençer
- Department of Infectious Diseases and Clinical Microbiology, Acıbadem Mehmet Ali Aydınlar University, 34752 Istanbul, Turkey; (S.B.); (S.G.)
| | - Banu Bayraktar
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Microbiology and Clinical Microbiology, 34396 Istanbul, Turkey
| | - İlyas Dökmetaş
- Istanbul Şişli Hamidiye Etfal Training and Research Hospital Infectious Diseases and Clinical Microbiology, 34396 Istanbul, Turkey; (A.D.B.); (A.Ö.); (D.Y.S.); (İ.D.)
- Hamidiye Faculty of Health Sciences, University of Health Sciences, 34668 Istanbul, Turkey; (Ş.A.); (B.B.)
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University, 34815 Istanbul, Turkey
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Puech B, Canivet C, Teysseyre L, Miltgen G, Aujoulat T, Caron M, Combe C, Jabot J, Martinet O, Allyn J, Ferdynus C, Allou N. Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia. Ann Intensive Care 2021; 11:160. [PMID: 34825962 PMCID: PMC8626555 DOI: 10.1186/s13613-021-00950-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. RESULTS This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43-73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5-18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01-1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03-1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24-0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28-0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). CONCLUSION In our study, appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.
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Affiliation(s)
- Bérénice Puech
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Clémence Canivet
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Laura Teysseyre
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Guillaume Miltgen
- Service de Microbiologie, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, France
| | - Thomas Aujoulat
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Margot Caron
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Chloé Combe
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Julien Jabot
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Olivier Martinet
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Jerome Allyn
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
- Département d’Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Cyril Ferdynus
- Département d’Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
- Département d’Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400 Saint Denis, France
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Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Abdel Fattah M, Haquin J, MacGowan A, Grier S, Gibbs J, Chazan B, Yanovskay A, Ami RB, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Rodriguez-Bano J, Morales I, Oliver A, Ruiz de Gopegui E, Cano A, Machuca I, Gozalo-Marguello M, Martinez LM, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstein Y, Leibovici L, Yahav D. Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study. J Antimicrob Chemother 2021; 76:2172-2181. [PMID: 33993273 DOI: 10.1093/jac/dkab134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa bacteraemia is a common and serious infection. No consensus exists regarding whether definitive combination therapy is superior to monotherapy. We aimed to evaluate the impact of combination therapy on mortality. METHODS This was a multicentre retrospective study (nine countries, 25 centres), including 1277 patients with P. aeruginosa bacteraemia during 2009-15. We evaluated the association between β-lactam plus aminoglycoside or quinolone combination therapy versus β-lactam monotherapy and mortality. The primary outcome was 30 day all-cause mortality. Univariate and multivariate Cox regression analyses were conducted, introducing combination as a time-dependent variable. Propensity score was conducted to adjust for confounding for choosing combination therapy over monotherapy. RESULTS Of 1119 patients included, 843 received definitive monotherapy and 276 received combination therapy (59% aminoglycoside and 41% quinolone). Mortality at 30 days was 16.9% (189/1119) and was similar between combination (45/276; 16.3%) and monotherapy (144/843; 17.1%) groups (P = 0.765). In multivariate Cox regression, combination therapy was not associated with reduced mortality (HR 0.98, 95% CI 0.64-1.53). No advantage in terms of clinical failure, microbiological failure or recurrent/persistent bacteraemia was demonstrated using combination therapy. Likewise, adverse events and resistance development were similar for the two regimens. CONCLUSIONS In this retrospective cohort, no mortality advantage was demonstrated using combination therapy over monotherapy for P. aeruginosa bacteraemia. Combination therapy did not improve clinical or microbiological failure rates, nor affect adverse events or resistance development. Our finding of no benefit with combination therapy needs confirmation in well-designed randomized controlled trials.
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Affiliation(s)
- Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Manal Abdel Fattah
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Justine Haquin
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Alasdair MacGowan
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Sally Grier
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Julie Gibbs
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ronen Ben Ami
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Landes
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Susanna Mauer
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Jesus Rodriguez-Bano
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Isabel Morales
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Antonio Oliver
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Enrique Ruiz de Gopegui
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain
| | | | - Luis Martinez Martinez
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Ljubljana; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Virginie Vitrat
- Infectious Diseases Unit, Annecy-Genevois Hospital Center (CHANGE), Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yulia Weissman
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Leonard Leibovici
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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