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  • Open Access

Clinical aspects and predictors of mortality of Pseudomonas aeruginosa pneumonia in a cohort of critically ill patients

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 2,
  • 1,
  • 2 and
  • 1
Critical Care201115 (Suppl 1) :P184

https://doi.org/10.1186/cc9604

  • Published:

Keywords

  • Pneumonia
  • Independent Risk Factor
  • Pseudomonas Aeruginosa
  • Related Factor
  • Median Length

Introduction

Pseudomonas aeruginosa (PA) pneumonia (PN) represents a serious complication of long-term hospitalization [1]. The aim of our study is to analyze the clinical characteristics and predictors of mortality of PAPN in critically ill patients.

Methods

All patients admitted to the 18-bed ICU of our university hospital between 1 January 2009 and 30 June 2010, affected by PAPN, were retrospectively enrolled in a cohort study.

Results

Over the study period 1,109 patients were admitted and 322 bacterial PN were diagnosed. Sixty-five PAPN occurred: 52 ICU-acquired (ICUa) and 13 non-ICU-acquired (nICUa). Patients were mainly admitted because of a medical condition (71%), with a median length of ICU stay of 29.2 ± 27.6 days. The median SAPS II and SOFA scores were 40 ± 13.5 and 6.2 ± 3. A total of 35.4% of PA isolated were multidrug-resistant (MDR), 49.2% of patients with PAPN received a >24 hour delayed adequate antimicrobial treatment (DAAT >24 hours) and 57% received an anti-pseudomonas combination therapy; 25 patients (38.5%) died in the ICU. Comparing patients with ICUaPN with those with nICUaPN, the former group were younger (P < 0.01), with a longer length of ICU stay (P < 0.01), more frequently admitted for a traumatic reason (P = 0.02) and presented less severe SAPS II (P < 0.05). The independent risk factors associated with ICU mortality are listed in Table 1.
Table 1

Chronic renal failure (CRF)

 

P value

OR

CRF

0.01

12.2 (1.6 to 91)

MDR PA

0.01

5.9 (1.4 to 25.6)

DAAT >24 hours

0.01

5.8 (1.4 to 23.6)

SAPS II score

0.01

1.1 (1.01 to 1.13

Conclusions

PA has appeared as a relevant respiratory pathogen in our cohort of critically ill patients, either in ICU or pre/ICU settings. Patients' (baseline clinical condition), PA (MDR) and physicians' (DAAT >24 hours) related factors can influence the outcome of PN. The knowledge of local bacterial epidemiology and the prompt use of an anti-pseudomonas empiric treatment in patients with recognized PA risk factors could improve the outcome of severe MDR PAPN.

Authors’ Affiliations

(1)
Department of Anesthesiology, Intensive Care, Sacro Cuore Catholic University, Rome, Italy
(2)
Institute of Infectious Diseases, Sacro Cuore Catholic University, Rome, Italy

References

  1. Jones RN: Clin Infect Dis. 2010, 51: S81-S87. 10.1086/653053View ArticlePubMedGoogle Scholar

Copyright

© De Pascale et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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