Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: Prospective observational study

Eun Jeong Yoon, Dokyun Kim, Hyukmin Lee, Hye Sun Lee, Jeong Hwan Shin, Yoon Soo Park, Young Ah Kim, Jong Hee Shin, Kyeong Seob Shin, Young Uh, Seok Hoon Jeong

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Abstract

Background: To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality. Methods: A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan-Meier survival analyses were performed to determine the mortality dynamics. Results: During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency. Conclusions: BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

Original languageEnglish
Pages (from-to)2774-2783
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume74
Issue number9
DOIs
Publication statusPublished - 2019 Sep 1

Bibliographical note

Funding Information:
This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2017E4400100#).

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

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