[Effect of adequate initial antimicrobial therapy on mortality in critical patients with Pseudomonas aeruginosa bacteremia]. / Efecto del tratamiento antibiótico inicial adecuado sobre la mortalidad en pacientes en estado crítico con bacteriemia por Pseudomonas aeruginosa.
Biomedica
; 34 Suppl 1: 58-66, 2014 Apr.
Article
em Es
| MEDLINE
| ID: mdl-24968037
INTRODUCTION: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. OBJECTIVE: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. MATERIALS AND METHODS: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. RESULTS: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). CONCLUSION: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Pseudomonas
/
Estado Terminal
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Bacteriemia
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Farmacorresistência Bacteriana Múltipla
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Antibacterianos
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Aged
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Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
America do sul
/
Colombia
Idioma:
Es
Revista:
Biomedica
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Colômbia
País de publicação:
Colômbia