Mortality and Length of Stay in Patients with Bloodstream Infections Due to Drug-Susceptible Versus Drug-Resistant Gram-Negative Bacteria

Abstract

A prospective patient surveillance and analysis in three urban hospitals with the objective of comparing the mortality rates among patients with antimicrobials-sensitive versus -resistant gram-negative bacterial bloodstream infections. The analysis focused on the rates of in-hospital and 28-days mortality. There were 189 patients with BSI, drug-susceptible gram-negative bacteria (DSGNB) 40.7%, multi-drug resistant bacteria (MDRGNB) 42.3% and extensive-drug resistant bacteria (XDRGNB) 16.9%. The mean age, gender, SOFA score on the initial evaluation, APACHE II score, comorbidities, identified bacterial species, and BSI-associated diagnoses were not statistically different except for VAP (P = 0.000) in the XDRGNB infected patients. In-hospital and 28-days mortalities were significantly higher in the XDRGNB-BSI group (P = 0.000), and ICU length of stay (P = 0.000). XDRGNB-BSI was significantly higher in inappropriate and delayed treated patients (P < 0.05). Logistic regression analysis demonstrated no significant interaction for the 28 days mortality neither with the admission diagnoses, the antimicrobial class (except aminoglycosides), the comorbidities (except for solid tumors) (P > 0.05, Nagelkerke R 2 < 0.4). In conclusion, BSI due to multiple class antimicrobial resistance has higher mortality and ICU length of stay.