OBJECTIVES To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.

中文翻译：

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嗜中性白血球减少症患者的多药耐药铜绿假单胞菌感染的预测因素。

目的评估中性粒细胞减少症患者多药耐药性铜绿假单胞菌（MDR-PA）感染的危险因素。方法连续血流感染（BSI）发作的单中心回顾性分析（2004-2017，巴塞罗那）。在BSI诊断和铜绿假单胞菌检测中使用了两个多元回归模型。重要的预测因素用于建立根据MDR-PA BSI风险对患者进行分层的规则。结果661例革兰氏阴性BSI发作中，有190例（28.7％）是由铜绿假单胞菌（70 MDR-PA）引起的。革兰氏阴性菌中与MDR-PA相关的独立因素是血液系统恶性肿瘤（OR 3.30; 95％CI 1.15-9.50），肺部感染源（OR 7.85; 95％CI 3.32-18.56），医院获得性BSI（OR 3.52） ； 95％CI 1.74-7.09），先前使用过的抗假性头孢菌素（OR 13.66； 95％CI 6.64-28。10）和哌拉西林/他唑巴坦（OR 2.42; 95％CI 1.04-5.63），而BSI在头孢曲松治疗期间发生（OR 4.27; 95％CI 1.15-15.83）。一旦铜绿假单胞菌被确定为BSI病原菌，医院获得（OR 7.13; 95％CI 2.87-17.67），血液系统恶性肿瘤（OR 3.44; 95％CI 1.07-10.98），先前的抗假性头孢菌素（OR 3.82; 95％CI 1.42-10.22）和喹诺酮类药物（OR 3.97; 95％CI 1.37-11.48），皮质类固醇（OR 2.92; 95％CI 1.15-7.40）和BSI在喹诺酮期间发生（OR 4.88; 95％CI 1.58-15.05）和β-除厄他培南（OR 4.51； 95％CI 1.45-14.04）以外的内酰胺均与MDR-PA相关。对于每个回归系数，除医院获得的BSI（3分）外，每个参数均分配1分。在第二项分析中，得分> 3分则确定为60（86。在70名患有MDR-PA BSI的个体中，有3％），在120名非MDR-PA BSI的个体中，有100人（84.2％）被丢弃。结论基于人口统计学和临床​​因素的简单评分可以使菌血症患者根据其MDR-PA BSI风险进行分层，并可能有助于促进快速MDR检测工具的使用并改善早期抗生素的适用性。