3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。https://note.mu/twin1980。

Rates, Predictors and Mortality of Community-Onset Bloodstream Infections due to Pseudomonas aeruginosa: Systematic Review and Meta-Analysis.

CMIに報告された、CO-BSIのメタアナ

www.sciencedirect.com

 

f:id:akinohanayuki:20190421073724j:plain

 

感想

渋いけど、気になっていたCO-BSI。

やはり、市中と言えども死亡率高いですね。初期治療の重要性も再認識。

 

Abstract


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 Medline, EMBASE, Cochrane Library, SCOPUS and Web of Science, databases.

Study eligibility criteria and participants
Articles published between, 1st January 2002 and 31st 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 both for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA, using a Mantel-Haenzel effects model.

Results
Twelve studies with 1,120 patients were included in the systematic review. Solid tumor (33.1%), hematologic 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% cases and 30-day crude mortality was 33.8%. Mortality in meta-analysis (4 studies) was associated with septic shock at presentation (OR 22.31, 95% CI 3.52 – 141.35, p=0.001) and with inappropriate empiric antibiotic therapy (OR 1.83, 95% CI 1.12 – 2.98, 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.