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P. aeruginosa bloodstream infections among hematological patients: an old or new question?

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Abstract

Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections among hematological patients. A prospective epidemiological surveillance program ongoing at our Hematology Unit revealed an increase over time of P. aeruginosa bloodstream infections (BSI). Their impact on outcome and antibiotic susceptibility was analyzed. BSI which consecutively occurred at our institution during a 70-month period were evaluated and correlated with type of pathogen, status of underlying disease, neutropenia, previous antibiotic therapy, resistance to antibiotics, and outcome. During the observation period, 441 BSI were recorded. Frequency of Gram-negative BSI was higher than that of other pathogens (57.3%). Overall, 66 P. aeruginosa BSI were recorded; 22 out of 66 were multiresistant (MR P. aeruginosa). Thirty-day mortality for all BSI was 11.3%; it was 27.3% for P. aeruginosa BSI and 36.4% for MR P. aeruginosa. At multivariate analysis, only active hematological disease and P. aeruginosa BSI were associated to an increased risk of death. For MR P. aeruginosa, BSI mortality was 83.3% vs. 18.8% when empiric therapy included or not an antibiotic with in vitro activity against P. aeruginosa (p = 0.011). Together with active disease, the emergence of P. aeruginosa BSI, particularly if multiresistant, was responsible for an increased risk of death among hematological patients at our institution. In this scenario, reconsidering the type of combination antibiotic therapy to be used as empiric treatment of neutropenic fever was worthwhile.

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Acknowledgments

The authors would like to thank Dr. Mario Tumbarello, Institute of Infectious Diseases, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy, and Dr. Liana Signorini, Inst. of Infectious and Tropical Disease, University of Brescia, Brescia, Italy for their assistance with the preparation of the manuscript.

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Authors and Affiliations

  1. Dept. of Haematology, Spedali Civili, Piazza Spedali Civili, 25100, Brescia, Italy

    Chiara Cattaneo, F. Antoniazzi, C. Pagani, M. D’Adda, E. Morello, A. Re, E. Borlenghi & G. Rossi

  2. Inst. of Infectious and Tropical Disease, University of Brescia, Brescia, Italy

    S. Casari

  3. Inst. of Microbiology, University of Brescia, Brescia, Italy

    G. Ravizzola, M. Gelmi & N. Manca

Authors
  1. Chiara Cattaneo
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  2. F. Antoniazzi
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  3. S. Casari
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  4. G. Ravizzola
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  5. M. Gelmi
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  6. C. Pagani
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  7. M. D’Adda
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  8. E. Morello
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  9. A. Re
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  10. E. Borlenghi
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  11. N. Manca
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  12. G. Rossi
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Correspondence to Chiara Cattaneo.

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Cattaneo, C., Antoniazzi, F., Casari, S. et al. P. aeruginosa bloodstream infections among hematological patients: an old or new question?. Ann Hematol 91, 1299–1304 (2012). https://doi.org/10.1007/s00277-012-1424-3

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  • DOI: https://doi.org/10.1007/s00277-012-1424-3

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