Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network)

被引：93

作者：

Falcone, Marco ^{[1
]}

Tiseo, Giusy ^{[1
]}

Carbonara, Sergio ^{[2
]}

Marino, Andrea ^{[3
]}

Di Caprio, Giovanni ^{[4
]}

Carretta, Anna ^{[5
]}

Mularoni, Alessandra ^{[6
]}

Mariani, Michele Fabiano

Maraolo, Alberto Enrico ^{[7
]}

Scotto, Riccardo ^{[8
]}

Dalfino, Lidia ^{[9
]}

Corbo, Lorenzo ^{[10
]}

Macera, Margherita ^{[11
]}

Medaglia, Alice Annalisa ^{[12
]}

d'Errico, Maria Luca ^{[5
]}

Gioe, Claudia ^{[12
]}

Sgroi, Christian ^{[13
]}

Del Vecchio, Rosa Fontana ^{[14
]}

Ceccarelli, Giancarlo ^{[15
]}

Albanese, Antonio ^{[16
]}

Buscemi, Calogero ^{[17
]}

Talamanca, Simona ^{[18
]}

Raponi, Giammarco ^{[15
,19
]}

Foti, Giuseppe ^{[20
]}

De Stefano, Giulio ^{[21
]}

Franco, Antonina ^{[14
]}

Iacobello, Carmelo ^{[22
]}

Corrao, Salvatore ^{[23
]}

Morana, Uccio ^{[13
]}

Pieralli, Filippo ^{[24
]}

Gentile, Ivan

Santantonio, Teresa ^{[5
]}

Cascio, Antonio ^{[25
]}

Coppola, Nicola ^{[11
]}

Cacopardo, Bruno

Farcomeni, Alessio ^{[26
]}

Venditti, Mario ^{[15
]}

Menichetti, Francesco ^{[1
]}

机构：

[1] Univ Pisa, Azienda Osped Univ Pisana, Dept Clin & Expt Med, Infect Dis Unit, Pisa, Italy

[2] Univ Bari Aldo Moro, Dept Biomed Sci & Human Oncol, Clin Infect Dis, Bari, Italy

[3] Univ Catania, Nesima Hosp, Dept Clin & Expt Med, Unit Infect Dis,ARNAS Garibaldi, Catania, Italy

[4] AORN St Anna & San Sebastiano, Infect Dis Unit, Caserta, Italy

[5] Univ Hosp Osped Riuniti Foggia, Dept Infect Dis, Foggia, Italy

[6] Ist Mediterraneo Trapianti & Terapie Ad Alta Spec, Dept Infect Dis, Palermo, Italy

[7] AORN Osped Colli, Cotugno Hosp, Div Infect Dis 1, Naples, Italy

[8] Univ Naples Federico II, Dept Clin Med & Surg, Sect Infect Dis, Naples, Italy

[9] Azienda Osped Univ Consorziale Policlin Bari, Anesthesia & Intens Care Unit, Bari, Italy

[10] Med Compless Assistenziale 1 AOU Careggi, Florence, Italy

[11] Univ Campania Luigi Vanvitelli, Dept Mental Hlth & Publ Med, Naples, Italy

[12] AOU Policlin P Giaccone, Infect & Trop Dis Unit, Palermo, Italy

[13] Azienda Osped Garibaldi, Catania, Italy

[14] Umberto I Publ Hosp, Dept Infect Dis, Siracusa, Italy

[15] Sapienza Univ Rome, Dept Publ Hlth & Infect Dis, Rome, Italy

[16] Osped Papardo, Infect Dis Unit, Messina, Italy

[17] ARNAS Osped Civ Palermo, Infect Dis Unit, Palermo, Italy

[18] Univ Palermo, Dipartimento Biomed Sperimentale & Neurosci Clin, Palermo, Italy

[19] Univ Hosp Policlin Umberto I, Microbiol & Virol Unit, Rome, Italy

[20] Bianchi Melacrino Morelli Hosp, Infetious Dis Unit, Reggio Di Calabria, Italy

[21] Hosp Potenza & Matera, Dept Infect Dis, Matera, Italy

[22] UOC Malattie Infett, Azienda Osped Emergenza, Catania, Italy

[23] ARNAS Civ Cristina Benfratelli Hosp Trust, Dept Clin Med, Internal Med Div, Palermo, Italy

[24] Careggi Univ Hosp, Intermediate Care Unit, Florence, Italy

[25] Univ Palermo, Internal Med & Med Specialties Alessandro G, Dept Hlth Promot Mother & Child Care, Palermo, Italy

[26] Univ Roma Tor Vergata, Dept Econ & Finance, Rome, Italy

来源：

CLINICAL INFECTIOUS DISEASES | 2023年 / 76卷 / 12期

关键词：

attributable mortality; Klebsiella pneumoniae; Acinetobacter baumannii; Pseudomonas aeruginosa; carbapenem resistance; KLEBSIELLA-PNEUMONIAE; BACTERIA;

D O I：

10.1093/cid/ciad100

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Our aim was to analyze mortality attributable to carbapenem-resistant (CR) gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs). Methods. Prospective multicentric study including patients with GNB-BSI from 19 Italian hospitals (June 2018-January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales, metallo-beta-lactamases (MBL)-producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aORs) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium. Results. Overall, 1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-producing CRE, 61/1276 (4.8%) CRPA, and 111/1276 (8.7%) CRAB BSI. Thirty-day mortality in patients with CS-GNB BSI was 13.7% compared to 26.6%, 36.4%, 32.8% and 43.2% in patients with BSI by KPC-CRE, MBL-CRE, CRPA and CRAB, respectively (P <.001). On multivariable analysis, age, ward of hospitalization, SOFA score, and Charlson Index were factors associated with 30-day mortality, while urinary source of infection and early appropriate therapy resulted protective factors. Compared to CS-GNB, MBL-producing CRE (aOR 5.86, 95% CI 2.72-12.76), CRPA (aOR 1.99, 95% CI 1.48-5.95) and CRAB (aOR 2.65, 95% CI 1.52-4.61) were significantly associated with 30-day mortality. Attributable mortality rates were 5% for KPC-, 35% for MBL, 19% for CRPA, and 16% for CRAB. Conclusions. In patients with BSIs, carbapenem-resistance is associated with an excess of mortality, with MBL-producing CRE carrying the highest risk of death.

引用

页码：2059 / 2069

页数：11

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