Pseudomonas aeruginosa Bacteremia among Immunocompetent and Immunocompromised Patients : Relation to Initial Antibiotic Therapy and Survival

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  • Migiyama Yohei
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences Department of Respiratory Medicine, Kumamoto University Graduate School of Medical Sciences
  • Yanagihara Katsunori
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Kaku Norihito
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Harada Yosuke
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Yamada Koichi
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Nagaoka Kentaro
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Morinaga Yoshitomo
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Akamatsu Norihiko
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Matsuda Junichi
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Izumikawa Koichi
    Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Kohrogi Hirotsugu
    Department of Respiratory Medicine, Kumamoto University Graduate School of Medical Sciences
  • Kohno Shigeru
    Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences Global COE Program, Nagasaki University

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タイトル別名
  • <i>Pseudomonas aeruginosa</i> Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival

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Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6%) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8% vs. 30%, P < 0.01; 30-day mortality, 23% vs. 39%, P = 0.053). Multivariate analysis showed that a higher sequential organ failure assessment score (hazard ratio [HR]: 1.27, P < 0.01) and underlying malignancies (HR: 3.33, P < 0.01) were independently associated with 30-day mortality. Initial antibiotic therapy (HR: 0.21, P < 0.01) and patients' immune status (HR: 0.29, P = 0.02) also had a significant impact on survival. However, there was a significant interaction between these 2 variables (P = 0.03 for interaction). A subgroup analysis showed that in immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5% vs. 66.7%, P < 0.01 by log-rank test).

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