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
. 2023 Jun 16;76(12):2059-2069.
doi: 10.1093/cid/ciad100.

Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)

Marco Falcone  1 , Giusy Tiseo  1 , Sergio Carbonara  2 , Andrea Marino  3 , Giovanni Di Caprio  4 , Anna Carretta  5 , Alessandra Mularoni  6 , Michele Fabiano Mariani  2 , Alberto Enrico Maraolo  7 , Riccardo Scotto  8 , Lidia Dalfino  9 , Lorenzo Corbo  10 , Margherita Macera  11 , Alice Annalisa Medaglia  12 , Maria Luca d'Errico  5 , Claudia Gioè  12 , Christian Sgroi  13 , Rosa Fontana Del Vecchio  14 , Giancarlo Ceccarelli  15 , Antonio Albanese  16 , Calogero Buscemi  17 , Simona Talamanca  18 , Giammarco Raponi  15   19 , Giuseppe Foti  20 , Giulio De Stefano  21 , Antonina Franco  14 , Carmelo Iacobello  22 , Salvatore Corrao  23 , Uccio Morana  13 , Filippo Pieralli  24 , Ivan Gentile  8 , Teresa Santantonio  5 , Antonio Cascio  25 , Nicola Coppola  11 , Bruno Cacopardo  3 , Alessio Farcomeni  26 , Mario Venditti  15 , Francesco Menichetti  1 ; Advancing knowLedge on Antimicrobial Resistant Infections Collaboration Network (ALARICO Network)
Collaborators, Affiliations

Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)

Marco Falcone et al. Clin Infect Dis. .

Abstract

Background: Our aim was to analyze mortality attributable to carbapenem-resistant (CR) gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs).

Methods: Prospective multicentric study including patients with GNB-BSI from 19 Italian hospitals (June 2018-January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales, metallo-β-lactamases (MBL)-producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aORs) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium.

Results: Overall, 1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)-GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-producing CRE, 61/1276 (4.8%) CRPA, and 111/1276 (8.7%) CRAB BSI. Thirty-day mortality in patients with CS-GNB BSI was 13.7% compared to 26.6%, 36.4%, 32.8% and 43.2% in patients with BSI by KPC-CRE, MBL-CRE, CRPA and CRAB, respectively (P < .001). On multivariable analysis, age, ward of hospitalization, SOFA score, and Charlson Index were factors associated with 30-day mortality, while urinary source of infection and early appropriate therapy resulted protective factors. Compared to CS-GNB, MBL-producing CRE (aOR 5.86, 95% CI 2.72-12.76), CRPA (aOR 1.99, 95% CI 1.48-5.95) and CRAB (aOR 2.65, 95% CI 1.52-4.61) were significantly associated with 30-day mortality. Attributable mortality rates were 5% for KPC-, 35% for MBL, 19% for CRPA, and 16% for CRAB.

Conclusions: In patients with BSIs, carbapenem-resistance is associated with an excess of mortality, with MBL-producing CRE carrying the highest risk of death.

Keywords: Acinetobacter baumannii; Klebsiella pneumoniae; Pseudomonas aeruginosa‌; attributable mortality; carbapenem resistance.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest. M. F. received unconditional grants from MSD and Gilead and grants or speaker honoraria from MSD, Angelini, Shionogi, Pfizer, Menarini, and Nordic Pharma. F. M. has participated on advisory boards and/or received speaker honoraria from Angelini, Correvio, MSD, Nordic Pharma, Pfizer, Astellas, Gilead, Bristol-Myers Squibb, Janssen, ViiV, bioMérieux, Biotest, Becton Dickinson, Pfizer, and Shionogi. G. T. received honoraria for educational meetings from Shionogi. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Publication types