Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Abstract

Purpose

Carbapenem-resistant Gram-negative bacteria bloodstream infection (CRGNB-BSI) has gradually become a major threat worldwide due to its treatment difficulty and high mortality. This study aimed to determine the risk factors for CRGNB-BSI in immunosuppressed patients.

Patients and Methods

A total of 427 immunosuppressed patients with CRGNB-BSI were retrospectively investigated from 2015 to 2021. Both univariate and multivariate logistic regression analyses were applied to evaluate independent risk factors for CRGNB-BSI.

Results

The most common etiology was Klebsiella Pneumoniae (50.59%; 216/427), while the Acinetobacillus baumannii infection was associated with the highest mortality (58.25%) among all etiologies. The 60-day mortality of immunosuppressed patients with CRGNB-BSI was 52.48% (224/427). Procalcitonin (PCT) > 0.5 μg/L (OR = 2.32, 95% CI: 1.28–4.19, P = 0.005) and age > 55 years (OR = 2.06, 95% CI: 1.17–3.64, P = 0.012) were found to be predictors of 60-day mortality of CRGNB-BSI, and tigecycline regimen (OR = 3.20, 95% CI: 1.81–5.67, P < 0.001) was associated with higher mortality. Multivariate analysis also revealed that patients who developed acute kidney injury (AKI) (OR = 2.19, 95% CI: 1.11–4.30, P = 0.023), gastrointestinal bleeding (OR = 3.18, 95% CI: 1.10–9.16, P = 0.032), multiple organ dysfunction syndrome (MODS) (OR = 12.11, 95% CI: 2.61–56.19, P = 0.001), and septic shock (OR = 3.24, 95% CI: 1.77–5.94, P < 0.001) showed worse outcomes. The risk factors were also significantly associated with mortality in the different subgroups.

Conclusion

This study demonstrated that PCT > 0.5 μg/L, age > 55 years, and the tigecycline regimen were significantly associated with higher 60-day mortality among immunosuppressed patients with CRGNB- BSI. Patients developing MODS, septic shock, or AKI had worse clinical outcomes. 

Keywords:

• bloodstream infection
• carbapenem-resistant
• immunosuppressed patients
• subgroups
• prognosis

Ethics Statements

All analyses were based on previous clinical data and the study obtained ethical clearance from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine Ethic committee with the approval of patient informed consent exemption. And this study followed the guidelines outlined in the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Yulian Gao, Hongxia Lin, Yumin Xu, and Yijin Yao are co-first authors for this study. The authors report no conflicts of interest in this work.

Additional information

Funding

The present study was supported by the National Natural Science Foundation of China (No.82170086), Shanghai Shenkang Hospital Development Center Clinical Science and Technology Innovation Project (SHDC12018102), Shanghai Municipal Key Clinical Specialty (shslczdzk02202), Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases (20dz2261100).