Assessing the burden of disease of gram-negative bloodstream infections in a Brazilian hospital: A retrospective cohort study from 2015 to 2019

IF 1.5 Q4 INFECTIOUS DISEASES IJID regions Pub Date : 2024-07-05 DOI:10.1016/j.ijregi.2024.100401

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Abstract

Objectives

This study aimed to estimate the disease burden of BSIs caused by gram-negative bacteria (GNB-BSIs) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs).

Methods

A retrospective cohort study of adult patients with GNB-BSI was conducted from April 01, 2015 to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical intensive care unit located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, using life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010).

Results

A total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92 ± 17.97 years, with 61.1% being male. The most common bacterial infections were Klebsiella pneumoniae and Escherichia coli (66.5%), whereas carbapenem-resistant gram-negative bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752, 95% confidence interval [CI]: 520-1021 with Brazilian Life Tables and 782, 95% CI: 540-1062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly, in 2017, reaching 7050 (95% CI: 3200-12,150 with Brazilian Life Tables and 7350, 95% CI: 3350-12,700 with GBD 2010) DALYs per 1000 patient days and an estimated mortality rate of 40% per 1000 patient days.

Conclusions

The persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria.

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评估巴西一家医院革兰氏阴性血流感染的疾病负担：2015年至2019年的回顾性队列研究

目的本研究旨在估算2015年至2019年巴西一家医院由革兰阴性菌引起的BSI（GNB-BSI）所造成的疾病负担，以残疾调整生命年（DALYs）来衡量。方法从2015年4月1日至2019年3月31日对GNB-BSI成年患者进行了一项回顾性队列研究。该研究在巴西萨尔瓦多一家拥有 356 张床位的私立医院进行，该医院的重症医学科拥有 68 张床位。通过查阅病历收集了人口统计学和临床数据。使用蒙特卡洛模拟法估算了残疾调整寿命年数，采用的是巴西人2020年生命表和《2010年全球疾病负担》（GBD 2010）。平均年龄为 59.92 ± 17.97 岁，61.1% 为男性。最常见的细菌感染是肺炎克雷伯菌和大肠埃希菌（66.5%），而耐碳青霉烯类革兰阴性菌（CR-GNB）占 32.7%。2018 年的总体残疾调整寿命年数最高（752，95% 置信区间 [CI]：根据巴西生命表，为 752，95% 置信区间 [CI]：520-1021；根据 2010 年 GBD，为 782，95% 置信区间：540-1062）。CR-GNB 感染造成的残疾调整寿命年数最高，尤其是在 2017 年，达到 7050 年（根据巴西生命表，95% CI：3200-12150；根据 2010 年 GBD，7350 年，95% CI：3350-12700）。结论 CR-GNB 相关的残疾调整寿命年数居高不下，令人担忧，在未来几年内，每 1000 个患者日可能导致 300 多人死亡。这些发现突出表明，巴西急需解决 GNB-BSI 这一重大公共卫生问题。这些结果有望为公共卫生政策制定者提供有用的信息，以便优先干预抗生素耐药菌引起的感染。

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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