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

Figures & data

Figure 1 Study flow chart.

Table 1 The Clinical Characteristics of Carbapenem-Resistant Gram-Negative Bloodstream Infections in Immunosuppressed Patients

	60-Day Survivals	60-Day Death	P-value
Age	50.82(1.23)	58.40(1.04)	<0.001
BMI^a	22.98(0.25)	23.40(0.27)	0.263
PCT^b>0.5 ug/L	126(67%)	178(84%)	<0.001
Male	151(74%)	158(71%)	0.374
Smoking	58(29%)	53(24%)	0.248
Drinking	45(22%)	50(22%)	0.970
Age>55 Years	86(42%)	141(63%)	<0.001
ICU^c-Stay	73(36%)	127(57%)	<0.001
Hypertension	55(27%)	111(50%)	<0.001
Diabetes	40(20%)	66(29%)	0.020
Asthma	2(1%)	2(1%)	0.921
COPD^d	1(0%)	3(1%)	0.364
Chronic Bronchitis	2(1%)	1(0%)	0.506
Cerebral Infarction	11(5%)	14(6%)	0.715
Coronary Heart Disease	17(8%)	37(17%)	0.011
Anemia	24(12%)	30(13%)	0.626
Hypoproteinemia	24(12%)	48(21%)	0.008
Hyperlipidemia	10(5%)	7(3%)	0.342
Chronic Renal Failure	9(4%)	9(4%)	0.831
Chronic Kidney Disease	2(1%)	5(2%)	0.311
Underlying Conditions (n,%)
Liver Cirrhosis	4(2%)	11(5%)	0.099
Acute Myocardial Infarction	2(1%)	9(4%)	0.048
Acute Pancreatitis	20(10%)	33(15%)	0.127
Rheumatic Heart Disease	1(0%)	3(1%)	0.364
Valvular Heart Disease	9(4%)	23(10%)	0.022
Rheumatic Systemic Diseases	5(2%)	11(5%)	0.184
Skin Disease	2(1%)	5(2%)	0.311
Burning	69(34%)	49(22%)	0.005
Biliary Infection	15(7%)	24(11%)	0.234
Aortic Dissection	0(0%)	5(2%)	0.032
Aortic Aneurysm	2(1%)	4(2%)	0.483
Tumors	70(34%)	60(27%)	0.084
Haematological Diseases	19(9%)	22(10%)	0.871
Gastrointestinal Cancer	35(17%)	33(15%)	0.479
Respiratory System Tumors	0(0%)	1(0%)	0.341
Urinary System Tumors	4(2%)	1(0%)	0.144
Complications (n, %)
AKI^e	22(11%)	63(28%)	<0.001
Cerebral Hemorrhage	5(2%)	2(1%)	0.202
Abdominal Infection	29(14%)	53(24%)	0.014
Abdominal Hemorrhage	10(5%)	17(8%)	0.259
Acute Respiratory Failure	12(6%)	25(11%)	0.054
Gastrointestinal Bleeding	8(4%)	24(11%)	0.008
MODS^f	4(2%)	27(12%)	<0.001
Shock	33(16%)	95(42%)	<0.001
Inducement (n, %)
Surgery	75(37%)	104(46%)	0.047
Chemotherapy	18(9%)	20(9%)	0.982
Burning	68(33%)	48(21%)	0.005
Catheter Placement	6(3%)	20(9%)	0.010
Transplant Status	9(4%)	3(1%)	0.053
Hormone	2(1%)	6(3%)	0.197
Hormone+ Immunosuppressant	4(2%)	5(2%)	0.851
Pathogen Sources (n, %)
Respiratory Tract	52(26%)	85(38%)	0.006
Digestive Tract	48(24%)	53(24%)	0.997
Skin	48(24%)	39(17%)	0.110
Urinary System	6(3%)	4(2%)	0.425
Catheter	21(10%)	18(8%)	0.408
Etiologies (n, %)
ECO^g	10(5%)	3(1%)	0.031
ECL^h	4(2%)	0(0%)	0.035
KPN^i	96(47%)	120(54%)	0.195
PAE^j	29(14%)	22(10%)	0.155
ABA^k	43(21%)	60(27%)	0.177
Others	16(8%)	11(5%)	0.208
Antibacterial therapy
Third Generation Cephalosporin	33(16%)	29(13%)	0.332
Quinolone	26(13%)	23(10%)	0.411
Fourth Generation Cephalosporin	2(1%)	4(2%)	0.483
Tetracycline	6(3%)	4(2%)	0.425
Polymyxin	11(5%)	26(12%)	0.023
Macrolides	11(5%)	16(7%)	0.465
Ceftazidime-Avibactam	3(1%)	2(1%)	0.575
Oxazolidinone	31(15%)	40(18%)	0.474
Tigecycline	36(18%)	79(35%)	<0.001
Aminoglycosides	22(11%)	17(8%)	0.245
Cyclo-Lipopeptide	0(0%)	5(2%)	0.032
Nitroimidazole	6(3%)	8(4%)	0.721
Carbapenem	134(66%)	147(66%)	0.933
Sulfonamides	4(2%)	10(4%)	0.148
Glycopeptide	67(33%)	72(32%)	0.849
Penicillin	7(3%)	6(3%)	0.644
Antifungal Agents	79(39%)	104(46%)	0.117
Mono Carbapenem	37(18%)	26(12%)	0.054
Mono Tigecycline	0(0%)	7(3%)	0.011
Mono Polymyxins	0(0%)	2(1%)	0.177
Carbapenem combination	97(48%)	121(54%)	0.198
Tigecycline combination	36(18%)	72(32%)	0.001
Polymyxins combination	11(5%)	24(11%)	0.046
Mono Ceftazidime-Avibactam	0(0%)	0(0%)	NA
Ceftazidime-Avibactam combination	3(1%)	2(1%)	0.575

Notes: ^aBody Mass Index, ^bProcalcitonin, ^cIntensive Care Unit, ^dChronic Obstructive Pulmonary Disease, ^eAcute kidney injury, ^fMultiple Organ Dysfunction Syndrome, ^gEscherichia Coli, ^hEnterobacter cloacae, ⁱKlebsiella pneumoniae, ^jPseudomonas aeruginosa, ^kAcinetobacter baumannii.

Table 2 Therapeutic Regimen of CRGNB BSI Patients in Immunosuppressive Status

	60-Day Survivals	60-Day Death	P-value
Mono-therapy	54(27%)	34(15%)	0.004
Combination-therapy	140(69%)	185(83%)	0.001
CRAB^a
Mono-therapy
Carbapenem	6(14%)	9(15%)	0.882
Tigecycline	0(0%)	2(3%)	0.227
Polymyxins	0(0%)	1(2%)	0.395
Combination-therapy
Carbapenem Combination	21(49%)	33(55%)	0.537
Tigecycline Combination	8(19%)	13(22%)	0.704
Polymyxins Combination	4(9%)	5(8%)	0.864
CRE^b
Mono-therapy
Carbapenem	21(20%)	13(11%)	0.050
Tigecycline	0(0%)	4(3%)	0.061
Polymyxins	0(0%)	1(1%)	0.352
Ceftazidime-avibactam	0(0%)	0(0%)	NA
Combination-therapy
Carbapenem Combination	56(53%)	68(55%)	0.710
Tigecycline Combination	24(23%)	46(37%)	0.016
Polymyxins Combination	3(3%)	13(11%)	0.022
Ceftazidime-avibactam Combination	3(3%)	2(2%)	0.534
CRPA^c
Mono-therapy
Carbapenem	4(14%)	3(14%)	0.987
Ceftazidime-avibactam	0(0%)	0(0%)	NA
Polymyxins	0(0%)	0(0%)	NA
Combination-therapy
Carbapenem Combination	13(45%)	8(36%)	0.543
Ceftazidime-avibactam Combination	0(0%)	0(0%)	NA
Polymyxins Combination	3(10%)	4(18%)	0.421

Notes: ^aCarbapenem-resistant Gram-negative Acinetobacillus baumannii. ^bCarbapenem-resistant Gram-negative Enterobacteriaceae, ^cCarbapenem-resistant Gram-negative Pseudomonas aeruginosa.

Table 3 Univariate and Multivariate Analysis of Factors Related to Over 60-Day Survivals

	Univariate Analysis		Multivariate Analysis
	OR (95% CI)	P value	OR (95% CI)	P value
PCT>0.5 ug/L	2.50 (1.56,4.02)	<0.001	2.32 (1.28,4.19)	0.005
Age>55 years	2.31 (1.57,3.41)	<0.001	2.06 (1.17,3.64)	0.012
ICU-Stay	2.33 (1.58,3.44)	<0.001	NA	0.511
Hypertension	2.64 (1.76,3.96)	<0.001	NA	0.299
Diabetes	1.70 (1.09,2.67)	0.020	NA	0.862
Coronary Heart Disease	2.16 (1.18,3.98)	0.013	NA	0.848
Hypoproteinemia	2.03 (1.19,3.46)	0.009	NA	0.469
Valvular Heart Disease	2.47 (1.11,5.46)	0.026	NA	0.407
Burning	0.54 (0.35,0.84)	0.005	NA	0.955
Surgery	1.48 (1.00,2.18)	0.048	NA	0.822
Catheter Placement	3.22 (1.27,8.18)	0.014	NA	0.142
AKI	3.22 (1.90,5.47)	<0.001	2.19 (1.11,4.30)	0.023
Abdominal Infection	1.86 (1.13,3.06)	0.015	NA	0.851
Gastrointestinal Bleeding	2.92 (1.28,6.67)	0.011	3.18 (1.10,9.16)	0.032
MODS	6.82 (2.34,19.85)	<0.001	12.11 (2.61,56.19)	0.001
Shock	3.79 (2.40,5.99)	<0.001	3.24 (1.77,5.94)	<0.001
Respiratory Tract	1.78 (1.17,2.69)	0.007	NA	0.899
ECO^a	0.26 (0.07,0.97)	0.044	NA	0.294
Polymyxin	2.29 (1.10,4.77)	0.026	NA	0.182
Tigecycline	2.53 (1.61,3.97)	<0.001	3.20 (1.81,5.67)	<0.001

Notes: ^aEscherichia coli.

Figure 2 Survival analysis of patients with carbapenem-resistant Gram-negative bloodstream infections in immunosuppressed patients, Kaplan–Meier curves showing the impact on 60-day mortality of (A) Procalcitonin > or <=0.5ug/L, (B) Age> or <=55 years, (C) patients with or without acute kidney injury, (D) patients with or without multiple organ dysfunction syndrome (E) patients with or without Shock, (F) patients took or did not take tigecycline.

Table 4 Univariate and Multivariate Analysis of Factors Related to Over 60-Day Survivals in Different Subgroups

	Univariate Analysis		Multivariate Analysis
ICU-Admission Subgroup	OR (95% CI)	P value	OR (95% CI)	P value
PCT>0.5 ug/L	3.06 (1.49,6.26)	0.002	2.23 (1.02,4.88)	0.046
Age>55 years	2.22 (1.21,4.09)	0.010	2.88 (1.39,5.98)	0.005
Hypertension	2.04 (1.14,3.66)	0.017	NA	0.206
AKI	2.65 (1.34,5.24)	0.005	2.91 (1.27,6.70)	0.012
Shock	2.21 (1.21,4.04)	0.010	2.49 (1.22,5.05)	0.012
Tigecycline	5.59 (2.09,14.98)	0.001	4.96 (1.70,14.44)	0.003
Diabetes Subgroup	OR (95% CI)	P value	OR (95% CI)	P value
Age>55 years	3.36 (1.33,8.50)	0.011	NA	0.057
ICU Stay	2.51 (1.07,5.89)	0.034	NA	0.119
Hyperlipidemia	0.22 (0.05,0.93)	0.039	NA	0.290
Shock	2.50 (1.05,5.93)	0.038	3.89 (1.20,12.64)	0.024
CRAB	4.20 (1.32,13.34)	0.015	7.20 (1.85,27.93)	0.004
Tigecycline	22.29 (2.88,172.65)	0.003	34.16 (4.05,288.06)	0.001
CRAB Infection Subgroup	OR (95% CI)	P value	OR (95% CI)	P value
PCT>0.5 ug/L	4.48 (1.63,12.31)	0.004	3.77 (1.20,11.85)	0.023
ICU Stay	2.29 (1.03,5.11)	0.042	NA	0.750
Hypertension	3.31 (1.35,8.07)	0.009	NA	0.391
Diabetes	5.25 (1.65,16.71)	0.005	NA	0.063
Coronary Heart Disease	3.26 (1.10,9.63)	0.033	NA	0.814
Hypoproteinemia	5.67 (1.21,26.62)	0.028	7.28 (1.16,45.49)	0.034
Tumors	0.36 (0.13,0.95)	0.040	NA	0.125
AKI	4.40 (1.51,12.83)	0.007	NA	0.251
CRKP Infection Subgroup	OR (95% CI)	P value	OR (95% CI)	P value
Age>55 years	2.40 (1.39,4.16)	0.002	2.35 (1.13,4.91)	0.022
ICU-Stay	2.09 (1.21,3.60)	0.008	NA	0.772
Hypertension	2.43 (1.39,4.26)	0.002	NA	0.528
Coronary Heart Disease	3.54 (1.14,10.96)	0.029	NA	0.173
Burning	0.41 (0.22,0.77)	0.005	NA	0.997
AKI	2.69 (1.27,5.69)	0.010	NA	0.323
Abdominal Infection	2.15 (1.12,4.13)	0.021	NA	0.132
MODS	7.76 (1.75,34.47)	0.007	7.49 (1.47,38.23)	0.015
Shock	4.52 (2.37,8.63)	<0.001	3.49 (1.63,7.49)	0.001
Respiratory Tract	2.09 (1.15,3.82)	0.016	NA	0.683
Skin	0.46 (0.24,0.88)	0.020	NA	0.952
Polymyxin	3.77 (1.04,13.62)	0.043	NA	0.219
Tigecycline	2.27 (1.25,4.10)	0.007	2.63 (1.29,5.37)	0.008