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Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin
The incidence of multidrug-resistant (MDR) bloodstream infections (BSIs) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilit...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10383448/ https://www.ncbi.nlm.nih.gov/pubmed/37512883 http://dx.doi.org/10.3390/microorganisms11071711 |
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author | Tsachouridou, Olga Pilalas, Dimitrios Nanoudis, Sideris Antoniou, Athanasios Bakaimi, Isidora Chrysanthidis, Theofilos Markakis, Konstantinos Kassomenaki, Angeliki Mantzana, Paraskevi Protonotariou, Efthymia Skoura, Lemonia Metallidis, Symeon |
author_facet | Tsachouridou, Olga Pilalas, Dimitrios Nanoudis, Sideris Antoniou, Athanasios Bakaimi, Isidora Chrysanthidis, Theofilos Markakis, Konstantinos Kassomenaki, Angeliki Mantzana, Paraskevi Protonotariou, Efthymia Skoura, Lemonia Metallidis, Symeon |
author_sort | Tsachouridou, Olga |
collection | PubMed |
description | The incidence of multidrug-resistant (MDR) bloodstream infections (BSIs) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilitate and improve patient management. Data were assessed from patients with MDR Gram-negative bacteremia at a university tertiary hospital over a 12-month period. In total, 157 episodes of MDR Gram-negative BSI were included in the study. The overall mortality rate was 50.3%. Rapid molecular diagnostic tests were used in 94% of BSI episodes. In univariate analysis, age (OR 1.05 (95% CI 1.03, 1.08) p < 0.001), Charlson Comorbidity Index (OR 1.51 (95% CI 1.25, 1.83) p < 0.001), procalcitonin ≥ 1(OR 3.67 (CI 95% 1.73, 7.79) p < 0.001), and monotherapy with tigecycline (OR 3.64 (95% CI 1.13, 11.73) p = 0.030) were the only factors associated with increased overall mortality. Surprisingly, time to appropriate antimicrobial treatment had no impact on mortality. MDR pathogen isolation, other than Klebsiella pneumoniae and Acinetobacter baumanii, was associated with decreased mortality (OR 0.35 (95% CI 0.16, 0.79) p = 0.011). In multivariate analysis, the only significant factor for mortality was procalcitonin ≥ 1 (OR 2.84 (95% CI 1.13, 7.11) p = 0.025). In conclusion, in an endemic area, mortality rates in MDR BSI remain notable. High procalcitonin was the only variable that predicted death. The use of rapid diagnostics did not improve mortality rate. |
format | Online Article Text |
id | pubmed-10383448 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103834482023-07-30 Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin Tsachouridou, Olga Pilalas, Dimitrios Nanoudis, Sideris Antoniou, Athanasios Bakaimi, Isidora Chrysanthidis, Theofilos Markakis, Konstantinos Kassomenaki, Angeliki Mantzana, Paraskevi Protonotariou, Efthymia Skoura, Lemonia Metallidis, Symeon Microorganisms Article The incidence of multidrug-resistant (MDR) bloodstream infections (BSIs) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilitate and improve patient management. Data were assessed from patients with MDR Gram-negative bacteremia at a university tertiary hospital over a 12-month period. In total, 157 episodes of MDR Gram-negative BSI were included in the study. The overall mortality rate was 50.3%. Rapid molecular diagnostic tests were used in 94% of BSI episodes. In univariate analysis, age (OR 1.05 (95% CI 1.03, 1.08) p < 0.001), Charlson Comorbidity Index (OR 1.51 (95% CI 1.25, 1.83) p < 0.001), procalcitonin ≥ 1(OR 3.67 (CI 95% 1.73, 7.79) p < 0.001), and monotherapy with tigecycline (OR 3.64 (95% CI 1.13, 11.73) p = 0.030) were the only factors associated with increased overall mortality. Surprisingly, time to appropriate antimicrobial treatment had no impact on mortality. MDR pathogen isolation, other than Klebsiella pneumoniae and Acinetobacter baumanii, was associated with decreased mortality (OR 0.35 (95% CI 0.16, 0.79) p = 0.011). In multivariate analysis, the only significant factor for mortality was procalcitonin ≥ 1 (OR 2.84 (95% CI 1.13, 7.11) p = 0.025). In conclusion, in an endemic area, mortality rates in MDR BSI remain notable. High procalcitonin was the only variable that predicted death. The use of rapid diagnostics did not improve mortality rate. MDPI 2023-06-30 /pmc/articles/PMC10383448/ /pubmed/37512883 http://dx.doi.org/10.3390/microorganisms11071711 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Tsachouridou, Olga Pilalas, Dimitrios Nanoudis, Sideris Antoniou, Athanasios Bakaimi, Isidora Chrysanthidis, Theofilos Markakis, Konstantinos Kassomenaki, Angeliki Mantzana, Paraskevi Protonotariou, Efthymia Skoura, Lemonia Metallidis, Symeon Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title | Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title_full | Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title_fullStr | Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title_full_unstemmed | Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title_short | Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin |
title_sort | mortality due to multidrug-resistant gram-negative bacteremia in an endemic region: no better than a toss of a coin |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10383448/ https://www.ncbi.nlm.nih.gov/pubmed/37512883 http://dx.doi.org/10.3390/microorganisms11071711 |
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