Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa

We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aerugin...

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Detalhes bibliográficos
Autores: Gudiol, C, Albasanz-Puig, A, Laporte-Amargos, J, Pallares, N, Mussetti, A, Ruiz-Camps, I, Puerta-Alcalde, P, Abdala, E, Oltolini, C, Akova, M, Montejo, M, Mikulska, M, Martin-Davila, P, Herrera, F, Gasch, O, Drgona, L, Morales, HP, Brunel, AS, Garcia, E, Isler, B, Kern, WV, Morales, I, Maestro-de la Calle, G, Montero, M, Kanj, SS, Sipahi, OR, Calik, S, Marquez-Gomez, I, Marin, JI, Gomes, MZR, Hemmatti, P, Araos, R, Peghin, M, del Pozo, JL, Yanez, L, Tilley, R, Manzur, A, Novo, A, Carratala, J
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Recursos:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p2678
Acesso em linha:https://i3pt.portalinvestigacion.com/publicaciones/2678
Access Level:acceso abierto
Palavra-chave:multidrug resistant
Pseudomonas aeruginosa
bacteremia
bloodstream infection
neutropenia
cancer
risk factors
predictive model
Descrição
Resumo:We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR), 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa. The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development.

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