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Microbiological and Infection-Source Predictors of Mortality in Severe Sepsis Patients Undergoing Polymyxin B
Wei-Hung Chang1, Li-Kuo Kuo1, Kuan-Pen Yu1
1Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
Background:
The microbiological landscape and infection-source profiles of severe sepsis in Asian ICUs differ markedly from Western cohorts and may influence the effectiveness and prognosis of adjunctive therapies such as polymyxin B hemoperfusion (PMX-HP). However, real-world data on how pathogen categories, multidrug resistance (MDR), and infection sources affect outcomes in PMX-HP-treated patients are lacking.
Methods:
We conducted a retrospective cohort study in a tertiary medical ICU in Taiwan, including adult patients with severe sepsis or septic shock who received PMX-HP between 2013 and 2019. Microbiological data, infection sources, MDR profiles, organ support requirements, vasoactive-inotropic score (VIS), and mortality outcomes were retrieved from electronic records. Pathogen groups (Gram-negative, Gram-positive, fungal, no-growth), MDR status, and infection sources were analyzed for associations with 28-day, ICU, and hospital mortality.
Results:
Among 64 patients (mean age 66.1 years; 67.2% male), Gram-negative pathogens predominated (70.3%), with Escherichia coli (31.3%) and Klebsiella pneumoniae (21.9%) being the most frequently identified organisms. MDR organisms were isolated in 26.6% of patients. The most common infection sources were pneumonia (29.7%), intra-abdominal infection (18.8%), and urinary tract infection (17.2%). Gram-negative infections were associated with higher CRRT utilization (71.9% vs. 47.1%, p = 0.04) and higher VIS at 24 h. MDR status was significantly associated with early CRRT requirement (64.7% vs. 38.6%, p = 0.048), but not with 28-day mortality (52.9% vs. 43.2%, p = 0.42). No infection source was independently associated with mortality after adjustment for APACHE II, CRRT, and VIS. Instead, greater organ failure severity-particularly renal failure requiring CRRT-was strongly associated with mortality in this cohort.
Conclusions:
In PMX-HP-treated severe sepsis patients, Gram-negative predominance and MDR status were associated with increased organ support requirements but were not independently associated with mortality. Outcomes were primarily associated with overall illness severity rather than microbiological category. These findings highlight the importance of combining microbiological data with dynamic physiological markers for prognostic risk stratification in Asian ICUs.
Insights
In severe sepsis patients treated with polymyxin B hemoperfusion (PMX-HP), Gram-negative infections and multidrug resistance (MDR) increased organ support needs but did not impact mortality. Overall illness severity, not pathogen type, determined outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Nephrology
Background:
- Asian ICU severe sepsis differs from Western cohorts, impacting therapies like polymyxin B hemoperfusion (PMX-HP).
- Limited real-world data exists on pathogen types, multidrug resistance (MDR), and infection sources influencing outcomes in PMX-HP-treated patients.
Purpose of the Study:
- To investigate the impact of pathogen categories, MDR, and infection sources on outcomes in severe sepsis patients undergoing PMX-HP in Taiwan.
- To analyze associations between microbiological data, infection sources, and mortality in this specific patient population.
Main Methods:
- Retrospective cohort study of 64 adult severe sepsis/septic shock patients receiving PMX-HP (2013-2019) in a Taiwanese tertiary medical ICU.
- Analysis of microbiological data, infection sources, MDR status, organ support (CRRT), vasoactive-inotropic score (VIS), and mortality outcomes.
- Statistical analysis to determine associations between pathogen groups, MDR, infection sources, and 28-day, ICU, and hospital mortality.
Main Results:
- Gram-negative pathogens predominated (70.3%), with E. coli and K. pneumoniae most common. MDR organisms found in 26.6%.
- Gram-negative infections linked to higher CRRT use and VIS. MDR status associated with early CRRT need.
- No specific infection source independently predicted mortality; overall organ failure severity, especially renal failure requiring CRRT, was the primary mortality predictor.
Conclusions:
- In PMX-HP-treated severe sepsis, Gram-negative predominance and MDR correlate with increased organ support needs but not mortality.
- Patient outcomes are driven by overall illness severity rather than specific microbiological factors.
- Integrating microbiological data with dynamic physiological markers is crucial for prognostic risk stratification in Asian ICUs.
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