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Bloodstream Infections in Non-ICU Hospitalized Patients: Impact of Pathogen Group on Clinical Outcomes-A
Hasip Kahraman1, Yelda Nur Özmutlu1, Süleyman Alperen Hafif1
1Department of Infectious Diseases and Clinical Microbiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye.
Background:
Bloodstream infections (BSIs) in non-intensive care unit (ICU) wards are common yet less well characterized than ICU BSIs. Differences in monitoring intensity, diagnostic timelines, empirical therapy, and local resistance may shape outcomes, but pathogen-specific data in non-ICU settings remain limited. To address this gap, we provide regional data from Türkiye.
Methods:
We conducted a retrospective cohort study at a tertiary-care center in Türkiye, including 537 adult non-ICU inpatients with first monomicrobial BSI episodes between January 2020 and November 2023. Pathogens were grouped as Gram-negative, Gram-positive, or fungal. Demographic, clinical, microbiological, and outcome data were analyzed. Independent predictors of mortality were evaluated using multivariable logistic regression.
Results:
Among 537 patients (mean age 66.4 ± 16.4 years), Gram-negative pathogens predominated (65.0%), followed by Gram-positive (25.0%) and fungal pathogens (10.1%). The most frequent microorganisms were Escherichia coli (27.7%), Klebsiella spp. (20.7%; including clinically significant resistance), and Staphylococcus aureus (16.9%). Overall, 12.5% required ICU transfer, and in-hospital mortality was 23.3%, higher in fungal infections (46.3%) than bacterial infections (p<0.001). Fungal BSIs were associated with delayed initiation of appropriate therapy. In adjusted analyses, higher Charlson Comorbidity Index (OR 1.20; p<0.001), fungal pathogens (OR 2.41; p=0.026), ICU transfer (OR 24.66; p<0.001), and longer time from admission to infection onset (OR 1.03; p=0.003) were independently associated with mortality.
Conclusion:
In non-ICU settings, early recognition, rapid organism identification, and tailored antimicrobial/antifungal stewardship are essential-particularly given local resistance pressures (eg, carbapenem-resistant Klebsiella) and the elevated risk with candidemia. Implementing pathways that expedite diagnosis and timely appropriate therapy may improve patient outcomes.
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