Gram-Negative Bloodstream Infection: Implications of Antimicrobial Resistance on Clinical Outcomes and Therapy

Al-Hasan, Majdi N.

doi:10.3390/antibiotics9120922

Cited by 4 publications

(7 citation statements)

References 32 publications

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“…Several studies compared short and prolonged antibiotic therapy for GNB BSI in hemodynamically stable patients in terms of mortality and B recurrence. The same survival rates were found in the two treatment groups [175][176][177][178].…”

Section: Treatment Duration: Short Courses or Long Courses? Combinati...supporting

confidence: 79%

“…Prolonged courses (>10–14 days) of intravenous antibiotics have been recommended for SAB because of concerns that infective endocarditis, deep infective foci, or metastatic infections might be present but not diagnosed [ 175 ]. A systematic review on the length of treatment of GNB secondary to UTI reported that the current limited evidence may corroborate that SCAb are as effective at obtaining clinical recovery microbiological eradication as longer courses [ 176 ]. Uno et al performed a study suggesting that acute cholangitis with Gram-negative bacillary bacteremia can be treated safely with a shorter antimicrobial treatment duration of <14 days [ 166 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indications for management of intra-vascular catheter-related BSI due to GNB recommend 7–14 days of therapy in the absence of complications based on the consensus opinion of experts [ 174 , 175 , 176 , 177 ]. Concern about infection recurrence and overall survival are the main factors contributing to prolonged antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Corona,

De Santis,

Agarossi

et al. 2023

Antibiotics

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Introduction: Not enough data exist to inform the optimal duration and type of antimicrobial therapy against GN infections in critically ill patients. Methods: Narrative review based on a literature search through PubMed and Cochrane using the following keywords: “multi-drug resistant (MDR)”, “extensively drug resistant (XDR)”, “pan-drug-resistant (PDR)”, “difficult-to-treat (DTR) Gram-negative infection,” “antibiotic duration therapy,” “antibiotic combination therapy” “antibiotic monotherapy” “Gram-negative bacteremia”, “Gram-negative pneumonia”, and “Gram-negative intra-abdominal infection”. Results: Current literature data suggest adopting longer (≥10–14 days) courses of synergistic combination therapy due to the high global prevalence of ESBL-producing (45–50%), MDR (35%), XDR (15–20%), PDR (5.9–6.2%), and carbapenemases (CP)/metallo-β-lactamases (MBL)-producing (12.5–20%) Gram-negative (GN) microorganisms (i.e., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumanii). On the other hand, shorter courses (≤5–7 days) of monotherapy should be limited to treating infections caused by GN with higher (≥3 antibiotic classes) antibiotic susceptibility. A general approach should be based on (i) third or further generation cephalosporins ± quinolones/aminoglycosides in the case of MDR-GN; (ii) carbapenems ± fosfomycin/aminoglycosides for extended-spectrum β-lactamases (ESBLs); and (iii) the association of old drugs with new expanded-spectrum β-lactamase inhibitors for XDR, PDR, and CP microorganisms. Therapeutic drug monitoring (TDM) in combination with minimum inhibitory concentration (MIC), bactericidal vs. bacteriostatic antibiotics, and the presence of resistance risk predictors (linked to patient, antibiotic, and microorganism) should represent variables affecting the antimicrobial strategies for treating GN infections. Conclusions: Despite the strategies of therapy described in the results, clinicians must remember that all treatment decisions are dynamic, requiring frequent reassessments depending on both the clinical and microbiological responses of the patient.

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Section: Treatment Duration: Short Courses or Long Courses? Combinati...supporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Corona,

De Santis,

Agarossi

et al. 2023

Antibiotics

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“…The mortality rate of this study was 10.86% which was lower than that in the USA (vs 12–15%). 4 However, this was only a result from one hospital and data were not available at the country level in China. However, the mortality rate of BSI was higher than that of other kind of infections, so preemptive treatment and optimization of treatment plan for BSI were very important to save patients’ lives.…”

Section: Discussionmentioning

confidence: 97%

“…2,3 GNBSI accounts for 279,000 cases and 33,500-41,900 deaths annually in the USA based on the current population. 4 Although the mortality rate did not rise, increasing antimicrobial resistance rates of GNBSI isolates, especially the emerging of multidrug resistant (MDR, non-susceptible to at least one agent in ≥3 classes of antibiotics) isolates, the extended spectrum beta-lactamases (ESBLs) producing isolates and carbapenem-resistant (CR) isolates have become one of the greatest threats to global health and a common drug-resistant pattern with a quite high epidemic trend around the world. [5][6][7][8] Therefore, fully understanding the epidemiological of GNBSI and drug resistance data was essential for selecting empirical antibacterial agents as well as optimizing antibiotic therapy regimen.…”

Section: Introductionmentioning

confidence: 99%

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China

Song¹,

Kang²,

Wang³

et al. 2022

IDR

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The aim of this study was to analyze the epidemiological of gram-negative bloodstream infection (GNBSI) and establish a risk prediction model for mortality and acquiring multidrug resistant (MDR), the extended spectrum beta-lactamases (ESBLs) producing and carbapenem-resistant (CR) GNBSI. Methods: This retrospective study covered five years from January 2015 to December 2019. Data were obtained from Hospital Information System (HIS) and microbiology department records. The risk factors for mortality and acquiring MDR, ESBLs-producing and CR GNBSI were analyzed by univariable and multivariable analysis. Results: A total of 1018 GNBSI cases were collected. A majority of GNBSI patients were in hematology ward (23.77%). There were 38.61% patients who were assigned in the 41-60 age group. Escherichia coli was the most common gram-negative organism (49.90%). Among isolates of GNBSI, 40.47% were found to be MDR strains, 34.09% were found to be ESBLs-producing strains and 7.06% were found to be CR strains. Escherichia coli was the most common MDR (71.36%) and ESBLs-producing strain (77.81%). Acinetobacter baumannii was the most common CR isolate (46.15%). Multivariate analysis indicated that diabetes mellitus, solid organ tumor, non-fermentative bacteria, MDR strain, central venous cannula, urinary catheter, therapy with carbapenems or tigecycline prior 30 days of infection were independent mortality risk factors for GNBSIs. Over all, therapy with tigecycline prior 30 days of infection was the mutual predictor for mortality of GNBSI,

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Adult acute leukemia patients with gram-negative bacteria bloodstream infection: Risk factors and outcomes of antibiotic-resistant bacteria

Wang,

Mu,

Zhu

et al. 2024

Ann Hematol

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This study aims to analyze the risk factors for the development of multidrug-resistant (MDR) and carbapenem-resistant (CR) bacteria bloodstream infection (BSI) in a patient with acute leukemia (AL) and the mortality in gram-negative bacteria (GNB) BSI. This is a retrospective study conducted at West China Hospital of Sichuan University, which included patients diagnosed with AL and concomitant GNB BSI from 2016 to 2021. A total of 206 patients with GNB BSI in AL were included. The 30-day mortality rate for all patients was 26.2%, with rates of 25.8% for those with MDR GNB BSI and 59.1% for those with CR GNB BSI. Univariate and multivariate analyses revealed that exposure to quinolones (Odds ratio (OR) = 3.111, 95% confidence interval (95%CI): 1.623–5.964, p = 0.001) within the preceding 30 days was an independent risk factor for MDR GNB BSI, while placement of urinary catheter (OR = 6.311, 95%CI: 2.478–16.073, p < 0.001) and exposure to cephalosporins (OR = 2.340, 95%CI: 1.090–5.025, p = 0.029) and carbapenems (OR = 2.558, 95%CI: 1.190–5.497, p = 0.016) within the preceding 30 days were independently associated with CR GNB BSI. Additionally, CR GNB BSI (OR = 2.960, 95% CI: 1.016–8.624, p = 0.047), relapsed/refractory AL (OR = 3.035, 95% CI: 1.265–7.354, p = 0.013), septic shock (OR = 5.108, 95% CI: 1.794–14.547, p = 0.002), platelets < 30 × 109/L before BSI (OR = 7.785, 95% CI: 2.055–29.492, p = 0.003), and inappropriate empiric antibiotic therapy (OR = 3.140, 95% CI: 1.171–8.417, p = 0.023) were independent risk factors for 30-day mortality in AL patients with GNB BSI. Prior antibiotic exposure was a significant factor in the occurrence of MDR GNB BSI and CR GNB BSI. CR GNB BSI increased the risk of mortality in AL patients with GNB BSI.

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Gram-Negative Bloodstream Infection: Implications of Antimicrobial Resistance on Clinical Outcomes and Therapy

Abstract: The age- and sex-adjusted incidence rate of Gram-negative bloodstream infection (GN-BSI) is 84 [...]

Cited by 4 publications

References 32 publications

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China

Adult acute leukemia patients with gram-negative bacteria bloodstream infection: Risk factors and outcomes of antibiotic-resistant bacteria

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