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Difficult-to-treat resistant gram-negative blood stream infections - the beginning of a superbug era - a prospective
Naveenraj P1, Deepak Kumar1, Durga Shankar Meena1
1Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Introduction:
Carbapenem resistant gram-negative bacterial infections are a growing concern worldwide. However, India is already in the era of a shortage of effective antibiotics for the management of these infections. Moreover, Difficult-to-Treat Resistance (DTR) gram-negative infections, which are not much studied, further complicate the scenario. This study emphasized the incidence and outcomes of DTR infections.
Methodology:
This is a single-center prospective observational study. The study included hospitalised patients aged ≥18 years with gram-negative bacterial bloodstream infections (GNBSI). Blood cultures with the growth of contaminants and/or single positive culture taken from the femoral site were excluded. Incidences of DTR infections and outcomes in the form of 30-day mortality were analysed.
Results:
Two hundred forty patients with GNBSI episodes were recorded. The Incidence of DTR GNBSI was 37.9% (91/240). Multivariate analysis found that Hospital-acquired infections, ICU admission and mechanical ventilation were independent risk factors for DTR GNBSI. The most common DTR GNB isolates were Klebsiella pneumoniae (31/49, 63.3%) and Acinetobacter baumannii (26/52, 50%). The adjusted relative risk of mortality was remarkably high in DTR GNBSI (aRR 3.9; 95% CI 1.9-7.9) as compared to CR+/DTR- GNBSI (aRR 0.3; 95% CI 0.1-1.0) and ESCR/CS GNBSI (aRR 1.1; 95% CI 0.5-2.4).
Conclusion:
DTR GNB infections are growing concern in India and this need to be evaluated in multicentric studies. Moreover, DTR GNBSI was associated with significantly higher mortality and there is need of further empowerment of antibiotic stewardship practices.
Insights
Difficult-to-Treat Resistance (DTR) gram-negative bacterial infections are a growing problem in India. These DTR infections are linked to significantly higher mortality rates, highlighting an urgent need for better antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Antimicrobial Resistance
- Public Health
Background:
- Carbapenem-resistant gram-negative bacterial infections pose a significant global health threat.
- India faces a critical shortage of effective antibiotics for managing these infections.
- Difficult-to-Treat Resistance (DTR) gram-negative infections are understudied but complicate the clinical landscape.
Purpose of the Study:
- To determine the incidence of DTR gram-negative bacterial bloodstream infections (GNBSI) in hospitalized patients.
- To analyze the outcomes, specifically 30-day mortality, associated with DTR GNBSI.
- To identify risk factors and common causative agents of DTR GNBSI in the Indian context.
Main Methods:
- A single-center prospective observational study was conducted.
- Included hospitalized patients aged ≥18 years with gram-negative bacterial bloodstream infections (GNBSI).
- Analyzed incidences of DTR infections and 30-day mortality, excluding contaminants and single femoral site cultures.
Main Results:
- DTR GNBSI occurred in 37.9% of 240 GNBSI episodes.
- Hospital-acquired infections, ICU admission, and mechanical ventilation were independent risk factors for DTR GNBSI.
- Klebsiella pneumoniae and Acinetobacter baumannii were the most common DTR isolates. DTR GNBSI showed a significantly higher adjusted relative risk of mortality (aRR 3.9).
Conclusions:
- DTR gram-negative infections represent a growing concern in India, necessitating multicenter studies.
- DTR GNBSI is associated with substantially increased mortality.
- There is a critical need to enhance antibiotic stewardship practices to combat DTR infections.
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