Abstract：
BACKGROUND: Carbapenem-resistant gram-negative bacteria (CRGNB) present a considerable global threat due to their challenging treatment and increased mortality rates, with bloodstream infection (BSI) having the highest mortality rate. Patients with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT) face an increased risk of BSI. Limited data are available regarding the prognosis and treatment outcomes of CRGNB-BSI in patients with ESRD in intensive care units (ICUs).
METHODS: This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes.
RESULTS: Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI.
CONCLUSIONS: CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.
METHODS: This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes.
RESULTS: Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI.
CONCLUSIONS: CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.
摘要：
背景：耐碳青霉烯类革兰阴性菌（CRGNB）由于其具有挑战性的治疗和死亡率的增加而构成了相当大的全球威胁，血流感染（BSI）的死亡率最高。接受肾脏替代治疗（RRT）的终末期肾病（ESRD）患者面临BSI的风险增加。关于重症监护病房（ICU）ESRD患者CRGNB-BSI的预后和治疗结果的数据有限。
方法：这项多中心回顾性观察性研究包括2015年1月至2019年12月在台湾的149例ESRD和CRGNB-BSIICU患者。评估临床和微生物学结果，多变量回归分析用于评估第28天死亡率的独立危险因素以及抗菌治疗方案对治疗结局的影响.
结果：在149名患者中，共有127例患者（85.2%）在ICU获得BSI，导管相关性感染(47.7%)和肺炎(32.2%)是最常见的病因。鲍曼不动杆菌(49.0%)和肺炎克雷伯菌(31.5%)是最常见的病原菌。BSI发病后第28天的死亡率为52.3%，住院死亡率为73.2%,幸存者经历长时间的住院。更高的序贯器官衰竭评估(SOFA)评分(调整后的危险比[AHR]，1.25；95%置信区间[CI]1.17-1.35)和休克状态(AHR，2.12；95%CI1.14-3.94）独立预测第28天死亡率。基于粘菌素的治疗可降低休克患者28天的死亡率，SOFA评分≥13，鲍曼不动杆菌相关BSI。
结论：CRGNB-BSI导致ESRD危重患者的高死亡率。第28天死亡率由较高的SOFA评分和休克状态独立预测。在疾病严重程度和鲍曼不动杆菌相关性BSI较高的患者中，基于粘菌素的治疗改善了治疗结果.
方法：这项多中心回顾性观察性研究包括2015年1月至2019年12月在台湾的149例ESRD和CRGNB-BSIICU患者。评估临床和微生物学结果，多变量回归分析用于评估第28天死亡率的独立危险因素以及抗菌治疗方案对治疗结局的影响.
结果：在149名患者中，共有127例患者（85.2%）在ICU获得BSI，导管相关性感染(47.7%)和肺炎(32.2%)是最常见的病因。鲍曼不动杆菌(49.0%)和肺炎克雷伯菌(31.5%)是最常见的病原菌。BSI发病后第28天的死亡率为52.3%，住院死亡率为73.2%,幸存者经历长时间的住院。更高的序贯器官衰竭评估(SOFA)评分(调整后的危险比[AHR]，1.25；95%置信区间[CI]1.17-1.35)和休克状态(AHR，2.12；95%CI1.14-3.94）独立预测第28天死亡率。基于粘菌素的治疗可降低休克患者28天的死亡率，SOFA评分≥13，鲍曼不动杆菌相关BSI。
结论：CRGNB-BSI导致ESRD危重患者的高死亡率。第28天死亡率由较高的SOFA评分和休克状态独立预测。在疾病严重程度和鲍曼不动杆菌相关性BSI较高的患者中，基于粘菌素的治疗改善了治疗结果.
