Clinical Analysis of Patients with Pseudomonas aeruginosa Bacteremia
Eighty-six cases with Pseudomonas aeruginosa bacteremia during last five years were analyzed with regard to predisposing factors and clinical manifestations. We divided these cases into two groups to compare clinical features; 27 cases from 1994 to 1995 (group A) and 59 cases from 1991 to 1993 (group B), because the susceptibility of Pseudomonas aeruginosa to antibiotics has recently been changed and β-lactam- or new quinolone-resistant strains has increased. The main underlying diseases of group A were hematological diseases in 8 cases, traumatic diseases in 7 cases and gastrointestinal diseases in 6 cases. In group B, there were 21 patients with hematological diseases, 10 with gastrointestinal diseases and 6 with cardiovascular diseases. The primary source of bacteremia in group A was the urinary tract with 13 episodes, followed by the respiratory tract with 7 (pharyngeal swab 4, sputum 3). In group B, the primary source was distinctly the respiratory tract with 37 episodes (sputum 21, throat swab 16), followed by the urinary tract with 20 episodes. An IVH catheter was inserted in 15 cases but Pseudomonas aeruginosa was detected in only one case by a culture from the IVH catheter tip in group A, and in 6 out of 35 cases in group B. Antibiotics were used prior to the onset of Pseudomonas aeruginosa bacteremia in 50 episodes in both groups but most of them were not active effective against Pseudomonas aeruginosa. The prognosis was comparatively good in group A, that is, the clinical effect was good in 20 episodes (efficacy rate: 71%), fair in 1 and poor in 7. All the patients of the 7 poor cases died of septic shock (mortality rate: 27%) and antibiotics were not administered in five of these cases because the culture results were reported after the death of the patients. In group B, however, the prognosis was poor, that is, the clinical effect was good in 29 episodes (efficacy rate: 46%), fair in 3 and poor in 32. In these 32 poor cases, 26 patients died of septic shock, other 5 died of pneumonia and 1 died of multiple organ failure. No antibiotics were administered in 15 cases of these 32 poor cases for the lack of culture results. β-lactam antibiotics were still effective against Pseudomonas aeruginosa isolated from group A, while new quinolones were resistant in many cases of both groups.