1478. A Retrospective Review of <i>Pseudomonas aeruginosa</i> Infection in a Quarternary Intensive Care Unit: Epidemiology, Outcomes, and Antimicrobial Susceptibilities: 2013–2016
Bibliographic record
Abstract
Pseudomonas aeruginosa (PA) is known to cause infection in the intensive care unit (ICU) and contribute to substantial morbidity and mortality. The objectives of this study were to describe the epidemiology, antimicrobial resistance and outcomes in critically ill patients with pseudomonal infection. Patients with PA isolated during ICU admission from 2013–2016 were identified using provincial microbiology data. Patients were classified as colonized or infected. Those with infection were reviewed for source of infection, patient characteristics, antimicrobial susceptibilities, appropriateness of empiric antimicrobial therapy and 30-day mortality. Independent predictors of mortality were identified using multivariable logistic regression. A total of 196 unique patients were culture-positive for PA. 140 (71%) were infected and included for analysis. Mean patient age was 55.4 years (18.4 SD) and 62% were male. Admission categories included medical (71%), surgical (20%), and trauma or neurological (9%). Mean APACHE II score at the time of ICU admission was 19.4 (9.8 SD). One hundred and twenty-six (90%) patients required invasive mechanical ventilation, 102 (73%) vasopressor support and 27 (19%) new initiation of renal replacement therapy. Thirty-two (23%) died within 30 days of ICU admission. The median ICU length of stay was 13 days (IQR 5–27). Median time to infection was 1 day (IQR 0–9). Sources were respiratory (66%) followed by skin/soft tissue (11%), urinary (10%), and blood (5%). Twenty (14%) isolates were multi-drug-resistant (MDR) and six (4%) were extensively drug resistant (XDR). There were no pan-resistant isolates. One hundred and one (52%) of infections were nosocomial. Empiric antimicrobial therapy was effective in 97 (69%) cases. On multivariable analysis liver disease (aOR 6.2, 95% CI 1.5–25.7; P = 0.01), malignancy (aOR 5.0, 95% CI 1.5–17.3; P = −0.01) and higher APACHE II score at the time of admission (aOR 1.1, 95% CI 1.0–1.1; P = 0.02), were independently associated with 30-day mortality. PA in the ICU is associated with substantial mortality and is most commonly isolated from the respiratory tract. Existing malignancy, liver disease and higher APACHE II score at admission were independently associated with mortality. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".