Clinical significance and predictors of community-onset Pseudomonas aeruginosa bacteremia

BACKGROUND: Pseudomonas aeruginosa bacteremia is a serious and possibly fatal condition. It is important to determine the likelihood of P. aeruginosa bacteremia when Gram-negative sepsis is suspected in community-onset infection. METHODS: We performed a retrospective cohort study to identify the risk factors for P. aeruginosa infection in community-onset Gram-negative bacteremia. RESULTS: A total of 106 patients with P. aeruginosa bacteremia and a total 508 patients with E. coli bacteremia were included in this study. Factors associated with P. aeruginosa bacteremia in the multivariate analysis included presentation with neutropenia, presentation with septic shock, indwelling central venous catheter, and health-care-associated infection (all P <. 05). The 30-day mortality rate was 26.4% in patients with P. aeruginosa and 13.6% in those with E. coli bacteremia (P <.001). Multivariate analysis demonstrated that risk factors for mortality included a P. aeruginosa bacteremia, inappropriate initial antimicrobial therapy, a higher Charlson's weighted index of comorbidity, and a higher Pitt bacteremia score (all P <. 05). In addition, urinary tract infection and benign pancreatobiliary disease were found to be protective factors for mortality based on multivariate analysis (all P <. 05). CONCLUSIONS: Our data suggest that initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with neutropenia, presentation with septic shock, indwelling central venous catheter, or health-care-associated infection, when Gram-negative sepsis is suspected in community-onset infection. (c) 2008 Elsevier Inc. All rights reserved.