AUTHOR=Xiao Shuzhen , Liang Xianghui , Han Lizhong , Zhao Shengyuan 

TITLE=Incidence, antimicrobial resistance and mortality of Pseudomonas aeruginosa bloodstream infections among hospitalized patients in China: a retrospective observational multicenter cohort study from 2017 to 2021

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1294141

DOI=10.3389/fpubh.2023.1294141

ISSN=2296-2565

ABSTRACT=<sec><title>Background</title><p><italic>Pseudomonas aeruginosa (P. aeruginosa)</italic> accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs). We aim to investigate incidence, antimicrobial resistance and risk factors for mortality of <italic>P</italic>. <italic>aeruginosa</italic> BSIs among inpatients.</p></sec><sec><title>Methods</title><p>A retrospective cohort study were conducted at two tertiary hospitals in 2017–2021. Medical and laboratory records of all inpatients diagnosed with <italic>P</italic>. <italic>aeruginosa</italic> BSIs were reviewed. A generalized linear mixed model was used to identify risk factors for mortality.</p></sec><sec><title>Results</title><p>A total of 285 patients with <italic>P</italic>. <italic>aeruginosa</italic> BSIs were identified. Incidence of <italic>P</italic>. <italic>aeruginosa</italic> BSIs fluctuated between 2.37 and 3.51 per 100,000 patient-days over the study period. Out of 285 <italic>P</italic>. <italic>aeruginosa</italic> isolates, 97 (34.04%) were carbapenem-resistant (CR) and 75 (26.32%) were multidrug-resistant (MDR). These isolates showed low resistance to aminoglycosides (9.51–11.62%), broad-spectrum cephalosporins (17.19–17.61%), fluoroquinolones (17.25–19.43%), and polymyxin B (1.69%). The crude 30-day mortality rate was 17.89% (51/285). Healthcare costs of patients with MDR/CR isolates were significantly higher than those of patients with non-MDR/CR isolates (<italic>P</italic> &lt; 0.001/=0.002). Inappropriate definitive therapy [adjusted odds ratio (aOR) 4.47, 95% confidence interval (95% CI) 1.35–14.77; <italic>P</italic> = 0.014], ICU stay (aOR 2.89, 95% CI: 1.26–6.63; <italic>P</italic> = 0.012) and corticosteroids use (aOR 2.89, 95% CI: 1.31–6.41; <italic>P</italic> = 0.009) were independently associated with 30-day mortality.</p></sec><sec><title>Conclusion</title><p>Incidence of <italic>P</italic>. <italic>aeruginosa</italic> BSIs showed an upward trend during 2017–2020 but dropped in 2021. MDR/CR <italic>P</italic>. <italic>aeruginosa</italic> BSIs are associated with higher healthcare costs. Awareness is required that patients with inappropriate definitive antimicrobial therapy, ICU stay and corticosteroids use are at higher risk of death from <italic>P</italic>. <italic>aeruginosa</italic> BSIs.</p></sec>