scholarly journals Assessment of mortality-related risk factors and effective antimicrobial regimens for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacterales

2021 ◽  
Author(s):  
Liang Chen ◽  
Xiudi Han ◽  
YanLi Li
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Antimicrobial Treatment ◽  
Source Control ◽  
Teaching Hospitals ◽  
Treatment Regimens ◽  
Carbapenem Resistant ◽  
Related Risk

Abstract Background Bloodstream infections (BSIs) attributable to carbapenem-resistant Enterobacterales (CRE-BSIs) are dangerous and a major cause of mortality in clinical settings. This study was therefore designed to define risk factors linked to 30-day mortality in CRE-BSI patients and to examine the relative efficacy of different antimicrobial treatment regimens in affected individuals. Methods Data pertaining to 187 CRE-BSI cases from three teaching hospitals in China collected between January 2018 and June 2020 were retrospectively analyzed. Results For the 187 analyzed patients in this study, the 30-day mortality of CRE-BSI was 41.7% (78/187). Multivariate logistic regression analyses revealed that Pitt score [odd ratio (OR) 5.313, 95% confidence interval (CI) 3.209–8.797, P < 0.001], immunocompromised status (OR 4.605, 95% CI 1.629–13.020, P = 0.004), meropenem minimum inhibitory concentration (MIC) ≥ 8 mg/L (OR 3.736, 95% CI 1.091–12.795, P = 0.036), source control of infection (OR 0.316, 95% CI 0.117–0.854, P = 0.023), and appropriate empirical therapy (OR 0.129, 95% CI 0.027–0.625, P = 0.011) were independent predictors of CRE-BSI patient 30-day mortality. After controlling for potential confounding factors, relative to ceftazidime-avibactam (CAZ-AVI) treatment, combination therapies including CAZ-AVI (OR 1.287, 95% CI 0.124–13.403, P = 0.833) were not related to any significant change in patient mortality risk, whereas 30-day mortality risk was higher for patients administered other antimicrobial regimens (OR 12.407, 95% CI 1.684–31.430, P = 0.011). When patients were treated with antimicrobial regimens not containing CAZ-AVI, combination therapy (OR 0.239, 95% CI 0.077–0.741, P = 0.013) was related to a decreased 30-day mortality risk relative to monotherapy treatment. Conclusion The mortality-related risk factors and relative antimicrobial regimen efficacy data demonstrated in this study may guide the management of CRE-BSI patients.

scholarly journals Assessment of mortality-related risk factors and effective antimicrobial regimens for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacterales

2021 ◽  
Author(s):  
Liang Chen ◽  
Xiudi Han ◽  
YanLi Li ◽  
Minghui Li
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Antimicrobial Treatment ◽  
Source Control ◽  
Teaching Hospitals ◽  
Treatment Regimens ◽  
Carbapenem Resistant ◽  
Related Risk

Background Bloodstream infections (BSIs) attributable to carbapenem-resistant Enterobacterales (CRE-BSIs) are dangerous and a major cause of mortality in clinical settings. This study was therefore designed to define risk factors linked to 30-day mortality in CRE-BSI patients and to examine the relative efficacy of different antimicrobial treatment regimens in affected individuals. Methods Data pertaining to 187 CRE-BSI cases from four teaching hospitals in China collected between January 2018 and December 2020 were retrospectively analyzed. Results For the 187 analyzed patients in this study, the 30-day mortality of CRE-BSI was 41.7% (78/187). Multivariate logistic regression analyses revealed that Pitt score, immunocompromised status, meropenem minimum inhibitory concentration (MIC) ≥ 8 mg/L, absence of source control of infection and appropriate empirical therapy were independent predictors of CRE-BSI patient 30-day mortality. After controlling for potential confounding factors, relative to ceftazidime-avibactam (CAZ-AVI) treatment, combination therapies including CAZ-AVI ( OR 1.287, 95% CI 0.124 - 13.403, P = 0.833) were not related to any significant change in patient mortality risk, whereas 30-day mortality risk was higher for patients administered other antimicrobial regimens ( OR 12.407, 95% CI 1.684 - 31.430, P = 0.011). When patients were treated with antimicrobial regimens not containing CAZ-AVI, combination therapy ( OR 0.239, 95% CI 0.077 - 0.741, P = 0.013) was related to a decreased 30-day mortality risk relative to monotherapy treatment. Conclusion The mortality-related risk factors and relative antimicrobial regimen efficacy data demonstrated in this study may guide the management of CRE-BSI patients.

scholarly journals Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients

2019 ◽  
Vol 13 (05) ◽  
pp. 357-364 ◽  
Author(s):  
Jianling Liu ◽  
Haichen Wang ◽  
Ziyan Huang ◽  
Xiaoyan Tao ◽  
Jun Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Klebsiella Pneumoniae ◽  
Empirical Therapy ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Observation Study ◽  
Hematological Patients ◽  
Carbapenem Resistant ◽  
Independent Risk Factors

Introduction: Carbapenem-resistant Klebsiella pneumoniae (KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality. The purpose of our study was to identify the risk factors for KP bloodstream infections (BSIs) and mortality in onco-hematological patients. Methodology: A retrospective observation study was conducted on KP BSIs in the onco-hematology departments at Xiangya hospital from January 2014 to September 2018. Multivariate analysis was employed to identify the independent risk factors for carbapenem-resistant (CR) KP BSIs and related mortality. Results: A total of 89 strains of KP were analyzed in our study, in which 20 strains were CRKP. The only risk factor for CRKP BSI was carbapenem exposure within 30 days before the onset of BSIs (HR 25.122). The 30-day mortality was 24.7%. CRKP caused more mortality than carbapenem-susceptible KP (55.0% vs 15.9%, P = 0.001). In the multivariate analysis, unresolved neutropenia (HR 16.900), diarrhea (HR 3.647) and RDW > 14% (HR 6.292) were independent risk factors for mortality, and appropriate empirical therapy (HR 0.164) was protective against mortality. Conclusions: Our findings showed that carbapenem resistance was spreading in our setting, and a precise combination of antibiotics covering the common pathogen is crucial to improving patient survival.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings

2019 ◽  
Vol 6 (3) ◽  
pp. 180-185
Author(s):  
Zümrüt Şahbudak Bal ◽  
Muhterem Duyu ◽  
Fulya Kamit ◽  
Pınar Yazıcı ◽  
Ayşe Berna Anıl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Bloodstream Infections ◽  
Pediatric Critical Care ◽  
Gram Negative ◽  
Carbapenem Resistant

scholarly journals Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children

2020 ◽  
Vol 76 (1) ◽  
pp. 220-225 ◽  
Author(s):  
M F Ara-Montojo ◽  
L Escosa-García ◽  
M Alguacil-Guillén ◽  
N Seara ◽  
C Zozaya ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Paediatric Population ◽  
Carbapenem Resistant ◽  
Paediatric Cohort ◽  
Single Centre Study ◽  
Sources Of Infection ◽  
Underlying Diseases ◽  
Hospital Acquired

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). Objectives To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. Methods A retrospective observational single-centre study (December 2005–August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. Results Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P &lt; 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. Conclusions CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.

scholarly journals Clinical and Microbiological Analysis of Risk Factors for Mortality in Patients With Carbapenem-Resistant Acinetobacter baumannii Bacteremia

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Hyo-Ju Son ◽  
Eun Been Cho ◽  
Moonsuk Bae ◽  
Seung Cheol Lee ◽  
Heungsup Sung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acinetobacter Baumannii ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Source Control ◽  
Microbiological Analysis ◽  
Clinical Factors ◽  
Carbapenem Resistant ◽  
Infection Source ◽  
Independent Risk Factors

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with significant mortality, causing worldwide concern, yet there are limited data on contributing microbiological factors. This study aimed to identify the clinical and microbiologic risk factors for mortality in CRAB bacteremia. Methods Adult patients with monomicrobial CRAB bacteremia in a 2700-bed tertiary hospital between December 2012 and December 2018 were retrospectively enrolled. Risk factors for 30-day mortality were evaluated. All isolates collected on the first day of bacteremia were subjected to colistin susceptibility testing by broth microdilution and to genotyping by multilocus sequence typing. Results A total of 164 patients were enrolled, and 90 (55%) died within 30 days. The most common genotype among the isolates was ST191 (49%), and 12 isolates (7%) were resistant to colistin. Genotype, colistin minimum inhibitory concentration, and colistin resistance were not significantly associated with mortality, in contrast to several clinical factors. In multivariable analysis, ineradicable or not-eradicated focus (adjusted odds ratio [aOR], 4.92; 95% CI, 1.95–12.42; P = .001), septic shock (aOR, 4.72; 95% CI, 2.12–10.49; P &lt; .001), and inappropriate antimicrobial therapy (aOR, 2.54; 95% CI, 1.05–6.16; P = .04) were independent risk factors for mortality. Among antibiotic strategies, colistin combined with tigecycline or other antibiotics were significantly associated with lower mortality after adjustment for confounding factors. Conclusions Clinical factors such as the nature of the infection source and source control, severity of bacteremia, and appropriateness of antibiotics, rather than microbiological factors, contribute to mortality in CRAB bacteremia. A specific antibiotic combination may help improve outcomes.

scholarly journals Clinical and Mortality Risk Factors in Bloodstream Infections with Carbapenem-Resistant Enterobacteriaceae

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Xiaopeng Li ◽  
Huan Ye
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Medical Information ◽  
Central Venous Catheterization ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Central Venous ◽  
Carbapenem Resistant ◽  
Venous Catheterization ◽  
Carbapenem Resistant Enterobacteriaceae

Objective. To investigate the risk factors underlying the occurrence and mortality of bloodstream infections (BSIs) with carbapenem-resistant Enterobacteriaceae (CRE). Methods. Medical information was retrospectively analyzed from 148 cases of patients with Enterobacteriaceae BSIs at a medical center in China, between 2013 and 2015. Results. The 30-day mortality rate in the CRE group was 65.4%. Indwelling urethral catheterization, admission to the ICU, use of antibiotics within 30 days, and BSIs from the respiratory system were associated with CRE BSIs. Lung infection, abdominal infection, central venous catheterization, and use of hormones within 30 days were associated with mortality. Conclusion. The 30-day mortality rate of CRE BSIs was high. Lung infections, abdominal infections, central venous catheterization, and use of hormones within 30 days increased the mortality rate of Enterobacteriaceae BSIs.

scholarly journals Risk Factors for Treatment Failure of Polymyxin B Monotherapy for Carbapenem-Resistant Klebsiella pneumoniae Infections

2013 ◽  
Vol 57 (11) ◽  
pp. 5394-5397 ◽  
Author(s):  
Yanina Dubrovskaya ◽  
Ting-Yi Chen ◽  
Marco R. Scipione ◽  
Diana Esaian ◽  
Michael S. Phillips ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Renal Insufficiency ◽  
Treatment Failure ◽  
Clinical Cure ◽  
Polymyxin B ◽  
Antimicrobial Treatment ◽  
Carbapenem Resistant

ABSTRACTPolymyxins are reserved for salvage therapy of infections caused by carbapenem-resistantKlebsiella pneumoniae(CRKP). Though synergy has been demonstrated for the combination of polymyxins with carbapenems or tigecycline,in vitrosynergy tests are nonstandardized, and the clinical effect of synergy remains unclear. This study describes outcomes for patients with CRKP infections who were treated with polymyxin B monotherapy. We retrospectively reviewed the medical records of patients with CRKP infections who received polymyxin B monotherapy from 2007 to 2011. Clinical, microbiology, and antimicrobial treatment data were collected. Risk factors for treatment failure were identified by logistic regression. Forty patients were included in the analysis. Twenty-nine of 40 (73%) patients achieved clinical cure as defined by clinician-documented improvement in signs and symptoms of infections, and 17/32 (53%) patients with follow-up culture data achieved microbiological cure. End-of-treatment mortality was 10%, and 30-day mortality was 28%. In a multivariate analysis, baseline renal insufficiency was associated with a 6.0-fold increase in clinical failure after adjusting for septic shock (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 1.22 to 29.59). Breakthrough infections with organisms intrinsically resistant to polymyxins occurred in 3 patients during the treatment. Eighteen of 40 (45%) patients developed a new CRKP infection a median of 23 days after initial polymyxin B treatment, and 3 of these 18 infections were polymyxin resistant. The clinical cure rate achieved in this retrospective study was 73% of patients with CRKP infections treated with polymyxin B monotherapy. Baseline renal insufficiency was a risk factor for treatment failure after adjusting for septic shock. Breakthrough infections with organisms intrinsically resistant to polymyxin B and development of resistance to polymyxin B in subsequent CRKP isolates are of concern.

Medical Comorbidity Related Risk Factors For Hospital-Based Mortality In Psychiatric Disorders of Icd-10 Classes F1–F4: A Comparative Overview of Five Studies In General Hospital Admissions

2016 ◽  
Vol 33 (S1) ◽  
pp. S485-S485
Author(s):  
D. Schoepf ◽  
R. Heun
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorders ◽  
General Hospital ◽  
Mortality Risk ◽  
Hospital Admissions ◽  
Medical Comorbidity ◽  
Medical Comorbidities ◽  
Related Risk ◽  
Icd 10 ◽  
Independent Risk Factors

IntroductionUp to 60% of the non-suicide related premature mortality of individuals with major psychiatric disorders is said to be mainly due to medical diseases.Objectives and aimsBased on five representative studies in general hospital admissions over 12.5-year observation, we will represent a comparative overview of medical comorbidity related risk factors for general hospital-based mortality in prevalent psychiatric disorders of ICD-10 major classes F1–F4.MethodsIn the original studies, medical comorbidities that increased the risk for hospital-based mortality were identified using multivariate forward logistic regression analysis. In secondary analysis, independent risk factors for general hospital-based mortality were compared between studies using the OR and the 95% CI.ResultsA total of fifteen medical comorbidities represented independent risk factors for general hospital-based mortality in more than one psychiatric disorder of ICD-10 major classes F1–F4. Infectious lung diseases and chronic obstructive pulmonary disease were mortality risk factors in all diagnostic classes. Type 2 diabetes mellitus represented a risk factor for general hospital-based mortality in individuals with schizophrenia (SCH), bipolar disorder (BD), and major depressive disorder (MDD). Atrial fibrillation was a mortality risk factor in individuals with MDD, anxiety disorder (ANX), and alcohol dependence (AD). In addition, nineteen medical comorbidities represented independent mortality risk factors in only one of the diagnostic classes, i.e. two in individuals with SCH, three in individuals with MDD, three in ANX, and eleven in AD.ConclusionsIn general hospitals, the pattern of medical comorbidities that explain the outcome of in-hospital deaths differs considerably between psychiatric disorders of ICD-10 major classes F1–F4.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document