Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 2:15:6451-6462.
doi: 10.2147/IDR.S386342. eCollection 2022.

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Yulian Gao #  1 , Hongxia Lin #  1 , Yumin Xu #  2 , Yijin Yao #  1 , Dake Shi  1 , Junjie Li  1 , Haixing Zhu  1 , Hanssa Dwarka Summah  3 , Lei Ni  1 , Yun Feng  1
Affiliations

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Yulian Gao et al. Infect Drug Resist. .

Abstract

Purpose: Carbapenem-resistant Gram-negative bacteria bloodstream infection (CRGNB-BSI) has gradually become a major threat worldwide due to its treatment difficulty and high mortality. This study aimed to determine the risk factors for CRGNB-BSI in immunosuppressed patients.

Patients and methods: A total of 427 immunosuppressed patients with CRGNB-BSI were retrospectively investigated from 2015 to 2021. Both univariate and multivariate logistic regression analyses were applied to evaluate independent risk factors for CRGNB-BSI.

Results: The most common etiology was Klebsiella Pneumoniae (50.59%; 216/427), while the Acinetobacillus baumannii infection was associated with the highest mortality (58.25%) among all etiologies. The 60-day mortality of immunosuppressed patients with CRGNB-BSI was 52.48% (224/427). Procalcitonin (PCT) > 0.5 μg/L (OR = 2.32, 95% CI: 1.28-4.19, P = 0.005) and age > 55 years (OR = 2.06, 95% CI: 1.17-3.64, P = 0.012) were found to be predictors of 60-day mortality of CRGNB-BSI, and tigecycline regimen (OR = 3.20, 95% CI: 1.81-5.67, P < 0.001) was associated with higher mortality. Multivariate analysis also revealed that patients who developed acute kidney injury (AKI) (OR = 2.19, 95% CI: 1.11-4.30, P = 0.023), gastrointestinal bleeding (OR = 3.18, 95% CI: 1.10-9.16, P = 0.032), multiple organ dysfunction syndrome (MODS) (OR = 12.11, 95% CI: 2.61-56.19, P = 0.001), and septic shock (OR = 3.24, 95% CI: 1.77-5.94, P < 0.001) showed worse outcomes. The risk factors were also significantly associated with mortality in the different subgroups.

Conclusion: This study demonstrated that PCT > 0.5 μg/L, age > 55 years, and the tigecycline regimen were significantly associated with higher 60-day mortality among immunosuppressed patients with CRGNB- BSI. Patients developing MODS, septic shock, or AKI had worse clinical outcomes. .

Keywords: bloodstream infection; carbapenem-resistant; immunosuppressed patients; prognosis; subgroups.

PubMed Disclaimer

Conflict of interest statement

Yulian Gao, Hongxia Lin, Yumin Xu, and Yijin Yao are co-first authors for this study. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Survival analysis of patients with carbapenem-resistant Gram-negative bloodstream infections in immunosuppressed patients, Kaplan–Meier curves showing the impact on 60-day mortality of (A) Procalcitonin > or <=0.5ug/L, (B) Age> or <=55 years, (C) patients with or without acute kidney injury, (D) patients with or without multiple organ dysfunction syndrome (E) patients with or without Shock, (F) patients took or did not take tigecycline.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Zhang P, Wang J, Hu H, et al. Clinical characteristics and risk factors for bloodstream infection due to carbapenem-resistant Klebsiella pneumoniae in patients with hematologic malignancies. Infect Drug Resist. 2020;13:3233–3242. doi:10.2147/IDR.S272217 - DOI - PMC - PubMed
    1. Babiker A, Clarke LG, Saul M, et al. Changing epidemiology and decreased mortality associated with carbapenem-resistant gram-negative bacteria, 2000–2017. Clin Infect Dis. 2020;73(11):e4521–e4530. doi:10.1093/cid/ciaa1464 - DOI - PMC - PubMed
    1. Hu FP China Antimicrobial Surveillance Network, the results of bacterial resistance in 2021[DB/OL]; 2022. Available from: https://www.chinets.com/Document. Accessed October 28, 2022.
    1. Birru M, Woldemariam M, Manilal A, et al. Bacterial profile, antimicrobial susceptibility patterns, and associated factors among bloodstream infection suspected patients attending arba minch general hospital, Ethiopia. Sci Rep. 2021;11:1. doi:10.1038/s41598-021-95314-x - DOI - PMC - PubMed
    1. Wu D, Chen C, Liu T, et al. Epidemiology, susceptibility, and risk factors associated with mortality in carbapenem-resistant gram-negative bacterial infections among abdominal solid organ transplant recipients: a retrospective C. Infect Dis Ther. 2021;10(1):559–573. doi:10.1007/s40121-021-00411-z - DOI - PMC - PubMed

LinkOut - more resources