Predictors of Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli or Vancomycin-Resistant Enterococci Bacteremia

Figures & data

Table 1 Baseline Characteristics of the Study Population (N=171)

	Number (%) Median ± IQR		Number (%) Median ± IQR
		Gastrointestinal Origin	67 (39.2%)
Age	70 ± 18	Respiratory origin	50 (29.2%)
Male sex	102 (59.7%)	CLABSI	81 (47.4%)
CRGNB	100 (58.4%)	Genitourinary origin	19 (11.1%)
Hospitalized within 3 months	89 (52.0%)	SSTI	14 (8.2%)
		CNS origin	7 (4.1%)
HD	40 ± 46	APS	59 ± 35
Length of ICU stay (days)	24.52 ± 62.43	APACHE IV score	78 ± 35
FUBC negative conversion	114 (66.7%)	SOFA score	9 ± 4.5
Underlying disorder		PBS	2.96 ± 3.55
Bed-ridden patient	47 (27.5%)	Charlson comorbidity index	6.67 ± 3.06
Diabetes mellitus	66 (38.6%)	Laboratory data (units)
Hypertension	87 (50.9%)	WBC (×10^3/µL)	12.22 ± 9.81.
Heart failure	87 (50.9%)	Neutrophil count (×10^3/µL)	117.48
Coronary disease	19 (11.1%)	Platelet (×10^3/µL)	163.5 ± 134.0
Solid tumor	62 (3.3%)	Prothrombin time (INR)	1.68 ± 1.41
Hematologic tumor	26 (15.2%)	Albumin (g/dL)	2.63 ± 0.57
Neutropenia	25 (14.6%)	BUN (mg/dL)	34.40 ± 26.9
End stage renal disorder	16 (9.4%)	Creatinine (mg/dL)	1.50 ± 1.45
COPD	24 (14%)	Total bilirubin (mg/dL)	3.88 ± 6.27
Liver cirrhosis	30 (17.5%)	Sodium	136.50 ± 6.91
Solid organ transplantation	5 (2.9%)	Potassium	3.86 ± 0.66
HSCT	6 (3.5%)	C-reactive protein (mg/dL)	13.89 ± 12.11
Rheumatic disorder	19 (11.1%)	ESR (mm/h)	33.43 ± 18.29
Cerebrovascular accident	49 (28.7%)	Procalcitonin (mg/dL)	13.98 ± 24.87

Note: *Effective percent excluding missing values.

Abbreviations: N, number; IQR, interquartile range; CRGNB, carbapenem-resistant gram-negative bacilli; HD, hospital days; IQR, interquartile range; ICU, intensive care unit; FUBC, follow-up blood culture; COPD, chronic obstructive pulmonary disease; HSCT, hematopoietic stem cell transplantation; CLABSI, central line associated blood stream infection; SSTI, skin and soft tissue infection; CNS, central nerve system; APS, Admission Point Score; APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; PBS, Pitt bacteremia score; WBC, white blood cell; BUN, blood urea nitrogen; ESR, erythrocyte sedimentation rate.

Table 2 Severity Indexes and One-Week Mortality Data from Univariate and Multivariate Analyses

Severity Score	Univariate Analysis			Multivariate Analysis
	Alive (Mean ± SD)	Death (Mean ± SD)	P-value	Exp (B)	95% CI
APACHE IV score	74.63 ± 21.04	106.18 ± 29.85	0.00	1.041	0.995–1.089
APACHE mortality rate	44.30 ± 26.47	71.39 ± 18.10	0.00	0.974	0.928–1.023
SOFA score	7.38 ± 4.16	11.92 ± 3.59	0.00	1.151	0.971–1.365
PBS	1.88 ± 2.67	25.58 ± 4.07	0.00	1.316	1.026–1.688
SIRS	2.09 ± 1.12	2.76 ± 1.10	0.00	1.016	0.586–1.762
Charlson comorbidity index	66.52 ± 3.06	7.02 ± 3.07	0.33	NA	NA

Abbreviations: SD, standard deviation; Exp (B), odds ratio; CI, confidence interval; APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; PBS, Pitt bacteremia score; SIRS, systemic inflammatory response syndrome; NA, not available.

Table 3 Severity Indices and 28-Day Mortality Data from Univariate and Multivariate Analyses

Severity Score	Univariate Analysis			Multivariate Analysis
	Alive (Mean± SD)	Death (Mean±SD)	P-value	Exp (B)	95% CI
APACHE IV	73.07 ± 18.75	91.89 ± 30.78	0.000	1.011	0.981–1.042
SOFA score	6.84 ± 4.32	10.37 ± 04.13	0.000	1.106	0.950–1.288
PBS	1.71 ± 2.53	3.91 ± 3.92	0.000	1.201	0.975–1.479
SIRS	2.04 ± 1.23	2.47 ± 1.16	0.021	0.794	0.496–1.269
Charlson comorbidity index	6.03 ± 2.90	7.14 ± 3.11	0.017	1.178	0.981–1.416

Abbreviations: IQR, interquartile range; Exp (B), odds ratio; CI, confidence interval; APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; PBS, Pitt bacteremia score; SIRS, systemic inflammatory response syndrome.

Table 4 Factors Associated with One-Week Mortality from CRE^a or VRE^b Bacteremia (Univariate and Multivariate Analyses)

Severity Score	Univariate Analysis			Multivariate Analysis
	Alive	Death	P-value	Exp (B)	95% CI
Hospitalized over 90 days	25 (20.7%)	4 (8.0%)	0.05	0.267	0.046–1.544
Respiratory origin	28 (23.1%)	22 (44.0%)	0.01	1.060	0.276–4.702
CLABSI	65 (53.7%)	16 (32.0%)	0.01	0.369	0.112–1.215
FUBC-negative conversion	104 (86.0%)	10 (20.4%)	<0.01	17.623	5.726–54.244
Hypotension	30 (25.0%)	32 (64.0%)	<0.01	4.153	0.841–20.499
CRP ≥15 (mg/dL)	38 (32.5%)	28 (58.3%)	0.01	3.051	0.981–9.271
PITTS bacteremia score	1.88 ± 2.67	5.58 ± 4.07	<0.01	1.061	0.802–1.404
APACHE IV score	74.63 ± 21.04	106.18 ± 29.85	<0.01	1.028	0.997–1.060

Notes: ^aCarbapenem-resistant Enterobacteriaceae. ^bVancomycin-resistant Enterococci.

Abbreviations: Exp (B), odds ratio; CI, confidence interval; CLABSI, central line associated blood stream infection; FUBC, follow-up blood culture; CRP, C-reactive protein; APACHE, Acute Physiology and Chronic Health Evaluation.

Table 5 Factors Associated with 28-Day Mortality from CRE^a or VRE^b Bacteremia (Univariate and Multivariate Analyses)

Severity Score	Univariate Analysis			Multivariate Analysis
	Alive Group	Death Group	P-value	Exp (B)	95% CI
Respiratory origin	10 (13.7%)	40 (40.8%)	<0.01	4.491	1.622–12.435
Genitourinary origin	13 (17.8%)	6 (6.1%)	0.02	0.659	0.204–2.127
FUBC negative-conversion	64 (87.7%)	50 (51.5%)	<0.01	0.245	0.098–0.615
Treatment began after 48 hours	59 (80.8%)	81 (82.7%)	0.76	NA	NA
Hypotension	17 (23.6%)	45 (45.9%)	<0.01	0.698	0.202–2.409
CRP ≥15 mg/dL	21 (30.0%)	45 (47.4%)	0.02	2.063	0.940–4.527
Albumin <3.5 g/dL	62 (86.1%)	95 (96.9%)	0.01	2.888	0.594–14.048
APACHE IV Score (mean ± SD)	73.07 ± 18.75	91.89 ± 30.78	<0.01	1.015	0.993–1.037
PBS (mean ± SD)	1.71 ± 2.53	3.90 ± 3.92	<0.01	1.053	0.848–1.309

Notes: ^aCarbapenem-resistant Enterobacteriaceae. ^bVancomycin-resistant Enterococci.

Abbreviations: Exp (B), odds ratio; CI, confidence interval; CLABSI, central line associated blood stream infection; FUBC, follow-up blood culture; CRP, C-reactive protein; APACHE, Acute Physiology and Chronic Health Evaluation; PBS, Pitt bacteremia score; SD, standard deviation; NA, not available.