Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
J Antimicrob Chemother. 2019 Sep 1;74(9):2774-2783. doi: 10.1093/jac/dkz245.
To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality.
A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan-Meier survival analyses were performed to determine the mortality dynamics.
During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency.
BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.
评估铜绿假单胞菌血流感染（BSI）患者的死亡率动态变化，以及该微生物的 OprD 缺乏对早期死亡率的影响。
对 2016 年 5 月至 2017 年 4 月期间韩国 6 家综合医院的 120 例铜绿假单胞菌 BSI 患者进行了前瞻性多中心观察性研究。采用 PCR 和测序技术确定 oprD 改变和毒力因子的存在。Cox 回归分析用于估计各时间点死亡的危险因素，Kaplan-Meier 生存分析用于确定死亡率动态。
在 6 周的随访期间，10.8%（13/120）的铜绿假单胞菌 BSI 患者在 2 周内死亡，14.2%（17/120）在 4 周内死亡，20.0%（24/120）在 6 周内死亡，第 4 周到第 6 周之间累积生存率急剧下降。BSI 发病后任何时间的 ICU 入院和 SOFA 评分都是死亡的危险因素，6 周内 OprD 缺陷型铜绿假单胞菌感染导致死亡的风险倾向。在 120 株铜绿假单胞菌血分离株中，14 株为 XDR，9 株产生 IMP-6 或 VIM-2 MBL，21 株 OprD 缺乏。
与 OprD 完整的铜绿假单胞菌 BSI 相比，OprD 缺陷型铜绿假单胞菌 BSI 导致 6 周死亡率增加 2 倍（33.3%），可能是由于对碳青霉烯类药物的敏感性降低和细菌在临床环境中的持续存在。
