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Antimicrobial Agents and Chemotherapy, October 2007, p. 3510-3515, Vol. 51, No. 10
0066-4804/07/$08.00+0     doi:10.1128/AAC.00338-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic Selection{triangledown}

Thomas P. Lodise Jr.,1,2* Nimish Patel,1 Andrea Kwa,1,3 Jeffrey Graves,1 Jon P. Furuno,4 Eileen Graffunder,5 Ben Lomaestro,6 and Jessina C. McGregor7

Albany College of Pharmacy, Pharmacy Practice Department, Albany, New York,1 Ordway Research Institute, Albany, New York,2 Singapore Hospital, Singapore, Singapore,3 Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, Maryland,4 Albany Medical Center Hospital, Department of Epidemiology, Albany, New York,5 Albany Medical Center Hospital, Department of Pharmacy, Albany, New York,6 Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Portland, Oregon7

Received 12 March 2007/ Returned for modification 1 May 2007/ Accepted 15 July 2007

Although a growing number of studies have found a relationship between delayed appropriate antibiotic therapy and mortality, few have attempted to quantify the temporal association between delayed appropriate antibiotic therapy and mortality. This study was designed to measure the elapsed time associated with an increased risk of 30-day mortality among patients with Pseudomonas aeruginosa bacteremia. The retrospective cohort study was conducted among immunocompetent, adult patients with P. aeruginosa bacteremia onset at least 2 days after hospital admission between 1 January 2001 and 30 September 2006. Classification and regression tree analysis (CART) was used to identify the delay in appropriate antibiotic therapy that was associated with an increased risk of 30-day mortality. During the study period, 100 patients met the inclusion criteria. The CART-derived breakpoint between early and delayed treatment was 52 h. The delayed treatment group experienced a >2-fold significant increase in 30-day mortality compared to the early treatment group (44 and 19%, respectively, P = 0.008). Delayed appropriate therapy of >52 h (odds ratio [OR] = 4.1; 95% confidence interval [CI] 1.2 to 13.9, P = 0.03) was independently associated with 30-day mortality in the multivariate analysis. Antibiotic resistance ≥3 classes (adjusted OR [AOR] = 4.6; 95% CI = 1.9 to 11.2, P = 0.001) and chronic obstructive pulmonary disease (AOR = 5.4; 95% CI = 1.5 to 19.7, P = 0.01) were independently associated with delayed appropriate therapy of >52 h. The data strongly suggest that delaying appropriate therapy for approximately 2 days significantly increases the risk of 30-day mortality in patients with P. aeruginosa bloodstream infections.

* Corresponding author. Mailing address: Pharmacy Practice, Albany College of Pharmacy, 106 New Scotland Avenue, Albany, NY 12208-3492. Phone: (518) 445-7292. Fax: (518) 445-7302. E-mail: lodiset{at}acp.edu

{triangledown} Published ahead of print on 23 July 2007.

Antimicrobial Agents and Chemotherapy, October 2007, p. 3510-3515, Vol. 51, No. 10
0066-4804/07/$08.00+0     doi:10.1128/AAC.00338-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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