1. Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network).
- Author
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Falcone M, Tiseo G, Carbonara S, Marino A, Di Caprio G, Carretta A, Mularoni A, Mariani MF, Maraolo AE, Scotto R, Dalfino L, Corbo L, Macera M, Medaglia AA, d'Errico ML, Gioè C, Sgroi C, Del Vecchio RF, Ceccarelli G, Albanese A, Buscemi C, Talamanca S, Raponi G, Foti G, De Stefano G, Franco A, Iacobello C, Corrao S, Morana U, Pieralli F, Gentile I, Santantonio T, Cascio A, Coppola N, Cacopardo B, Farcomeni A, Venditti M, and Menichetti F
- Subjects
- Humans, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Prospective Studies, Gram-Negative Bacteria, Italy epidemiology, Carbapenems pharmacology, Carbapenems therapeutic use, Sepsis drug therapy
- Abstract
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-β-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., Competing Interests: Conflicts of interest. M. F. received unconditional grants from MSD and Gilead and grants or speaker honoraria from MSD, Angelini, Shionogi, Pfizer, Menarini, and Nordic Pharma. F. M. has participated on advisory boards and/or received speaker honoraria from Angelini, Correvio, MSD, Nordic Pharma, Pfizer, Astellas, Gilead, Bristol-Myers Squibb, Janssen, ViiV, bioMérieux, Biotest, Becton Dickinson, Pfizer, and Shionogi. G. T. received honoraria for educational meetings from Shionogi. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
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