Clinical outcomes of carbapenem-resistant gram-negative bacterial bloodstream infection in patients with end-stage renal disease in intensive care units: a multicenter retrospective observational study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-02-01 Epub Date: 2024-07-12 DOI:10.1007/s15010-024-02343-5

Yu-Chao Lin, Kuang-Yao Yang, Chung-Kan Peng, Ming-Cheng Chan, Chau-Chyun Sheu, Jia-Yih Feng, Sheng-Huei Wang, Wei-Hsuan Huang, Chia-Min Chen, Ding-Han Chen, Chieh-Lung Chen

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Abstract

Background: Carbapenem-resistant gram-negative bacteria (CRGNB) present a considerable global threat due to their challenging treatment and increased mortality rates, with bloodstream infection (BSI) having the highest mortality rate. Patients with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT) face an increased risk of BSI. Limited data are available regarding the prognosis and treatment outcomes of CRGNB-BSI in patients with ESRD in intensive care units (ICUs).

Methods: This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes.

Results: Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI.

Conclusions: CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.

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重症监护病房终末期肾病患者耐碳青霉烯类革兰阴性菌血流感染的临床结果：一项多中心回顾性观察研究。

背景：耐碳青霉烯革兰阴性菌（CRGNB）因其治疗难度大和死亡率升高而对全球构成巨大威胁，其中血流感染（BSI）的死亡率最高。接受肾脏替代疗法（RRT）的终末期肾病（ESRD）患者发生 BSI 的风险更高。有关重症监护病房（ICU）ESRD 患者 CRGNB-BSI 的预后和治疗效果的数据十分有限：这项多中心回顾性观察研究纳入了 2015 年 1 月至 2019 年 12 月期间在台湾的 149 名 ESRD 和 CRGNB-BSI ICU 患者。评估了临床和微生物学结果，并采用多变量回归分析评估了第28天死亡率的独立风险因素以及抗菌治疗方案对治疗结果的影响：在149名患者中，共有127名患者（85.2%）在重症监护病房感染了BSI，其中导管相关感染（47.7%）和肺炎（32.2%）是最常见的病因。鲍曼不动杆菌（49.0%）和肺炎克雷伯菌（31.5%）是最常见的分离病原体。BSI 发病第 28 天的死亡率为 52.3%，院内死亡率为 73.2%，幸存者住院时间较长。较高的序贯器官衰竭评估（SOFA）评分（调整后危险比 [aHR]，1.25；95% 置信区间 [CI]，1.17-1.35）和休克状态（aHR，2.12；95% 置信区间 [CI]，1.14-3.94）可独立预测第 28 天的死亡率。在休克、SOFA评分≥13分以及与鲍曼不动杆菌相关的BSI患者中，以秋水仙碱为基础的治疗可降低第28天的死亡率：结论：CRGNB-BSI 会导致 ESRD 重症患者的高死亡率。SOFA评分越高和休克状态越能独立预测第28天的死亡率。对于疾病严重程度较高且与鲍曼不动杆菌相关的 BSI 患者，以可乐定为基础的治疗可改善治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.