<i>Pseudomonas aeruginosa</i> Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development—Results from the PRO-BAC Cohort
Pedro María Martínez Pérez-Crespo,
Álvaro Rojas,
Joaquín Felipe Lanz-García,
Pilar Retamar-Gentil,
José María Reguera-Iglesias,
Olalla Lima-Rodríguez,
Alfonso del Arco Jiménez,
Jonathan Fernández Suárez,
Alfredo Jover-Saenz,
Josune Goikoetxea Aguirre,
Eva León Jiménez,
María Luisa Cantón-Bulnes,
Pilar Ortega Lafont,
Carlos Armiñanzas Castillo,
Juan Sevilla Blanco,
Jordi Cuquet Pedragosa,
Lucía Boix-Palop,
Berta Becerril Carral,
Alberto Bahamonde-Carrasco,
Teresa Marrodan Ciordia,
Clara Natera Kindelán,
Isabel María Reche Molina,
Carmen Herrero Rodríguez,
Inés Pérez Camacho,
David Vinuesa García,
Fátima Galán-Sánchez,
Alejandro Smithson Amat,
Esperanza Merino de Lucas,
Antonio Sánchez-Porto,
Marcos Guzmán García,
Inmaculada López-Hernández,
Jesús Rodríguez-Baño,
Luis Eduardo López-Cortés,
on behalf of the PROBAC REIPI/GEIH-SEIMC/SAEI Group
Affiliations
Pedro María Martínez Pérez-Crespo
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
Álvaro Rojas
Departamento de Enfermedades Infecciosas del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
Joaquín Felipe Lanz-García
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
Pilar Retamar-Gentil
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
José María Reguera-Iglesias
Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, 29010 Málaga, Spain
Olalla Lima-Rodríguez
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
Alfonso del Arco Jiménez
Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, 29603 Marbella, Spain
Jonathan Fernández Suárez
Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
Alfredo Jover-Saenz
Unidad Funcional de Infecciones Nosocomiales, Hospital Arnau de Vilanova, 25198 Lérida, Spain
Josune Goikoetxea Aguirre
Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, 48903 Bizkaia, Spain
Eva León Jiménez
Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Nuestra Señora de Valme, 41014 Sevilla, Spain
Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
Alejandro Smithson Amat
Unidad de Medicina Interna, Fundació Hospital de l’Esperit Sant, 08923 Santa Coloma de Gramenet, Spain
Esperanza Merino de Lucas
Unidad de Enfermedades Infecciosas, Hospital Universitario General de Alicante, 03010 Alicante, Spain
Antonio Sánchez-Porto
Unidad de Enfermedades Infecciosas y Microbiología, Hospital de la Línea de la Concepción, 11300 La Línea de la Concepción, Spain
Marcos Guzmán García
Servicio de Medicina Interna, Hospital San Juan de la Cruz, 23400 Úbeda, Spain
Inmaculada López-Hernández
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
Jesús Rodríguez-Baño
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
Luis Eduardo López-Cortés
Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain
on behalf of the PROBAC REIPI/GEIH-SEIMC/SAEI Group
Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60–79), 68.8% were male, median Charlson score was 5 (IQR 3–7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14–3.12)], haematological malignancy [2.45 (1.20–4.99)], obstructive uropathy [2.86 (1.13–3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10–10.92)] and healthcare-associated BSI [1.85 (1.13–3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.
