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Título: | Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis |
Autor: | Rojas, Alvaro; Palacios-Baena, Zaira Raquel CSIC ORCID; López-Cortés, Luis Eduardo; Rodríguez-Baño, Jesús CSIC ORCID | Palabras clave: | Bacteraemia Bloodstream infections Community acquired Inappropriate antibiotic treatment Mortality Pseudomonas aeruginosa |
Fecha de publicación: | 2019 | Editor: | Elsevier | Citación: | Clinical Microbiology and Infection 25(8): 964-970 (2019) | Resumen: | [Background] Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional. [Objectives] To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy. Data source] A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. [Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered. [Intervention] Empiric antimicrobial therapy for CO-BSI-PA. [Methods] A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model. [Results] Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52–141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12–2.98l p 0.02). [Conclusions] CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions. | Versión del editor: | https://doi.org/10.1016/j.cmi.2019.04.005 | URI: | http://hdl.handle.net/10261/212865 | DOI: | 10.1016/j.cmi.2019.04.005 | Identificadores: | doi: 10.1016/j.cmi.2019.04.005 issn: 1198-743X e-issn: 1469-0691 |
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