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Background Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options. Methods A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients >18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia. Results We included 175 patients. Median age was 45 years (IQR 30–58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley’s catheter [aOR 2.7 (95% CI 1.1–6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6–15.8)] and Pitt bacteraemia score >4 [aOR 3.48 (95% CI 1.1–10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09–0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy. Conclusions Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control.

Introduction: Carbapenem are recommended for the treatment of Ceftriaxone (CRO) resistant Enterobacterales, however, there are concerns of cost and resistance. Our aim is to compare the outcome of CRO resistant E-coli and Klebsiella bacteremia between Carbapenem and Beta-lactam/beta-lactamase inhibitors (BL/BLI).Methods A prospective cohort study conducted from October 2021 to June 2022. All adult patients with E coli or Klebsiella spp. bacteremia, CRO resistant and sensitive to both BL/BLI and Carbapenem were included. The patients were divided into BL/BLI and Carbapenem groups. Demographics, clinical features, comorbidities, laboratory parameters and intensive care unit stay were compared. Outcomes were bacteriological clearance, clinical success and all-cause mortality at day 14 of bacteremia.Results A total of 156 patients, 93(59.6%) in BL/BLI and 63(40%) in Carbapenem group were included. There was no difference in co-morbidities, risk factors and severity of disease. The 14 day all-cause mortality was 14.1%. No statistically significant difference was found between BL/BLI and Carbapenem group regarding bacteriological clearance (p = 0.27) and mortality (p = 0.95). The Carbapenem group had less clinical success rate (69.8% vs 82.8%, p = 0.057), however not statistically significant.Conclusion BL/BLIs were as effective as Carbapenem in microbiological clearance, clinical success and mortality in CRO resistant E-coli and Klebsiella bacteremia.