Predictors of mortality in patients with Gram-Negative Bacilli (GNB) blood stream infections (BSI): multicentre data from India.

Infectious diseases (London, England) Pub Date : 2025-01-13 DOI:10.1080/23744235.2025.2453581

Nitin Bansal, Kalpesh Suresh Sukhwani, Veeren Ganta

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Abstract

Background: This study was done with objectives of determining the predictors of mortality in patients with Gram-Negative Bacilli (GNB) Blood stream Infection (BSI) along with estimating mortality attributable to carbapenem resistance (CR).

Methods: In this prospective cohort study (January 2023-September 2024), done in 3 tertiary care centres in India, patients found to have mono-microbial GNB BSI were included. Primary outcome was crude mortality at day 30 of onset of BSI.

Results: Out of 604 patients, mortality at day 30 happened in 140 (23.2%) patients. Intergroup analysis between patients alive (n = 464) and dead (n = 140) at day 30 revealed that lower age (p = 0.014), higher Sequential Organ Failure Assessment Score (SOFA) score (p < 0.001), higher Pitts Bacteraemia score (p < 0.001), acquisition of BSI in hospital (p = 0.003) and CR in Enterobacterales (Escherichia coli & Klebsiella pneumoniae[CRKP] and Acinetobacter baumannii (CRAB) and DTR (defined as non-susceptibility to carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones) in Pseudomonas aeroginosa [DTR-PA] (CR E. coli, p = 0.034; CRKP, p = 0.012; CRAB, p < 0.001; DTR-PA, p < 0.001) was associated with higher mortality. On multivariate logistic regression analysis, higher SOFA score (p < 0.001) and BSI due to DTR-PA (p = .006) and CRAB (p= .017) were found to be independent predictors of mortality. Attributable mortality of CR in E. coli and K. pneumoniae and DTR in PA was 7.32, 8.43 and 52.4% respectively.

Conclusion: We did not find CR as a major contributing factor for death among patients with BSI due to Enterobacterales in our study cohort.

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革兰氏阴性杆菌（GNB）血流感染（BSI）患者的死亡率预测因素：印度的多中心数据。

研究背景本研究旨在确定革兰氏阴性杆菌（GNB）血流感染（BSI）患者的死亡率预测因素，并估算碳青霉烯耐药性（CR）导致的死亡率：这项前瞻性队列研究（2023 年 1 月至 2024 年 9 月）在印度的 3 家三级医疗中心进行，纳入了发现患有单微生物 GNB BSI 的患者。主要结果是 BSI 发病第 30 天的粗死亡率：在 604 名患者中，第 30 天死亡的患者有 140 名（23.2%）。对第 30 天存活（464 人）和死亡（140 人）的患者进行组间分析发现，年龄较小（P = 0.014）、序贯器官衰竭评估评分（SOFA）较高（P = 0.003）、肠杆菌科（大肠埃希菌和肺炎克雷伯菌[CRKP]和鲍曼不动杆菌[CRAB]）的 CR 和铜绿假单胞菌[DTR-PA]的 DTR（定义为对碳青霉烯类、β-内酰胺-β-内酰胺酶抑制剂复方制剂和氟喹诺酮类药物不敏感）（CR E. coli，p = 0.大肠杆菌，p = 0.034；CRKP，p = 0.012；CRAB，p p = .006）和 CRAB（p= .017）是死亡率的独立预测因子。大肠杆菌和肺炎克氏菌中的 CR 和 PA 中的 DTR 的归因死亡率分别为 7.32%、8.43% 和 52.4%：在我们的研究队列中，我们没有发现 CR 是导致肠杆菌 BSI 患者死亡的主要因素。

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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Infectious diseases (London, England)

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