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Background: The phenomenon of co-infection with multiple carbapenem-resistant bacteria is growing, which pose a great challenge for infection control and treatment. This study aimed to analyze predictors of occurrence and 30-day mortality for carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii co-infection. Methods: From June 2018 to June 2021, clinical data of 103 patients co-infected with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected from a tertiary teaching hospital in Anhui Province, China. The clinical characteristics and predictors of mortality were analyzed. Meanwhile, the bacterial isolates were characterized for drug susceptibility, multi-locus sequence typing, and drug resistance genes. Results: The multivariate analysis revealed that fiberoptic bronchoscopy (p = 0.005, OR=2.72), repeat transfusions (p = 0.008, OR= 2.23) and exposure to tigecycline (p = 0.002, OR = 6.58) were independent risk factors for CRKP and CRAB co-infection. Neutrophil ≥11.9*109 (p = 0.035, adjusted HR = 3.12) and C-reactive protein ≥ 149 mg/L (p = 0.009, adjusted HR = 4.41) were found associated with 30-day mortality. Combined neutrophil with C-reactive protein could predict 30-day mortality, of which AUC value was 0.791 (95%CI: 0.661-0.921). KPC (46/51, 90.2%) was the most common carbapenemase in CRKP. 33 isolates of CRKP belong to ST11 (33/51, 64.7%), and three new ST types ST5882, ST5883, ST5885 were detected. Conclusions: Invasive operations and antibiotics exposure can lead to CRKP and CRAB co-infection. Combined neutrophil with C-reactive protein could predict 30-day mortality. [ABSTRACT FROM AUTHOR]

Introduction: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. Methods: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. Results: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59–6.38), readmission (OR 1.45; 95% CI 1.25–1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10–5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09–4.01), readmission (OR 1.38; 95% CI 1.21–1.57), and mortality (OR 6.50; 95% CI 4.00–7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. Conclusions: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients. Patients and Methods: A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality. Results: Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80– 6.55) for cognitive frailty, 1.85 (95% CI: 1.01– 3.41) for frailty only, and 1.43 (95% CI: 0.77– 2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621– 0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594– 0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556– 0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender. Conclusion: Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome. [ABSTRACT FROM AUTHOR]