Corcione Silvia, Mornese Pinna Simone, Vena Antonio, Schenone Michela, Sanino Maura, Pascale Renato, Pivetta Emanuele, Giacobbe Daniele Roberto, Giannella Maddalena, Shbaklo Nour, Giovannenze Francesca, Geremia Nicholas, Mikulska Malgorzata, Bavaro Davide, Taddei Eleonora, Scaglione Vincenzo, Vassia Veronica, Fumarola Benedetta, Bartoletti Michele, Viale Pierluigi, Bassetti Matteo, Giuseppe De Rosa Francesco
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
Tufts University School of Medicine, Boston, MA, United States of America.
PLoS One. 2025 May 19;20(5):e0317540. doi: 10.1371/journal.pone.0317540. eCollection 2025.
This large, multicenter, Italian retrospective study aimed to describe clinical characteristics and risk factors associated with 30-day mortality in patients with Pseudomonas aeruginosa bloodstream infections (PA-BSI) admitted to internal medicine wards (IMW). To enhance clinical decision-making, we also developed and internally validated a bedside prognostic model to predict the 30-day mortality risk.
We conducted a retrospective, multicenter cohort study across 14 public hospitals in Italy, analyzing all adult patients admitted to IMW with PA-BSI between 2021 and 2022.
Out of 285 eligible patients with PA-BSI, the median age was 73 years, and septic shock occurred in 13.3% of cases. Less than 5% of PA-BSI were caused by difficult-to-treat resistant P. aeruginosa (DTR-PA). Encouragingly, appropriate empiric therapy was administered in 69.8% of patients, yet the overall 30-day mortality remained 22.5%. Cox regression analysis identified age, and urinary catheter use as significant risk factors for mortality. Conversely, adequate source control and targeted therapy emerged as protective factors. Multivariate analysis confirmed septic shock at bloodstream infection onset (HR 6.96; 95% CI, 1.72-28.12) as a strong independent predictor of mortality, whereas effective source control (HR 0.152; 95% CI, 0.039-0.59) significantly improved survival odds. Using these insights, we developed a practical prognostic model capable of estimating the 30-day mortality risk, providing clinicians with a valuable predictive tool at the bedside.
PA-BSI in IMWs is characterized by a relatively low incidence of septic shock and rate of resistance, alongside high rates of appropriate empiric therapy. Despite these favorable factors, meropenem may represent a valuable therapeutic option for PA-BSI with severe presentations in this setting since mortality remains substantial (22.5%). Our findings underscore the critical importance of early source control and identify septic shock as a key predictor of mortality even in the setting of IMW. The proposed bedside nomogram model could empower clinicians to identify high-risk patients early, facilitating timely interventions and improving outcomes in this vulnerable population.
这项大型、多中心的意大利回顾性研究旨在描述内科病房（IMW）收治的铜绿假单胞菌血流感染（PA-BSI）患者的临床特征及与30天死亡率相关的危险因素。为加强临床决策，我们还开发并在内部验证了一种床旁预后模型，以预测30天死亡风险。
我们在意大利的14家公立医院开展了一项回顾性多中心队列研究，分析了2021年至2022年间因PA-BSI入住IMW的所有成年患者。
在285例符合条件的PA-BSI患者中，中位年龄为73岁，13.3%的病例发生感染性休克。不到5%的PA-BSI由难治疗的耐药铜绿假单胞菌（DTR-PA）引起。令人鼓舞的是，69.8%的患者接受了适当的经验性治疗，但总体30天死亡率仍为22.5%。Cox回归分析确定年龄和使用导尿管是死亡率的重要危险因素。相反，充分的源头控制和靶向治疗是保护因素。多变量分析证实血流感染发作时的感染性休克（HR 6.96；95%CI，1.72 - 28.12）是死亡率的强有力独立预测因素，而有效的源头控制（HR 0.152；95%CI，0.039 - 0.59）显著提高了生存几率。利用这些见解，我们开发了一种实用的预后模型，能够估计30天死亡风险，为临床医生提供了一种有价值的床旁预测工具。
IMW中的PA-BSI特点是感染性休克发生率和耐药率相对较低，同时适当经验性治疗率较高。尽管有这些有利因素，但美罗培南可能是这种情况下严重PA-BSI的一种有价值的治疗选择，因为死亡率仍然很高（22.5%）。我们的研究结果强调了早期源头控制的至关重要性，并确定感染性休克是即使在IMW环境下死亡率的关键预测因素。所提出的床旁列线图模型可使临床医生能够早期识别高危患者，便于及时干预并改善这一脆弱人群的治疗结果。
