Efecto del tiempo hasta el inicio de la terapia antibiótica adecuada sobre la mortalidad intrahospitalaria a treinta días en pacientes de cuidado intensivo con bacteriemia por Pseudomonas aeruginosa

Abstract

Introducción: Pseudomonas aeruginosa es uno de los patógenos más importantes en las infecciones nosocomiales. Objetivo: Estimar la asociación entre el tiempo desde el diagnóstico hasta el inicio de la terapia antibiótica adecuada y la mortalidad intrahospitalaria en pacientes con bacteriemia por Pseudomonas aeruginosa en cuidado intensivo. Métodos: Cohorte retrospectiva multicéntrica. Se usó análisis de supervivencia bivariado y regresión paramétrica. Resultados y conclusiones: Se estudiaron 178 pacientes, un 55.6% recibieron al menos un antibiótico adecuado con una media de inicio de 2.4 días. La mortalidad a 30 días fue de 42%. No se encontró una asociación entre el tiempo hasta el inicio de la terapia antibiótica adecuada y la mortalidad intrahospitalaria (razón de tiempo al evento, métrica de tiempo acelerado 1.08, intervalo de confianza del 95% 0.89-1.3). Se encontró una tendencia hacia el efecto protector de la terapia adecuada (razón de tiempo al evento 1.78, intervalo de confianza del 95% 0.92-3.43). / Abstract. Background: Pseudomonas aeruginosa is one of the most important pathogens in hospital-acquired infections. Objective: To estimate the association between time from diagnosis to onset of adequate antimicrobial therapy and hospital mortality in critical care patients with Pseudomonas aeruginosa bacteremia. Methods: Multicenter historic cohort study. Survival analysis and parametric survival regression was used. Results and conclusions: 178 patients were studied, 55.6% of them received at least one antibiotic considered adequate, with a mean onset of 2.4 days. 30-day mortality was 42%. An association between time to onset of adequate antimicrobial therapy and mortality was not found (time ratio, accelerated failure time metric 1.08, 95% confidence interval 0.89-1.3). A trend was found towards a protector effect of adequate antimicrobial therapy (time ratio 1.78, 95% confidence interval 0.92-3.43) (Texto tomado de la fuente).

Background: Pseudomonas aeruginosa is one of the most important pathogens in hospital-acquired infections. Objective: To estimate the association between time from diagnosis to onset of adequate antimicrobial therapy and hospital mortality in critical care patients with Pseudomonas aeruginosa bacteremia. Methods: Multicenter historic cohort study. Survival analysis and parametric survival regression was used. Results and conclusions: 178 patients were studied, 55.6% of them received at least one antibiotic considered adequate, with a mean onset of 2.4 days. 30-day mortality was 42%. An association between time to onset of adequate antimicrobial therapy and mortality was not found (time ratio, accelerated failure time metric 1.08, 95% confidence interval 0.89- 1.3). A trend was found towards a protector effect of adequate antimicrobial therapy (time ratio 1.78, 95% confidence interval 0.92-3.43).