Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional.
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.
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.
Empiric antimicrobial therapy for CO-BSI-PA.
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.
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).
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.