Statistical analysis of the relationship between mortality and nosocomial factors in patients with septicemia and the importance of Pseudomonas aeruginosa

The ongoing evolution of sepsis as a condition constitutes a global health concern and necessitates continuous monitoring and investigation of incidence rates, mortality factors, and disease patterns. This study sought to elucidate the frequency of bacterial cultures in patients with septicemia at our hospital and identify the factors influencing mortality. Zoonotic risk factors with reference to the literature were also taken into account.Independent variables of all patients diagnosed with sepsis were retrospectively screened to reveal factors affecting mortality. Incomplete or unclear data were not included. Continuous variables are represented as means and standard deviations, whereas binary variables are represented as percentages and frequency values. The distribution was evaluated using the Kolmogorov?Smirnov test. Separately, the Student's t-test or Mann-Whitney U test was used to compare differences for continuous variables between independent groups according to distribution status. Dichotomous variables were evaluated using the chi-squared or Fisher's exact test. Significant results found during univariate analysis were reevaluated using linear and binary logistic regression. Neither the length of hospital stay nor patient age was statistically significant, for mortality. Among dichotomous variables, sex also did not impact the mortality rate. Meanwhile, Salmonella, Shigella, and Pseudomonas aeruginosa infections were found to cause mortality. During the final statistical analysis using multiple logistic regression, only P. aeruginosa was a factor influencing the mortality rate. P. aeruginosa is an important pathogen that contributes to increased risks of mortality and zoonotic transmission among patients with sepsis.

___

  • 1. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. The Journal of the American Medical Association 2017; 318 (13): 1241-1249. doi: 10.1001/jama.2017. 13836 CDC Prevention Epicenter Program
  • 2. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A et al. Hospital deaths in patients with sepsis from 2 independent cohorts. The Journal of the American Medical Association 2014; 312 (1): 90- 92. doi: 10.1001/jama.2014.5804
  • 3. Czura CJ. Merinoff symposium 2010: Sepsis, speaking with one voice. Molecular Medicine 2011; 17 (1 and 2): 2-3. doi: 10.2119 / molmed. 2010.00001
  • 4. Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet 2013; 381: 774-775.
  • 5. Chinn RY, Sehulster L. Guidelines for environmental infection control in health-care facilities, 2003; 52 (RR-10):1-42.
  • 6. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T et al. Assessment of global incidence and mortality of hospital-treated sepsis. American Journal of Respiratory and Critical Care Medicine 2016; 193 (3): 259-272.
  • 7. Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the United States. A population-based study. Annals of the American Thoracic Society 2015; 12 (2): 216-220.
  • 8. Cohen J, Vincent JL, Adhikari NK, Machado FR, Angus DC et al. Sepsis: a roadmap for future research. The Lancet. Infectious Diseases 2015; 15: 581-614.
  • 9. Wenzel RP. The mortality of hospital-acquired bloodstream infections: Need for a new vital statistic? International Journal of Epidemiology 1988; 17 (1): 225-227.
  • 10. Parrillo JE, Parker NN, Natanson C, Suffredini AF, Danner RL et al. Septic shock in humans-advances in the understanding of pathogenesis, cardiovascular dysfunction and therapy. Annals of Internal Medicine 1990; 113 (3): 227-242.
  • 11. Niederman MS, Fein AM. Sepsis syndrome, the adult respiratory distress syndrome, and nosocomial pneumonia: a common clinical consequence. Clinics in Chest Medicine 1990; 11(4): 633-656.
  • 12. Core Topics in General and Emergency Surgery. In: Simon Paterson-Brown (editor). 3rd edition. Amsterdam, Netherlands: Elsevier; 2005. pp. 330-331.
  • 13. Ghasemzadeh I, Namazi SH. Review of bacterial and viral zoonotic infections transmitted by dogs. Journal of Medicine and Life 2015; 8 (4): 1-5.
  • 14. Khan HA, Baig FK, Mehboob R. Nosocomial infections: epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine 2017; 7 (5): 478-482. doi: 10.1016/j.apjtb
  • 15. Emily RM, Sydnor TMP. Hospital epidemiology and infection control in acute-care settings. Clinical Microbiology Reviews 2011; 24 (1): 141-173.
  • 16. Jones RN. Resistance patterns among nosocomial pathogens. Chest 2001; 119 (2): 397-404.
  • 17. Scott A, Pottenger S, Timofte D, Moore M, Wright L et al. Reservoirs of resistance: polymyxin resistance in veterinaryassociated companion animal isolates of Pseudomonas aeruginosa. Veterinary Record 2019; 185 (7): 206. doi: 10.1136 /vr. 105075
  • 18. Flammer K. Zoonoses acquired from birds. In: M. E. Fowler (editor). Zoo & Wild Animal Medicine: Current Therapy. 4th edition. Philadelphia, Pennsylvania, USA: W. B. Saunders Co.; 1999. pp. 151-156.
  • 19. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000; 356 (9238): 1307- 1312.
  • 20. Hall RF, Waldhalm DG, Meinershagen WA, Dubose DA. Isolation of Salmonella spp. from dead gulls (Larus californicus and Larus delawarensis) from an Idaho irrigation reservoir. Avian Diseases 1977; 21: 452- 454.
  • 21. Brand CJ, Windingstad RM, Siegfried LM, Duncan RM, Cook RM. Avian morbidity and mortality from botulism, aspergillosis, and salmonellosis at Jamaica Bay Wildlife Refuge, New York, USA. Colonial Waterbirds 1988; 11(2): 284-92.
  • 22. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP et al. Nosocomial bloodstream infections in US hospitals: analysis of 24, 179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases 2004; 39 (3): 309-317.
  • 23. Roy-Burman A, Savel RH, Racine S, Swanson BL, Revadigar NS et al. Type III protein secretion is associated with death in lower respiratory and systemic Pseudomonas aeruginosa infections. Journal of Infectious Diseases 2001; 183 (12): 1767- 1774.
  • 24. Balibar CJ, Grabowicz M. Mutant alleles of lptD increase the permeability of Pseudomonas aeruginosa and define determinants of intrinsic resistance to antibiotics. Antimicrob Agents Chemother 2015; 60 (2): 845-854. doi: 10.1128/ AAC.01747-15
  • 25. Wu CL, Domenico P, Hassett DJ, Beveridge TJ, Hauser AR et al. Subinhibitory Bismuth-Thiols reduce Virulence of Pseudomonas aeruginosa. American Journal of Respiratory Cell and Molecular Biology 2002; 26 (6): 731-738.
  • 26. Coburn, J, Frank DW. Macrophages and epithelial cells respond differently to the Pseudomonas aeruginosa type III secretion system. Infection and Immunity 1999; 67 (6), 3151-3154.
  • 27. Hauser AR, Cobb E, Bodí M, Mariscal D, Vallés J et al. Type III protein secretion is associated with poor clinical outcomes in patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Critical Care Medicine. 2002; 30 (3): 521-528.
  • 28. Lodise TP Jr., Lomaestro B, Drusano GL. PiperacillinTazobactam for Pseudomonas aeruginosa infection: Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 2007; 44 (3): 357-363.
  • 29. Scheetz MH, Hoffman M, Bolon MK, Schulert G, Estrellado W et al. Morbidity associated with Pseudomonas aeruginosa bloodstream infections. Diagnostic Microbiology and Infection Disease 2009; 64 (3): 311-319. doi: 10.1016/j. diagmicrobio. 2009.02.006
  • 30. Al-Aloul M, Miller H, Stockton P, Ledson MJ, Walshaw MJ. Acute renal failure in CF patients chronically infected by the Liverpool epidemic Pseudomonas aeruginosa strain (LES). Journal of Cystic Fibrosis 2005; 4 (3): 197-201.
  • 31. Bilgili B, Haliloğlu M, Cinel İ. Sepsis and acute kidney injury. Turkish Journal of Anaesthesiology and Reanimation 2014; 42 (6): 294-301. doi: 10.5152/TJAR. 2014.83436
  • 32. Souza LCD, Lopes FF, Bastos EG, Alves CMC. Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report. Brazilian Journal of Nephrology 2018; 40 (1): 82-85.
  • 33. Pradhan S, Ghimire A, Bhattarai B, Khanal B, Pokharelet K et al. The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal. Indian Journal of Critical Care Medicine 2016; 20 (7): 417-420. doi: 10.4103/0972-5229.186226k
  • 34. Irmak K, Sen I, Cöl R, Birdane FM, Güzelbektes H et al. The evaluation of coagulation profiles in calves with suspected septic shock. Veterinary Research Communications, 2006; 30 (5): 497-503. doi: 10.1007/s11259-006-3258-8
  • 35. Quinten VM, Meurs MV, Maaten JC, Ligtenberg JJM. Sepsis prediction and vital signs ranking in intensive care unit patients. BMJ Open 2016; 6 (e009718):1-9. doi: 10.1136/ bmjopen-2015-009718
  • 36. Dennesen PJ, Van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ et al. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine 2001; 163 (6): 1371-1375.
  • 37. Bisbe J, Gatell JM, Puig J, Mallolas J, Martinez JA, et al. Pseudomonas aeruginosa bacteremia: univariate and multivariate analyses of factors influencing the prognosis in 133 episodes. Reviews of Infectious Diseases 1988; 10 (3): 629- 635.