Department of Clinical Microbiology, Instituto de Investigación Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain.
Department of Internal Medicine, Instituto de Investigación Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain.
J Glob Antimicrob Resist. 2022 Sep;30:269-275. doi: 10.1016/j.jgar.2022.06.026. Epub 2022 Jul 3.
To investigate the impact of the time-to-positivity of blood cultures (TTP) on 30-day mortality in patients with Pseudomonas aeruginosa bacteremia.
All nonduplicated episodes of P. aeruginosa monomicrobial bacteremia in adult patients from January 2013 to February 2020 were analysed. Epidemiological and clinical data were collected. TTP of blood cultures for P. aeruginosa isolates was automatically recorded. Multivariate analysis identified factors predicting 30-day overall mortality.
A total of 328 patients were identified. The median TTP for P. aeruginosa isolates was 15 h (interquartile range [IQR] 12-18 h). All multidrug-resistant and extensively drug-resistant (MDR/XDR) episodes were positive within the first 36 h. The 30-day mortality rate was 32.3%. The best cut-off value of the TTP for predicting mortality was 16 h (area under the receiver operating characteristic curve 0.62, 95% confidence interval [CI] 0.56-0.67, P = 0.001). The 30-day mortality rate was significantly higher in the TTP ≤16 h group (41.0% vs. 19.5%, P < 0.001). In a multivariate analysis, severe neutropenia (adjusted odds ratio [aOR] 2.67, 95% CI 1.4-5.09, P = 0.002), septic shock (aOR 3.21, 95% CI 1.57-5.89, P < 0.001), respiratory source (aOR 4.37, 95% CI 2.24-8.52, P < 0.001), nosocomial acquisition (aOR 1.99, 95% CI 1.06-3.71, P = 0.030), TTP ≤16 h (aOR 2.27, 95% CI 2.12-4.25, P = 0.010), and MDR/XDR phenotype (aOR 2.54, 95% CI 1.38-4.67, P = 0.002) were independently associated with 30-day mortality.
A short TTP (≤16 h) was independently associated with increased 30-day mortality. After local validation, this routinely available microbiological parameter might be useful for guiding empirical antipseudomonal therapies and supporting the close monitoring of patients with P. aeruginosa bacteremia.
探讨血培养阳性时间（TTP）对铜绿假单胞菌菌血症患者 30 天死亡率的影响。
分析 2013 年 1 月至 2020 年 2 月成人患者中单一致病菌铜绿假单胞菌菌血症的所有非重复发作。收集流行病学和临床数据。自动记录血培养铜绿假单胞菌分离株的 TTP。多变量分析确定预测 30 天总死亡率的因素。
共确定 328 例患者。铜绿假单胞菌分离株的中位 TTP 为 15 小时（四分位距 [IQR] 12-18 小时）。所有耐多药和广泛耐药（MDR/XDR）发作均在最初 36 小时内呈阳性。30 天死亡率为 32.3%。预测死亡率的 TTP 最佳截断值为 16 小时（受试者工作特征曲线下面积 0.62，95%置信区间 [CI] 0.56-0.67，P=0.001）。TTP≤16 小时组的 30 天死亡率显著更高（41.0% vs. 19.5%，P<0.001）。多变量分析显示，严重中性粒细胞减少症（调整比值比 [aOR] 2.67，95%CI 1.4-5.09，P=0.002）、感染性休克（aOR 3.21，95%CI 1.57-5.89，P<0.001）、呼吸道来源（aOR 4.37，95%CI 2.24-8.52，P<0.001）、医院获得性感染（aOR 1.99，95%CI 1.06-3.71，P=0.030）、TTP≤16 小时（aOR 2.27，95%CI 2.12-4.25，P=0.010）和 MDR/XDR 表型（aOR 2.54，95%CI 1.38-4.67，P=0.002）与 30 天死亡率独立相关。
较短的 TTP（≤16 小时）与 30 天死亡率增加独立相关。经过当地验证后，这个常规可用的微生物学参数可能有助于指导经验性抗假单胞菌治疗，并支持对铜绿假单胞菌菌血症患者的密切监测。
