Clinical Outcomes of Carbapenem-resistant Gram-negative Bacterial Bloodstream Infection in Patients with End-stage Renal Disease in Intensive Care Units: a Multicenter Retrospective Observational Study

Overview

Journal Infection

Date 2024 Jul 12

PMID 38995550

Authors

Yu-Chao Lin

Kuang-Yao Yang

Chung-Kan Peng

Ming-Cheng Chan

Chau-Chyun Sheu

Jia-Yih Feng

Sheng-Huei Wang

Wei-Hsuan Huang

Chia-Min Chen

Ding-Han Chen

Chieh-Lung Chen

Affiliations

Soon will be listed here.

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

References

Britt N, Ritchie D, Kollef M, Burnham C, Durkin M, Hampton N . Clinical epidemiology of carbapenem-resistant gram-negative sepsis among hospitalized patients: Shifting burden of disease?. Am J Infect Control. 2018; 46(10):1092-1096. PMC: 6165681. DOI: 10.1016/j.ajic.2018.03.013. View

Babiker A, Clarke L, Saul M, Gealey J, Clancy C, Nguyen M . Changing Epidemiology and Decreased Mortality Associated With Carbapenem-resistant Gram-negative Bacteria, 2000-2017. Clin Infect Dis. 2020; 73(11):e4521-e4530. PMC: 8662792. DOI: 10.1093/cid/ciaa1464. View

Thompson S, Pannu N . Dialysis patients and critical illness. Am J Kidney Dis. 2011; 59(1):145-51. DOI: 10.1053/j.ajkd.2011.07.026. View

Dalgaard L, Norgaard M, Jespersen B, Jensen-Fangel S, Ostergaard L, Schonheyder H . Risk and Prognosis of Bloodstream Infections among Patients on Chronic Hemodialysis: A Population-Based Cohort Study. PLoS One. 2015; 10(4):e0124547. PMC: 4409390. DOI: 10.1371/journal.pone.0124547. View

Kato S, Chmielewski M, Honda H, Pecoits-Filho R, Matsuo S, Yuzawa Y . Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol. 2008; 3(5):1526-33. PMC: 4571158. DOI: 10.2215/CJN.00950208. View

Thomson P, Stirling C, Geddes C, Morris S, Mactier R . Vascular access in haemodialysis patients: a modifiable risk factor for bacteraemia and death. QJM. 2007; 100(7):415-22. DOI: 10.1093/qjmed/hcm040. View

DAgata E . Antimicrobial use and stewardship programs among dialysis centers. Semin Dial. 2013; 26(4):457-64. DOI: 10.1111/sdi.12090. View

Berman S, Johnson E, Nakatsu C, Alkan M, Chen R, LeDuc J . Burden of infection in patients with end-stage renal disease requiring long-term dialysis. Clin Infect Dis. 2004; 39(12):1747-53. DOI: 10.1086/424516. View

Wang T, Kodiyanplakkal R, Calfee D . Antimicrobial resistance in nephrology. Nat Rev Nephrol. 2019; 15(8):463-481. PMC: 7269065. DOI: 10.1038/s41581-019-0150-7. View

10.

Zacharioudakis I, Zervou F, Ziakas P, Rice L, Mylonakis E . Vancomycin-resistant enterococci colonization among dialysis patients: a meta-analysis of prevalence, risk factors, and significance. Am J Kidney Dis. 2014; 65(1):88-97. DOI: 10.1053/j.ajkd.2014.05.016. View

11.

Nielsen L, Jensen-Fangel S, Benfield T, Skov R, Jespersen B, Larsen A . Risk and prognosis of Staphylococcus aureus bacteremia among individuals with and without end-stage renal disease: a Danish, population-based cohort study. BMC Infect Dis. 2015; 15:6. PMC: 4296555. DOI: 10.1186/s12879-014-0740-8. View

12.

Montoya-Urrego D, Tellez-Carrasquilla S, Vanegas J, Quiceno J . High frequency of colonization by extended-spectrum beta-lactamase-producing Gram-negative bacilli in hemodialysis patients and their household contacts in Colombia: dissemination between the community and the hospital. Epidemiol Health. 2022; 44:e2022069. PMC: 9943636. DOI: 10.4178/epih.e2022069. View

13.

Eilertson B, Cober E, Richter S, Perez F, Salata R, Kalayjian R . Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy. Open Forum Infect Dis. 2017; 4(4):ofx216. PMC: 5695622. DOI: 10.1093/ofid/ofx216. View

14.

Martin C, Bradshaw J, Pipkins H, McDaniel L . Pulmonary Disease Associated With Nonencapsulated . Open Forum Infect Dis. 2018; 5(7):ofy135. PMC: 6299459. DOI: 10.1093/ofid/ofy135. View

15.

Ting S, Lee C, Liu J . Risk factors and outcomes for the acquisition of carbapenem-resistant Gram-negative bacillus bacteremia: A retrospective propensity-matched case control study. J Microbiol Immunol Infect. 2017; 51(5):621-628. DOI: 10.1016/j.jmii.2016.08.022. View

16.

Liu Y, Lu C, Yen T, Chang L, Chen J, Lee P . Clinical characteristics and outcomes of carbapenem-resistant Enterobacterales bacteremia in pediatric patients. J Microbiol Immunol Infect. 2022; 56(1):84-92. DOI: 10.1016/j.jmii.2022.09.010. View

17.

Bleumin D, Cohen M, Moranne O, Esnault V, Benenson S, Paltiel O . Carbapenem-resistant Klebsiella pneumoniae is associated with poor outcome in hemodialysis patients. J Infect. 2012; 65(4):318-25. DOI: 10.1016/j.jinf.2012.06.005. View

18.

Babar Z, Dodani S, Nasim A . Treatment outcome and adverse effects of colistin in adult patients with carbapenem-resistant gram-negative bacteremia from Pakistan. Int J Infect Dis. 2021; 106:171-175. DOI: 10.1016/j.ijid.2021.03.004. View

19.

Timsit J, Ruppe E, Barbier F, Tabah A, Bassetti M . Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med. 2020; 46(2):266-284. PMC: 7223992. DOI: 10.1007/s00134-020-05950-6. View

20.

Gouel-Cheron A, Swihart B, Warner S, Mathew L, Strich J, Mancera A . Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals. Crit Care Med. 2022; 50(12):1725-1736. PMC: 10829879. DOI: 10.1097/CCM.0000000000005662. View