Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Antimicrob Resist Infect Control. 2020 Feb 3;9(1):25. doi: 10.1186/s13756-020-0682-4.
Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day in-hospital all-cause mortality in patients with Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) bacteremia compared to patients with VIM-negative, carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia. Second, we identified determinants for mortality and survival.
All patients with a positive blood culture with VIM-PA or CS-PA between January 2004 and January 2016 were included. Kaplan-Meier survival curves were constructed, and survivors and non-survivors were compared on relevant clinical parameters using univariate analyses, and multivariable analyses using a Cox-proportional hazard model.
In total, 249 patients were included, of which 58 (23.3%) died. Seventeen out of 40 (42.5%) patients with VIM-PA died, compared to 41 out of 209 (19.6%) patients with CS-PA (difference = 22.9%, P-value = 0.001). Assumed acquisition of the bacterium at the intensive care unit was significantly associated with mortality (HR = 3.32, 95%CI = 1.60-6.87), and having had adequate antibiotic therapy in days 1-14 after the positive blood culture was identified as a determinant for survival (HR = 0.03, 95%CI = 0.01-0.06). VIM-PA vs CS-PA was not identified as an independent risk factor for mortality.
The crude mortality rate was significantly higher in patients with a VIM-PA bacteremia compared to patients with a CS-PA bacteremia; however, when analyzing the data in a multivariable model this difference was non-significant. Awareness of the presence of P. aeruginosa in the hospital environment that may be transmitted to patients and rapid microbiological diagnostics are essential for timely administration of appropriate antibiotics. Acquisition of P. aeruginosa should be prevented, independent of resistance profile.
多项革兰氏阴性菌研究表明，对碳青霉烯类抗生素的耐药性导致耐碳青霉烯类铜绿假单胞菌（VIM-PA）菌血症患者的死亡率增加；然而，结果并不确定。我们首先评估了 Verona 整合子编码的金属β-内酰胺酶阳性铜绿假单胞菌（VIM-PA）菌血症患者与 VIM 阴性、碳青霉烯类敏感铜绿假单胞菌（CS-PA）菌血症患者的 28 天院内全因死亡率。其次，我们确定了死亡率和生存的决定因素。
纳入 2004 年 1 月至 2016 年 1 月期间血培养阳性的 VIM-PA 或 CS-PA 的所有患者。绘制 Kaplan-Meier 生存曲线，使用单因素分析比较存活者和非存活者的相关临床参数，使用 Cox 比例风险模型进行多因素分析。
共纳入 249 例患者，其中 58 例（23.3%）死亡。40 例 VIM-PA 患者中有 17 例（42.5%）死亡，209 例 CS-PA 患者中有 41 例（19.6%）死亡（差异=22.9%，P 值=0.001）。假设在重症监护病房获得细菌与死亡率显著相关（HR=3.32，95%CI=1.60-6.87），并且在血培养阳性后 1-14 天接受适当的抗生素治疗是生存的决定因素（HR=0.03，95%CI=0.01-0.06）。VIM-PA 与 CS-PA 未被确定为死亡率的独立危险因素。
VIM-PA 菌血症患者的粗死亡率明显高于 CS-PA 菌血症患者；然而，在多变量模型中分析数据时，这种差异无统计学意义。认识到医院环境中可能传播给患者的铜绿假单胞菌的存在以及快速的微生物学诊断对于及时给予适当的抗生素至关重要。应预防铜绿假单胞菌的获得，而不考虑其耐药谱。
