Predictors of mortality in sepsis patients with Acinetobacter baumannii and Klebsiella pneumoniae bacteremia

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-06-07 DOI:10.1016/j.cegh.2025.102090

Danavath Nagendra , Vandana Kalwaje Eshwara , Souvik Chaudhuri , Vishal Shanbhag , Thejesh Srinivas

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Abstract

Background and aim

Sepsis with persistent bacteremia caused by Acinetobacter baumannii (A. baumannii) and Klebsiella pneumoniae (K. pneumoniae) poses a significant mortality risk in intensive care units (ICUs). The role of follow-up blood cultures (FUBCs) in predicting outcomes remains debated. This study investigates the key predictors of mortality and the importance of microbiological non-clearance (MNC) through FUBCs among these predictors in bacteremia due to K. pneumoniae and A. baumannii infections.

Materials and methods

We conducted a single-center, retrospective study at a tertiary teaching hospital in India involving 218 ICU patients with K. pneumoniae and A. baumannii bacteremia from October 2019 to December 2021. Blood cultures were analyzed using the BACT/ALERT VIRTUO system. Data were analyzed using logistic regression, receiver operating characteristic (ROC) curves, and an artificial neural network (ANN) model to determine the normalized importance of key predictors of mortality. Factors with a more than 50 % normalized importance were considered significant contributors to mortality.

Results

The overall mortality rate was 84 %, with 91 % in patients co-infected with K. pneumoniae and A. baumannii. Microbiological clearance (MC) was associated with a lower mortality rate (56.5 %) compared to MNC (97 %) or no FUBCs (84 %). Multivariable logistic regression identified the Charlson Comorbidity Index (CCI) score and MNC as independent predictors of mortality, with a predictive accuracy of 91.6 %. The ANN model confirmed the normalized importance of MNC as a key predictor, followed by CCI score, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at ICU admission, Sequential Organ Failure Assessment (SOFA) scores at ICU admission, age, SOFA score on culture-positive day, Pitts bacteremia score, and renal replacement therapy (RRT).

Conclusion

Persistent bacteremia involving K. pneumoniae and A. baumannii is associated with high mortality, particularly in co-infections. Achieving MC through FUBCs is critical for improving patient outcomes. Multivariate logistic regression analysis revealed that the CCI score, and MNC were identified as key predictors of mortality. The ANN analysis further highlighted these predictors and additional factors, including the APACHE II score at ICU admission, SOFA score at ICU admission, SOFA score on culture-positive day, Pitts bacteremia score, age, and RRT. These findings emphasize the importance of rigorous follow-up and optimal management strategies in ICU settings to improve survival outcomes.

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鲍曼不动杆菌和肺炎克雷伯菌血症脓毒症患者死亡率的预测因素

背景与目的鲍曼不动杆菌（鲍曼不动杆菌）和肺炎克雷伯菌（肺炎克雷伯菌）引起的脓毒症伴持续性菌血症在重症监护病房（icu）具有显著的死亡风险。随访血培养（fubc）在预测预后中的作用仍存在争议。本研究通过fubc探讨了肺炎克雷伯菌和鲍曼芽胞杆菌感染引起的菌血症中微生物非清除率（MNC）在这些预测因子中的重要性。材料与方法我们于2019年10月至2021年12月在印度一家三级教学医院进行了一项单中心回顾性研究，纳入了218例肺炎克雷伯菌和鲍曼不雅杆菌菌血症ICU患者。使用BACT/ALERT VIRTUO系统分析血培养。采用logistic回归、受试者工作特征（ROC）曲线和人工神经网络（ANN）模型对数据进行分析，以确定死亡率关键预测因素的归一化重要性。标准化重要性超过50%的因素被认为是死亡率的重要因素。结果总病死率为84%，其中肺炎克雷伯菌和鲍曼不动杆菌合并感染的病死率为91%。与MNC（97%）或无fubc（84%）相比，微生物清除率（MC）与较低的死亡率（56.5%）相关。多变量logistic回归确定Charlson合并症指数（CCI）评分和MNC为死亡率的独立预测因子，预测准确率为91.6%。ANN模型证实了MNC作为关键预测因子的标准化重要性，其次是CCI评分、ICU入院时急性生理和慢性健康评估II （APACHE II）评分、ICU入院时序事性器官衰竭评估（SOFA）评分、年龄、培养阳性日SOFA评分、Pitts菌血症评分和肾替代治疗（RRT）。结论包括肺炎克雷伯菌和鲍曼不动杆菌的持续性菌血症与高死亡率相关，特别是合并感染。通过fubc实现MC对于改善患者预后至关重要。多因素logistic回归分析显示，CCI评分和MNC被确定为死亡率的关键预测因子。ANN分析进一步强调了这些预测因子和其他因素，包括ICU入院时APACHE II评分、ICU入院时SOFA评分、培养阳性日SOFA评分、Pitts菌血症评分、年龄和RRT。这些发现强调了在ICU环境中严格随访和优化管理策略对改善生存结果的重要性。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.