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ICU-Associated Gram-Negative Bloodstream Infection: Risk Factors Affecting the Outcome Following the Emergence of
Marios Karvouniaris1, Garyphallia Poulakou2, Konstantinos Tsiakos2
1Intensive Care Unit, AHEPA University Hospital, 54636 Thessaloniki, Greece.
Abstract:
Intensive care unit patients may present infections by difficult-to-treat-resistant Gram-negative microorganisms. Colistin resurfaced as a last resort antibiotic for the treatment of multi-drug-resistant Gram-negative bacteria. However, colistin might not improve survival, particularly after the emergence of colistin-resistant isolates. We aimed to (1) examine the first Gram-negative-associated-bloodstream infection (GN-BSI) effect on 28-day mortality and (2) distinguish mortality risk factors. From 1 January 2018 to 31 December 2019, we retrospectively studied all adult patients admitted for more than 48 h in the critical care department of a regional Greek hospital, with prevalent difficult-to-treat Gram-negative pathogens. We examined the patient records for the first GN-BSI. The local laboratory used broth microdilution to evaluate bacterial susceptibility to colistin. Seventy-eight patients fulfilled the entry criteria: adult and first GN-BSI. They developed GN-BSI on day 10 (6-18), while the overall mortality was 26.9%. Thirty-two and 46 individuals comprised the respective colistin-resistant and colistin-sensitive groups. The admission Acute Physiology Assessment and Chronic Health Evaluation II score was associated with acquiring colistin-resistant GN-BSI in the multivariable logistic regression analysis (οdds ratio (CI), 1.11 (1.03-1.21)). Regarding mortality, the index day sequential organ failure assessment score was solely associated with the outcome (hazard-ratio (CI), 1.23 (1.03-1.48), Cox proportional hazard analysis). GN-BSI was often caused by colistin-resistant bacteria. Concerning our data, sepsis severity was the independent predictor of mortality regardless of the colistin-resistance phenotype or empirical colistin treatment.
Insights
Intensive care unit patients with Gram-negative-associated bloodstream infections (GN-BSI) face high mortality. Sepsis severity, not colistin resistance, independently predicted death in this study.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Intensive care units (ICUs) frequently encounter infections caused by multidrug-resistant Gram-negative bacteria.
- Colistin is a last-resort antibiotic for treating these infections, but its efficacy is challenged by emerging colistin resistance.
- The impact of colistin resistance on patient outcomes, particularly mortality, remains a critical concern.
Purpose of the Study:
- To investigate the effect of Gram-negative-associated bloodstream infection (GN-BSI) on 28-day mortality in ICU patients.
- To identify independent risk factors for mortality in patients with GN-BSI.
- To assess the influence of colistin resistance on GN-BSI outcomes.
Main Methods:
- Retrospective study of adult ICU patients with GN-BSI from January 2018 to December 2019.
- Bacterial susceptibility to colistin was determined using broth microdilution.
- Multivariable logistic regression and Cox proportional hazard analyses were used to identify mortality risk factors.
Main Results:
- The study included 78 patients, with GN-BSI developing on day 10 (interquartile range: 6-18).
- Overall mortality was 26.9%, with 32 patients in the colistin-resistant group and 46 in the colistin-sensitive group.
- Higher Acute Physiology Assessment and Chronic Health Evaluation II scores were associated with colistin-resistant GN-BSI; higher Sequential Organ Failure Assessment scores predicted mortality.
Conclusions:
- Gram-negative-associated bloodstream infections are often caused by colistin-resistant bacteria in ICUs.
- Sepsis severity, indicated by the Sequential Organ Failure Assessment score, is the primary predictor of mortality, irrespective of colistin resistance or empirical colistin treatment.
- These findings highlight the importance of managing sepsis severity in critically ill patients with GN-BSI.
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