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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...

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Autores principales: Tsachouridou, Olga, Pilalas, Dimitrios, Nanoudis, Sideris, Antoniou, Athanasios, Bakaimi, Isidora, Chrysanthidis, Theofilos, Markakis, Konstantinos, Kassomenaki, Angeliki, Mantzana, Paraskevi, Protonotariou, Efthymia, Skoura, Lemonia, Metallidis, Symeon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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.
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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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