Cedeño Kehvyn, Silva Marcio de Oliveira, Mendes Ana Verena, de Castro Adriele Conceição, Barbosa Matheus Sales, Barberino Maria Goreth, Reis Mitermayer Galvão Dos, Martins Ianick Souto, Reis Joice Neves
Global Health Disparities Research Training Program, Icahn School of Medicine at Mount Sinai, New York, USA.
Program of Biotechnology in Health and Investigative Medicine, Instituto Gonçalo Moniz/FIOCRUZ, Salvador, Brazil.
IJID Reg. 2024 Jul 5;12:100401. doi: 10.1016/j.ijregi.2024.100401. eCollection 2024 Sep.
This study aimed to estimate the disease burden of BSIs caused by gram-negative bacteria (GNB-BSIs) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs).
A retrospective cohort study of adult patients with GNB-BSI was conducted from April 01, 2015 to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical intensive care unit located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, using life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010).
A total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92 ± 17.97 years, with 61.1% being male. The most common bacterial infections were and (66.5%), whereas carbapenem-resistant gram-negative bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752, 95% confidence interval [CI]: 520-1021 with Brazilian Life Tables and 782, 95% CI: 540-1062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly, in 2017, reaching 7050 (95% CI: 3200-12,150 with Brazilian Life Tables and 7350, 95% CI: 3350-12,700 with GBD 2010) DALYs per 1000 patient days and an estimated mortality rate of 40% per 1000 patient days.
The persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria.
本研究旨在估计2015年至2019年巴西一家医院中革兰氏阴性菌引起的血流感染（GNB - BSIs）的疾病负担，以伤残调整生命年（DALYs）衡量。
对2015年4月1日至2019年3月31日期间患有GNB - BSI的成年患者进行回顾性队列研究。本研究在巴西萨尔瓦多一家拥有356张床位且设有68张床位的医疗重症监护病房的私立医院进行。通过查阅病历收集人口统计学和临床数据。使用蒙特卡洛模拟法，采用2020年估计的巴西生命表和《2010年全球疾病负担》（GBD 2010）来估计DALYs。
共识别出498例个体中的519次GNB - BSI发作。平均年龄为59.92±17.97岁，男性占61.1%。最常见的细菌感染是[此处原文缺失两种细菌名称]（66.5%），而耐碳青霉烯类革兰氏阴性菌（CR - GNB）占病例的32.7%。2018年观察到的总体DALYs最高（使用巴西生命表时为752，95%置信区间[CI]：520 - 1021；使用GBD 2010时为782，95%CI：540 - 1062）。CR - GNB引起的感染DALYs最高，特别是在2017年，每1000患者日达到7050（使用巴西生命表时95%CI：3200 - 12,150；使用GBD 2010时为7350，95%CI：3350 - 12,700）DALYs，估计每1000患者日死亡率为40%。
与CR - GNB相关的持续高DALYs引发了令人担忧的问题，未来几年每1000患者日可能导致超过300例死亡。这些发现强调了将GNB - BSI作为巴西一个重大公共卫生问题加以解决的紧迫性。这些结果有望为公共卫生政策制定者提供有用信息，以便对耐药菌感染的干预措施进行优先排序。
