Long term sepsis readmission, mortality and cause of death following Gram negative bloodstream infection: a propensity matched observational linkage study

McNamara, John F.; Harris, Patrick N A; Chatfield, Mark D.; Paterson, David L.

doi:10.1016/j.ijid.2021.10.047

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…These data support earlier observational work suggesting that non-infective causes, and in particular cancer, are responsible for most deaths following BSI, particularly for Gram negative pathogens. 5,6 Pancreatic cancer and cholangiocarcinoma were common underlying causes of death in patients with E. coli, Klebsiella and polymicrobial BSI. This is unsurprising given these cancers can cause biliary obstruction leading to biliary stasis, cholangitis and BSI with enteric organisms.…”

Section: Discussionmentioning

confidence: 99%

“…Our finding that about a quarter of deaths are directly attributable to BSI is a little higher than previous, smaller observational studies where infection was the reported cause of death in 8-20%. 5,6 Randomised controlled trials (RCTs) may provide more detailed information on a smaller, selected population, but selection bias may limit their generalisation. In the largest published RCT of SAB, ARREST, half of all deaths were attributed to SAB.…”

Section: Discussionmentioning

confidence: 99%

“…Attributable mortality or sepsis-associated mortality, a reasonable proxy for attributable death from uncontrolled infection, was not reported. A more recent study 6 from Queensland, Australia, reported mortality and causes of death following 7,061 cases of Gram-negative BSI between 2005-2010. Gastrointestinal malignancy was the commonest cause of death between 0-90 days and 90-365 days and up to four years after infection.…”

Section: Introductionmentioning

confidence: 99%

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All-cause and infection-attributable mortality amongst adults with bloodstream infection – a population-based study

Underwood,

Griffiths,

Gillespie

et al. 2023

Preprint

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BackgroundBloodstream infections (BSI), are common, life threatening infections. However, it remains unclear whether deaths following BSI are primarily due to uncontrolled infection or underlying comorbidities. We aimed to determine the overall mortality, infection-attributable mortality, and causes of death for four leading BSI pathogens.MethodsThis retrospective cohort study was conducted within the SAIL Databank, containing anonymised population-scale electronic health record data for Wales, UK. We included adults withEscherichia coli, Klebsiella sp, Pseudomonas aeruginosaandStaphylococcus aureusBSI between 2010-2022 using linked data from Public Health Wales and the Office for National Statistics. 30-day all-cause and sepsis-specific mortality, as a proxy for infection-attributable mortality, were compared using Cox proportional hazards and competing risk regression respectively.FindingsWe identified 35,691 adults with BSI.E. coliwas the most prevalent (59.6%). Adjusted analyses revealed that all organisms had a higher 30-day mortality vs.E. coliwith MRSA the highest (HR: 2.04 [1.83-2.37], p<0.001).Cancer was the leading cause of death following BSI for all organisms, particularly deaths occurring between 30-90 days (35.9%). 25.5% of deaths within 30 days involved sepsis. MRSA was associated with the highest sepsis mortality vs.E. coli(HR: 2.45 [2.12-2.82], p<0.001). Peak CRP was positively associated with increased sepsis mortality (p<0.001).InterpretationThis population-level study challenges the assumption that most deaths following BSI are directly attributable to uncontrolled infection. Our findings underscore the need for re-evaluating clinical trial design and developing better preventative strategies for BSI.FundingThis work is funded by the Medical Research Council [grant number MR/T023791/1].

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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All-cause and infection-attributable mortality amongst adults with bloodstream infection – a population-based study

Underwood,

Griffiths,

Gillespie

et al. 2023

Preprint

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“…Like other serious bacterial infections, allcause mortality is increased following treatment of melioidosis, predominantly driven by other infections and macrovascular disease in those with risk factors. 18,19 Therefore, proactive diagnosis and optimization of comorbidities is a vital component of the holistic care of patients with melioidosis. In this case, this included more aggressive management of his weight, diabetes, hypertension, and dyslipidemia.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Disseminated Burkholderia pseudomallei with Acute Suppurative Thyroiditis and Abscess Formation

Harris

Smith

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Melioidosis has a highly variable presentation. Almost any organ can be involved, although an antemortem diagnosis of acute suppurative thyroiditis (AST) has not, to our knowledge, been previously described. A 68-year-old Australian male with poorly controlled type 2 diabetes mellitus presented with fever, odynophagia, and thyroid function tests consistent with hyperthyroidism. Imaging demonstrated a lung abscess and an enlarged thyroid gland with three nodules. Blood cultures and fine-needle aspiration of the thyroid nodules grew Burkholderia pseudomallei. He received intravenous ceftazidime and concurrent oral trimethoprim/sulfamethoxazole (TMP/SMX) for 4 weeks followed by high-dose oral TMP/SMX for a further 3 months and made a complete recovery. Acute suppurative thyroiditis is an uncommon cause of hyperthyroidism and thyroid aspirates are not commonly sent for bacterial culture. The case highlights the need to consider AST in patients presenting with a hyperthyroid state and disseminated infection. It also demonstrates that in a case of disseminated melioidosis any symptom may be a clue to underlying metastatic infection.

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Long-term, all-cause mortality risk after infection episodes in older adults

Ramírez-Soto

2023

The Lancet Healthy Longevity

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Long term sepsis readmission, mortality and cause of death following Gram negative bloodstream infection: a propensity matched observational linkage study

Cited by 5 publications

References 23 publications

All-cause and infection-attributable mortality amongst adults with bloodstream infection – a population-based study

All-cause and infection-attributable mortality amongst adults with bloodstream infection – a population-based study

Case Report: Disseminated Burkholderia pseudomallei with Acute Suppurative Thyroiditis and Abscess Formation

Long-term, all-cause mortality risk after infection episodes in older adults

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