Predictors of Mortality in Gram-Negative Bloodstream İnfections

Abstract

Predictors of Mortality in Gram-Negative Bloodstream İnfections

Abstract

Purpose: Bloodstream infection (BSI) is the most common healthcare-associated infection in intensive care units (ICUs) and is associated with high mortality rates. In this study, we aimed to evaluate the etiological pathogens and susceptibility distribution and factors affecting mortality in patients followed up in the ICU with the diagnosis of healthcare-associated gram-negative BSI. Material and Methods: This study was designed as a retrospective cohort study. Patients diagnosed with healthcare-associated BSI during ICU follow-up were included in the study. Patients demographic data, source of BSI, causative microorganisms and their antimicrobial susceptibility and mortality (any cause) rates were collected retrospectively from patient files and patient information sheets. Patients were divided into survival and non- survival groups according to the prognosis and differences in clinical data between the two groups were compared. Results: The study included 162 patients with gram-negative BSI, of whom 85 (52.5%) died during their ICU stay. The three most common pathogens detected in patients were; Klebsiella pneumoniae [60/162(37%)], Acinetobacter baumannii [32/162(19.75%)] and Stenotrophomonas maltophilia [25/162(15.43%)]. The highest carbapenem resistance rates belonged to A. baumannii and K. pneumoniae with 93.75% and 81.66%, respectively. Multivariate logistic regression analysis identified, patients requiring invasive mechanical ventilation (IMV) had over three times the odds of death (OR: 3.10, 95% CI: 1.23–7.80, P = 0.016). Septic shock was associated with a nearly threefold increased risk of mortality (OR: 2.78, 95% CI: 1.29–6.00, P = 0.009), and continuous renal replacement therapy also significantly increased mortality risk (OR: 2.52, 95% CI: 1.11–5.71, P = 0.026). Conclusion: : IMV, septic shock, and the need for CRRT during ICU follow-up are risk factors for mortality in gram-negative BSI patients followed in the ICU. Among the etiologic pathogens, the highest resistance rates were found in A. baumannii and K. pneumoniae, respectively.

Keywords

• Bloodstream infectious
• intensive care unit
• mortality
• risk factors

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