Clinical characteristics and antimicrobial stewardship of Pseudomonas aeruginosa and other glucose non-fermenting gram-negative rods in bacteremia.

INTRODUCTION

Pseudomonas aeruginosa (PA) and other glucose non-fermenting gram-negative rods (nonPA-NFs) are critical nosocomial pathogens. Although PA is a known uropathogen, the entry sites for nonPA-NFs remain poorly defined. The primary objective of this study was to evaluate the clinical characteristics and antimicrobial stewardship (AS) recommendations for PA and nonPA-NFs, specifically to explain their contrasting differences from other bloodstream infections (BSIs) used as a baseline reference.

METHODS

We conducted a retrospective study at two university hospitals, analyzing 332 NF BSI cases (205 PA and 127 nonPA-NF) and 5869 other BSI cases. Multivariate logistic regression was used to compare patients with PA and nonPA-NF with other BSIs. Subsequently, the reference category was changed to nonPA-NF to enable a direct comparison between PA and nonPA-NF.

RESULTS

PA was significantly associated with urogenital tract infections, whereas nonPA-NF was more prevalent in catheter-related infections and unknown sources. A direct comparison confirmed a significant dissociation in the affinity for the urogenital tract (P = 0.002).

DISCUSSION: Patients with PA and nonPA-NFs exhibited distinct and often contrasting entry portals compared to the baseline represented by other BSIs. The presence of urogenital tract infection in NF bacteremia may suggest a higher likelihood of PA, whereas nonPA-NF should be considered in catheter-related or occult sources. These findings provide a clinical basis for differentiating between these entities to optimize empirical therapies.