Risk Factors for Development and Mortality of Bloodstream Infections Caused by Carbapenem-Resistant .

BACKGROUND

Bloodstream infections (BSIs) caused by (AB), especially carbapenem-resistant (CRAB), can lead to a high patient mortality rate.

METHODS

This study aimed to analyze the clinical data and prognosis of 191 patients with AB-BSI hospitalized in Southern China from January 2017 to December 2023.

RESULTS

CRAB was diagnosed in 128 (67.0%) of the 191 patients with AB-BSI. Endotracheal intubation (OR = 23.957, 95% CI: 5.123-112.022, P < 0.001), carbapenem treatment (OR = 6.422, 95% CI: 1.554-26.542, P = 0.010) and ≥2 antimicrobial drugs therapy (OR = 6.131, 95% CI: 1.763-21.324, P = 0.004) prior to the onset of BSI were independent risk factors for the development of CRAB-BSI, as revealed by the binary logistic regression analysis. The overall mortality rate of patients with AB-BSI was 27.7%, while that of patients with CRAB was significantly higher than that of patients with carbapenem-sensitive (CSAB) (39.1% vs 4.8%, P < 0.001). Multivariate Cox regression analysis revealed septic shock (HR = 3.664, 95% CI: 1.537-8.736, P = 0.003) as an independent risk factor for mortality in CRAB-BSI patients. Kaplan-Meier survival analysis showed a significantly lower 28-day survival rate for CRAB-BSI patients who developed septic shock compared to those who did not (58.4% vs 87.1%, P = 0.001).

CONCLUSION

Clinicians should closely monitor patients at high risk for CRAB-BSI, focusing on invasive procedure management and antimicrobial stewardship. Timely supportive care is crucial for CRAB-BSI patients at risk of septic shock to improve survival outcomes.