Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)

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Titel: Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)
Beteiligte: Falcone, Marco; Tiseo, Giusy; Carbonara, Sergio; Marino, Andrea; Di Caprio, Giovanni; Carretta, Anna; Mularoni, Alessandra; Mariani, Michele Fabiano; Maraolo, Alberto Enrico; Scotto, Riccardo; Dalfino, Lidia; Corbo, Lorenzo; Macera, Margherita; Medaglia, Alice Annalisa; d’Errico, Maria Luca; Gioè, Claudia; Sgroi, Christian; Del Vecchio, Rosa Fontana; Ceccarelli, Giancarlo; Albanese, Antonio; Buscemi, Calogero; Talamanca, Simona; Raponi, Giammarco; Foti, Giuseppe; [...]
Erschienen: Oxford University Press (OUP), 2023
Erschienen in: Clinical Infectious Diseases
Sprache: Englisch
DOI: 10.1093/cid/ciad100
ISSN: 1058-4838; 1537-6591
Schlagwörter: Infectious Diseases ; Microbiology (medical)
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Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Our aim was to analyze mortality attributable to carbapenem-resistant (CR) gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Prospective multicentric study including patients with GNB-BSI from 19 Italian hospitals (June 2018–January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacterales, metallo-β-lactamases (MBL)–producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aORs) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall, 1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)-GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-producing CRE, 61/1276 (4.8%) CRPA, and 111/1276 (8.7%) CRAB BSI. Thirty-day mortality in patients with CS-GNB BSI was 13.7% compared to 26.6%, 36.4%, 32.8% and 43.2% in patients with BSI by KPC-CRE, MBL-CRE, CRPA and CRAB, respectively (P &lt; .001). On multivariable analysis, age, ward of hospitalization, SOFA score, and Charlson Index were factors associated with 30-day mortality, while urinary source of infection and early appropriate therapy resulted protective factors. Compared to CS-GNB, MBL-producing CRE (aOR 5.86, 95% CI 2.72–12.76), CRPA (aOR 1.99, 95% CI 1.48–5.95) and CRAB (aOR 2.65, 95% CI 1.52–4.61) were significantly associated with 30-day mortality. Attributable mortality rates were 5% for KPC-, 35% for MBL, 19% for CRPA, and 16% for CRAB.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In patients with BSIs, carbapenem-resistance is associated with an excess of mortality, with MBL-producing CRE carrying the highest risk of death.</jats:p> </jats:sec>

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