부산대학교 도서관

Background: We sought to determine the risk factors, molecular epidemiology, antibiotic therapy and outcomes of bacteremia due to extensively drug-resistant (XDR) Pseudomonas aeruginosa in solid organ transplant (SOT) recipients. Methods: All episodes of bacteremia occurring in SOT recipients were prospectively documented from 2007 to 2013. Results: Of 318 episodes of bacteremia prospectively documented from 2007 to 2013, 49 were due to P. aeruginosa. Thirty-one strains (63%) were XDR, defi ned by non-susceptibility to =1 agent in all but =2 antipseudomonal antimicrobial categories. Time from transplantation to bacteremia was shorter in cases caused by XDR P. aeruginosa than in those due to other etiologies (median 66 days vs. 278; p=0.03). Factors independently associated with XDR P. aeruginosa bacteremia were prior transplantation, nosocomial acquisition, and septic shock at onset. XDR P. aeruginosa isolates belonged to a single clone (ST-175). Compared to patients with bacteremia due to other etiologies, those with bacteremia due to XDR P. aeruginosa more frequently received inadequate empirical antibiotic therapy. Persistence of bacteremia, shock, respiratory failure, ICU admission and need for mechanical ventilation were more frequent in patients with XDR P. aeruginosa. The overall case-fatality rate was higher among patients with XDR P. aeruginosa bacteremia than in the others (38% vs. 16%; p=0.009). Conclusions: Bacteremia due to XDR P. aeruginosa should be carefully considered when selecting empirical antibiotic therapy for hospitalized SOT recipients with prior transplantation presenting with septic shock.