Assessment of mortality-related risk factors and effective antimicrobial regimens for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacterales

Abstract

Background Bloodstream infections (BSIs) attributable to carbapenem-resistant Enterobacterales (CRE-BSIs) are dangerous and a major cause of mortality in clinical settings. This study was therefore designed to define risk factors linked to 30-day mortality in CRE-BSI patients and to examine the relative efficacy of different antimicrobial treatment regimens in affected individuals. Methods Data pertaining to 187 CRE-BSI cases from three teaching hospitals in China collected between January 2018 and June 2020 were retrospectively analyzed. Results For the 187 analyzed patients in this study, the 30-day mortality of CRE-BSI was 41.7% (78/187). Multivariate logistic regression analyses revealed that Pitt score [odd ratio (OR) 5.313, 95% confidence interval (CI) 3.209–8.797, P < 0.001], immunocompromised status (OR 4.605, 95% CI 1.629–13.020, P = 0.004), meropenem minimum inhibitory concentration (MIC) ≥ 8 mg/L (OR 3.736, 95% CI 1.091–12.795, P = 0.036), source control of infection (OR 0.316, 95% CI 0.117–0.854, P = 0.023), and appropriate empirical therapy (OR 0.129, 95% CI 0.027–0.625, P = 0.011) were independent predictors of CRE-BSI patient 30-day mortality. After controlling for potential confounding factors, relative to ceftazidime-avibactam (CAZ-AVI) treatment, combination therapies including CAZ-AVI (OR 1.287, 95% CI 0.124–13.403, P = 0.833) were not related to any significant change in patient mortality risk, whereas 30-day mortality risk was higher for patients administered other antimicrobial regimens (OR 12.407, 95% CI 1.684–31.430, P = 0.011). When patients were treated with antimicrobial regimens not containing CAZ-AVI, combination therapy (OR 0.239, 95% CI 0.077–0.741, P = 0.013) was related to a decreased 30-day mortality risk relative to monotherapy treatment. Conclusion The mortality-related risk factors and relative antimicrobial regimen efficacy data demonstrated in this study may guide the management of CRE-BSI patients.

Risk Factors for Mortality and Outcomes in Hematological Malignancy Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections

“…[27][28][29][30] In recent studies higher PBS was an independent risk factor for mortality in CRE BSI, as well as in CRKP BSI, confirming the value of the PBS in such infections. [31][32][33][34][35][36] However, reports on the use of PBS in HM patients with CRKP BSI are scarce. In the current study higher PBS was independently associated with mortality.…”