Abstract
Background
Short-term readmission is an important outcome reflecting the poor trajectory of sepsis survivors. The aim of this study was to identify the major risk factors for 30 day-readmission among patients with Gram-negative bacteremia.
Methods
Retrospective cohort study including all consecutive adults hospitalized in the medical departments in a referral hospital in Israel with Gram-negative bacteremia between 2011 to 2020, who were discharged alive. Predictors for 30-day readmission were investigated, considering death after discharge as a competing event. Cephalosporin resistance was our predictor of interest. Sub-distribution hazard ratios (HR) of the cumulative incidence function were investigated using the Fine and Gray multivariable competing-risk regression model. The prediction models were cross-validated using the k-fold method.
Results
Among 2,196 patients surviving hospitalization with Gram-negative bacteremia, the mean age was 70±16 years and 432 (19.6%) were readmitted within 30 days. Variables associated readmission hazards included were Arab ethnicity, active malignancy, conditions requiring immune-suppression, anxiolytics or hypnotics, anticoagulant or antiplatelet therapy, discharge with a nasogastric tube, higher pre-discharge heart rate, duration of antibiotic therapy during hospitalization and bacteremia caused by cephalosporin-resistant bacteria (HR 1.23, 95% CI 0.99-1.52). The area under the receiver-operating characteristics curve for this model was 75.5% (95% CI 71.3-79.1%). In secondary models, cephalosporin resistance and inappropriate empirical antibiotic treatment and lower pre-discharge albumin, were significantly associated with re-admission.
Conclusion
30-day re-admissions among patients with Gram-negative bacteremia surviving the index admission are high. Readmission was related to comorbidities and infections caused by multidrug-resistant infections.
Mortality burden related to infection with carbapenem-resistant Gram-negative bacteria among haematological cancer patients: a retrospective cohort study
