title: Predictors of mortality in bloodstream infections caused by multidrug-resistant gram-negative bacteria: 4 years of collection.
abstract: The study was undertaken to describe the profile of patients and the characteristics of all multidrug-resistant gram-negative bacteria (MDR-GNB) and to assess mortality. We examined 138 patients with bloodstream infections (BSIs) caused by MDR-GNB. Clinical characteristics, antibiotic therapy, and in-hospital mortality were analyzed. Survivor and nonsurvivor subgroups were compared to identify predictors of mortality. The in-hospital mortality rate was 25.4%. Univariate analysis revealed that comorbidities and inadequate initial antimicrobial treatment could increase risk of death. In Cox regression analysis, mortality was independently associated with the age (P = .034), hospitalization in an intensive care unit (ICU) (P = .04), invasive procedures (P < .001), and Acute Physiology and Chronic Health Evaluation II scores (P < .001), whereas combination therapy or monotherapy was not associated with mortality (P = .829). Postantibiogram therapy was associated with hospitalization in an ICU (P = .006), Charlson comorbidity index score (P = .003), and inadequate initial antimicrobial treatment (P < .001). MDR-GNB strains and antimicrobial regimens were not the major risk factors of mortality. Inadequate initial antimicrobial treatment, invasive procedures, high Acute Physiology And Chronic Health Evaluation II scores, hospitalization in an ICU, and comorbidities were the important factors responsible for mortality. Although there was no difference between combination therapy and monotherapy in mortality, combined treatment may be more effective than monotherapy for patients in an ICU, with a Charlson comorbidity index score < 4, or inadequate initial antimicrobial treatment.
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Department of Infection Management Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Weihong
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Chunyu
authors.initials: C
authors.lastname: Li
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, School of Public Health of Nanjing Medical University, Nanjing, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Xiang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.affiliation: State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.
authors.forename: Lian-Wen
authors.initials: LW
authors.lastname: Qi
authors.affiliation: State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Infection Management Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: metrischen@126.com.
authors.forename: Wensen
authors.initials: W
authors.lastname: Chen
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Medical Department, Women and Children Health Care Hospital of Jiangsu Province, Nanjing, China. Electronic address: chenyandoc@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Carbapenem-resistant; Gram-negative bacilli; Risk factor; Therapy