Time to positivity as prognostic tool in patients with Pseudomonas aeruginosa bloodstream infection

Summary Objectives The time to positivity (TTP), measured as the time span between the start of incubation and the alert signal from the blood culture device, has been described as useful tool of prognosis in patients suffering from blood stream infection with Staphylococcus aureus , Escherichia coli and Klebsiella pneumonia . The present study investigates the relationship between TTP and in-hospital mortality in patients with monomicrobial Pseudomonas aeruginosa blood stream infection (PA-BSI). Methods From 2006 until 2012 a retrospective cohort study was undertaken in 3 hospitals in the region surrounding Tubingen, Germany. Seventy-four patients with monomicrobial PA-BSI were studied. TTP and clinical parameters were determined and analyzed by receiver operating characteristic (ROC) analysis and Cox regression. Results The in-hospital mortality of our clinical cohort was 33.78%. In multivariate Cox regression, a TTP ≤ 18 h proved to be independently associated with mortality (HR 3.83, P  = 0.012) along with SAPS II score (HR 1.04, P  = 0.006), cardiac disease (HR 0.33, P  = 0.008) and appropriate definitive antimicrobial treatment (HR 0.21, P  = 0.013). Conclusions TTP is an easy-to-measure laboratory tool for prognosis in patients with monomicrobial PA-BSI, providing useful information in addition to clinical parameters.