Lin Yu-Chao, Yang Kuang-Yao, Peng Chung-Kan, Chan Ming-Cheng, Sheu Chau-Chyun, Feng Jia-Yih, Wang Sheng-Huei, Huang Wei-Hsuan, Chen Chia-Min, Chen Ding-Han, Chen Chieh-Lung
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
Infection. 2025 Feb;53(1):197-207. doi: 10.1007/s15010-024-02343-5. Epub 2024 Jul 12.
Carbapenem-resistant gram-negative bacteria (CRGNB) present a considerable global threat due to their challenging treatment and increased mortality rates, with bloodstream infection (BSI) having the highest mortality rate. Patients with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT) face an increased risk of BSI. Limited data are available regarding the prognosis and treatment outcomes of CRGNB-BSI in patients with ESRD in intensive care units (ICUs).
This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes.
Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI.
CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.
耐碳青霉烯类革兰氏阴性菌（CRGNB）因其治疗困难和死亡率上升，对全球构成了相当大的威胁，其中血流感染（BSI）的死亡率最高。接受肾脏替代治疗（RRT）的终末期肾病（ESRD）患者发生BSI的风险增加。关于重症监护病房（ICU）中ESRD患者CRGNB-BSI的预后和治疗结果的数据有限。
这项多中心回顾性观察研究纳入了2015年1月至2019年12月期间台湾地区149例患有ESRD和CRGNB-BSI的ICU患者。评估了临床和微生物学结果，并使用多变量回归分析来评估第28天死亡率的独立危险因素以及抗菌治疗方案对治疗结果的影响。
在这149例患者中，共有127例（85.2%）在ICU发生了BSI，其中导管相关感染（47.7%）和肺炎（32.2%）是最常见的病因。鲍曼不动杆菌（49.0%）和肺炎克雷伯菌（31.5%）是最常分离出的病原体。从BSI发病起第28天的死亡率为52.3%，住院死亡率为73.2%，幸存者住院时间延长。较高的序贯器官衰竭评估（SOFA）评分（调整后风险比[aHR]，1.25；95%置信区间[CI] 1.17-1.35）和休克状态（aHR，2.12；95%CI 1.14-3.94）独立预测第28天死亡率。基于黏菌素的治疗降低了休克患者、SOFA评分≥13以及鲍曼不动杆菌相关BSI患者的第28天死亡率。
CRGNB-BSI导致ESRD重症患者的高死亡率。较高的SOFA评分和休克状态独立预测第28天死亡率。在疾病严重程度较高且与鲍曼不动杆菌相关BSI的患者中，基于黏菌素的治疗改善了治疗结果。
