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img  36:  Gram-negative bacteremia upon hospital admission: when should Pseudomonas aeruginosa be suspected?
 
著者: Vered Schechner, Vandack Nobre, Keith S Kaye, Moshe Leshno, Michael Giladi, Peter Rohner, Stephan Harbarth, Deverick J Anderson, Adolf W Karchmer, Mitchell J Schwaber, Yehuda Carmeli
雑誌名: Clin Infect Dis. 2009 Mar 1;48(5):580-6. doi: 10.1086/596709.
Abstract/Text BACKGROUND: Pseudomonas aeruginosa is an uncommon cause of community-acquired bacteremia among patients without severe immunodeficiency. Because tension exists between the need to limit unnecessary use of anti-pseudomonal agents and the need to avoid a delay in appropriate therapy, clinicians require better guidance regarding when to cover empirically for P. aeruginosa. We sought to determine the occurrence of and construct a model to predict P. aeruginosa bacteremia upon hospital admission.
METHODS: A retrospective study was conducted in 4 tertiary care hospitals. Microbiology databases were searched to find all episodes of bacteremia caused by gram-negative rods (GNRs) RESULTS: P. aeruginosa caused 6.8% of 4114 unique patient episodes of GNR bacteremia upon hospital admission (incidence ratio, 5 cases per 10,000 hospital admissions). Independent predictors of P. aeruginosa bacteremia were severe immunodeficiency, age >90 years, receipt of antimicrobial therapy within past 30 days, and presence of a central venous catheter or a urinary device. Among 250 patients without severe immunodeficiency, if no predictor variables existed, the likelihood of having P. aeruginosa bacteremia was 1:42. If >or= 2 predictors existed, the risk increased to nearly 1:3.
CONCLUSIONS: P. aeruginosa bacteremia upon hospital admission in patients without severe immunodeficiency is rare. Among immunocompetent patients with suspected GNR bacteremia who have >or= 2 predictors, empirical anti-pseudomonal treatment is warranted.

PMID 19191643  Clin Infect Dis. 2009 Mar 1;48(5):580-6. doi: 10.1086/596709.
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