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

Abstract

The incidences of carbapenem-resistant gram-negative bacilli (CRGNB) and vancomycin-resistant Enterococci (VRE) have increased rapidly in South Korea since 2000. The mortality rate for CRGNB or VRE bacteremia cases is higher than that for nonresistant bacteremia cases. The factors associated with higher mortality are unclear. We investigated the factors associated with mortality from CRGNB or VRE bacteremia and compared the relative risk of these factors. Patients and Methods: We retrospectively collected data from adult patients with CRGNB or VRE bacteremia. Patients were grouped according to whether they survived or died. The data from both groups were compared. Results: During the study period, 171 cases of CRGNB or VRE bacteremia were identified, of which 100 were CRGNB bacteremia cases and 71 were VRE bacteremia cases. Multivariate analysis revealed significant associations with Pitt bacteremia score (PBS) (odds ratio [OR] 1.329, 95% confidence interval [CI] 1.049-1.684). In the multivariate analysis, negative conversion of follow-up blood culture (FUBC) was related with oneweek mortality from CRGNB or VRE bacteremia (OR 17.623, 95% CI 5.726-54.244). In the multivariate analysis of risk factors for 28-day mortality for CRGNB or VRE bacteremia, the significant risk factors were bacteremia of respiratory origin (OR 4.491, 95% CI 1.622-12.435) and positive FUBC (OR 4.082, 95% CI 1.626-10.204). Conclusion: Despite the high mortality rate in patients with CRGNB or VRE bacteremia, the related mortality could be predicted by independent risk factors of PBS, positive FUBC, and bacteremia of respiratory origin.

Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010–2020) in Oman

“…These agents may increase CRE colonization in the lower gastrointestinal tract through the suppression of gastrointestinal anerobic flora, and increase the likelihood of CRE invasion of the bloodstream. A significant association has been shown between exposure to carbapenems and hospital-acquired CRE in some multivariate models ( Marchaim et al., 2012 ; Swaminathan et al., 2013 ; Brizendine et al., 2015 ; Martin et al., 2018 ; Shi et al., 2020 ). Similarly, in a recent study from China that included 98 patients, adverse outcomes appeared to be more likely among patients with previous carbapenem exposure and neutropenia ( Li et al., 2019 ).…”

Development and Assessment of a Novel Predictive Nomogram to Predict the Risk of Secondary CR-GNB Bloodstream Infections among CR-GNB Carriers in the Gastroenterology Department: A Retrospective Case–Control Study

“…Carbapenem-resistant Gram-negative-bacteria (CR-GNB), namely, carbapenem-resistant Enterobacteriaceae (CRE) (for example, Klebsiella pneumoniae and Escherichia coli), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA), are important multidrug-resistant bacteria around the world that can induce serious infections [1]. Most hospital-acquired infections (HAI) are caused by these infections, which are related to a higher mortality rate and a longer hospital stay [2]. China has also faced challenges due to CR-GNB infection.…”

Efficacy and Safety of Fecal Microbiota Transplantation for Clearance of Multidrug-Resistant Organisms under Multiple Comorbidities: A Prospective Comparative Trial

“…CRE can spread in healthcare settings and have caused infections with mortality rates of 40% to 50% in the USA [ 4 ]. South Korea reported an increased incidence of CRE carriers from 5717 in 2017 to 14,205 in 2019 [ 5 ]. The prevalence of VRE has also increased worldwide.…”