The factors associated with the trend in incidence of Bacteraemia and associated mortality over 30 years

Abstract

Background Studies have reported increased incidence of BSI over the past decades and indicate that it is necessary to investigate the causes. The aim of this study was to determine the factors affecting trends in the incidence of bacteraemias and associated mortality. Methods We conducted a retrospective cohort study assessing prospectively collected data of all clinically significant bacteraemias between 1991 and 2020 in a 450-bed hospital. We determined the evolution of bacteraemia-associated incidence, adjusted 30-day mortality and performed multivariable logistic regression to compare the evolution of variables associated with mortality between 5-year periods. Results 6777 episodes were included, 59.7% males, age 66.5 ± 18.2, 39.4% ≥ 75 years. The incidence total increased: 43.8/100,000/year in 1991–1995 to 205 in 2016–2020; community-acquired bacteraemia (24.9 to 139) and hospital-acquired (0.36/1000 inpatients-days to 1.09). Bacteraemia with source in vascular catheter, urinary and biliary tract increased. The 30-day mortality rate of patients was 1179/6777 (17.4%) in the whole series and population-adjusted mortality incidence increased from 11.4/100,000 in 1991–1996 to 28.4 in 2016–2020 (RR 2.49, 95% CI 2.01–3.08). Mortality was higher in men (18.2% vs 16.3%) and those over 74 years (22.2% vs 14.3%). Appropriate empirical antimicrobial treatment improved (66.5% to 73.1%), 30-day mortality of patients decreased from 26.1 to 13.9%. When comparing the evolution of the factors associated with mortality between 1991 and 1996 vs 2016–2020, the frequency of some variables associated with higher mortality increased: male sex (OR 1.38, 95% CI 1.10–1,74), age (OR 1.02, 1.01–10.3), immunosuppressive treatment (OR 3.1, 2.09–4.6), polymicrobial bacteraemia (OR 1.76, 1.12–2.79), and others decreased: severe sepsis/septic shock (OR 0.70, 0.52–0.93), spontaneous bacterial peritonitis in cirrhosis (OR 0.06, 0.02–0.23), endocarditis (OR 0.54, 0.35–0.83); on the other hand, the frequency of factors associated with lower mortality increased: urinary (OR 1.67, 95% CI 1.23–2.27) and bile tract source (OR 1.59, 1.04–2.43), and adequate empirical treatment (OR 1.42, 95% CI 1.10–1.83). Conclusions The incidence of bacteraemia increased due to more elderly, co-morbid patients undergoing procedures and more device related bacteraemia. The percentage of mortality decreased because adequate empirical treatment improved, decreased spontaneous bacterial peritonitis in cirrhosis and endocarditis, and increased bacteraemia of urinary and biliary tract source.

Vitamin D Supplementation during Intensive Care Unit Stay Is Associated with Improved Outcomes in Critically Ill Patients with Sepsis: A Cohort Study

“…Age and septic shock have been identified as independent risk factors for bloodstream infections for more than 30 years [43]. In this study, the results showed that patients supplemented with vitamin D were significantly older than those not given vitamin D. Regarding potential reasons, as previously reported, elderly people are more likely to face the risk of vitamin D deficiency and osteoporosis [44,45].…”

“…As displayed in Table 5, the primary outcomes showed that the vitamin D supplementation group had lower in-hospital mortality (21.5% vs. 29.7%), as well as 28-day (19.5% vs. 26.7%) and 90-day (23.8% vs. 32.3%) mortality rates. As for the disease severity-related scores, SOFA (6 (4-8) vs. 7 (4-10)) and APS III (54 (43-73) vs. 62 (48-82)) scores were significantly lower in the patients with sepsis supplemented with vitamin D compared to those who did not receive vitamin D. Although the SAPS II score (40 (32-49) vs. 42 (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)) was lower in the vitamin D supplementation group, no statistical differences were found between the two cohorts (p = 0.115). Consistently, there were no significant differences for the LOS in the ICU and hospital between the two groups (p = 0.988 and p = 0.207, respectively).…”

Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock

“…This is consistent with a previous finding showing that Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae were the most commonly isolated organisms in community-acquired BSIs[ 8 ]. In recent years, it has been reported that respiratory tract, urinary tract, and intra-abdominal infections are the main sources of sepsis and sepsis shock[ 9 , 10 ], and gram-negative bacteraemia has a higher frequency in the ICU[ 11 ]. Similarly, our study also showed that respiratory tract infection was the main reason for admission to the ICU but the patients had a lower rate of BSIs.…”

Posterior Mitral Leaflet Prolapse and Subsequent Mitral Valve Endocarditis Complicated With Anterior Leaflet Perforation

“…Staphylococcus epidermidis is a gram-positive bacterium found in the skin and nasal cavity. Although it is generally not harmful, it can pose a risk for patients who are in a compromised condition such as those taking immunosuppressive drugs and have prostheses such as catheters and medical devices in the body [ 1 , 7 ]. In addition, a patient whose heart valve is regurgitant and stenotic or who has congenital heart defects is considered at high risk for infective endocarditis [ 1 ].…”