BACKGROUND Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day in-hospital all-cause mortality in patients with Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) bacteremia compared to patients with VIM-negative, carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia. Second, we identified determinants for mortality and survival. METHODS All patients with a positive blood culture with VIM-PA or CS-PA between January 2004 and January 2016 were included. Kaplan-Meier survival curves were constructed, and survivors and non-survivors were compared on relevant clinical parameters using univariate analyses, and multivariable analyses using a Cox-proportional hazard model. RESULTS In total, 249 patients were included, of which 58 (23.3%) died. Seventeen out of 40 (42.5%) patients with VIM-PA died, compared to 41 out of 209 (19.6%) patients with CS-PA (difference = 22.9%, P-value = 0.001). Assumed acquisition of the bacterium at the intensive care unit was significantly associated with mortality (HR = 3.32, 95%CI = 1.60-6.87), and having had adequate antibiotic therapy in days 1-14 after the positive blood culture was identified as a determinant for survival (HR = 0.03, 95%CI = 0.01-0.06). VIM-PA vs CS-PA was not identified as an independent risk factor for mortality. CONCLUSIONS The crude mortality rate was significantly higher in patients with a VIM-PA bacteremia compared to patients with a CS-PA bacteremia; however, when analyzing the data in a multivariable model this difference was non-significant. Awareness of the presence of P. aeruginosa in the hospital environment that may be transmitted to patients and rapid microbiological diagnostics are essential for timely administration of appropriate antibiotics. Acquisition of P. aeruginosa should be prevented, independent of resistance profile.

中文翻译：

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死亡率与碳青霉烯易感和维罗纳整合素编码的Metallo-β-内酰胺酶阳性铜绿假单胞菌菌血症有关。

背景技术对各种革兰氏阴性细菌的研究表明，对碳青霉烯类抗生素的耐药性是导致患者死亡率增加的原因。但是，结果不是结论性的。我们首先评估了维罗纳整合素编码的Metallo-β-内酰胺酶阳性铜绿假单胞菌（VIM-PA）菌血症患者与VIM阴性，碳青霉烯易感性铜绿假单胞菌患者的28天院内全因死亡率。 （CS-PA）菌血症。其次，我们确定了死亡率和生存率的决定因素。方法纳入2004年1月至2016年1月期间所有VIM-PA或CS-PA血培养阳性的患者。绘制了Kaplan-Meier生存曲线，并使用单变量分析比较了幸存者和非幸存者的相关临床参数，使用Cox比例风险模型进行多变量分析。结果总共纳入249例患者，其中58例（23.3％）死亡。40例VIM-PA患者中有17例死亡（42.5％），而209例CS-PA患者中有41例（19.6％）死亡（差异= 22.9％，P值= 0.001）。假定在重症监护病房获得细菌与死亡率显着相关（HR = 3.32，95％CI = 1.60-6.87），并且在确定阳性血液培养后的第1-14天接受了足够的抗生素治疗是决定因素（HR = 0.03，95％CI = 0.01-0.06）。VIM-PA vs CS-PA没有被确定为死亡率的独立危险因素。结论与CS-PA菌血症患者相比，VIM-PA菌血症患者的粗死亡率显着更高。然而，在多变量模型中分析数据时，这种差异不明显。意识到可能会传染给患者的铜​​绿假单胞菌在医院环境中的存在以及快速的微生物学诊断对于及时给予适当的抗生素至关重要。应当预防铜绿假单胞菌的获得，而与耐药性无关。