The epidemiology of gram-negative bacteremia in Lebanon: a study in four hospitals

Abstract

Introduction: Gram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon.

Methods: We conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020.

Results: Most bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes.

Conclusion: This is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

Keywords: Bacteremia; Gram-negative; Lebanon; Mortality; Multicentric.

Fig. 1

Bacteremia percentages according to the identified source

Fig. 2

Resistance pattern variations of different bacteria between 2013 and 2020

Fig. 3

Mortality, failure and cure rates between hospital and community-acquired pathogens

Fig. 4

Differences in mortality based on carbapenem resistance for Pseudomonas species and Enterobacterales

Fig. 5

Pathogens involved in Gram-negative bloodstream infections

Fig. 6

Percentage of each organism’s involvement in total Gram-negative bacteremias across different countries