Risk factors, clinical features, and outcome of Pseudomonas aeruginosa bacteremia in patients with hematologic malignancies: A case-control study

• Published in: American journal of infection control 2013-06, Vol.41 (6), p.527-530
• Main Authors: Vuotto, Fanny, JD, Berthon, Céline, JD, Lemaitre, Nadine, SD, Duhamel, Alain, PhD, Balkaran, Sandy, JD, Le Ray, Emmanuelle, JD, Micol, Jean Baptiste, SD, Faure, Karine, SD, PhD, Alfandari, Serge, SD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Aminoglycosides - administration & dosage; Anti-Bacterial Agents - administration & dosage; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteria; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Case-Control Studies; Ceftriaxone; Ceftriaxone - administration & dosage; Child; Comorbidity; Epidemiology. Vaccinations; Female; Fluoroquinolones - administration & dosage; General aspects; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - microbiology; Hematology; Hematology patients; Human bacterial diseases; Humans; Infection Control; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pseudomonas aeruginosa; Pseudomonas aeruginosa - drug effects; Pseudomonas Infections - diagnosis; Pseudomonas Infections - drug therapy; Pseudomonas Infections - epidemiology; Risk Factors; Treatment Outcome; Young Adult
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2012.07.012

Background We observed an increased rate of Pseudomonas aeruginosa bacteremia in our hematology unit in 2004-2007 without an identified environmental source. Methods We conducted a matched case-control study to investigate factors associated with P aeruginosa bacteremia in patients with hematologic malignancies. Results Forty-two episodes of P aeruginosa bacteremia were identified. At presentation, 26 patients (62%) had pneumonia and 9 patients (21%) were in shock. Twenty-five patients (60%) were aplastic. The clinical cure rate was 40%. Comparing the 42 cases with 84 matched controls identified the following independent risk factors for P aeruginosa bacteremia: hospitalization in the previous 3 months (odds ratio [OR], 12.84; 95% confidence interval [CI], 2.98-55.18), antibiotic therapy in the previous 3 months (OR, 5.34; 95% CI, 2.14-13.30), receipt of ceftriaxone in the previous 3 months (OR, 2.38; 95% CI, 1.08-5.27), receipt of aminoglycosides in the previous 3 months (OR, 6.65; 95% CI, 1.15-38.25) and receipt of fluoroquinolones in the previous 3 months (OR, 3.22; 95% CI, 1.48-7.00). Conclusions Local antibiotic therapy algorithms were modified to decrease prescriptions of ceftriaxone and combination therapy with aminoglycosides and fluoroquinolones in an effort to decrease the risk of P aeruginosa bacteremia.