Assessing the Burden of Disease of Gram-Negative Bloodstream Infections in a Brazilian Hospital: A Retrospective Cohort Study from 2015 to 2019

Abstract

BackgroundBloodstream infections (BSI) are a global health concern, causing substantially morbidity, mortality and lead to a substantial financial burden on healthcare systems. This study aimed to estimate the disease burden of BSI caused by Gram-Negative Bacteria (GNB-BSI) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs). MethodsA retrospective cohort study of adult patients with GNB-BSI was conducted from April 1, 2015, to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical–intensive care unit (ICU) located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, employing life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010). ResultsA total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92±17.97 years, with 61.1% being male. The most common bacterial infections were K. pneumoniae and E. coli (66.5%), while Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752; 95% CI: 520 – 1,021 with Brazilian Life Tables and 782; 95% CI: 540 – 1,062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly in 2017, reaching 7,050 (95% CI: 3,200-12,150 with Brazilian Life Tables and 7,350; 95% CI: 3350 – 12,700 with GBD 2010) DALYs per 1,000 patient-days and an estimated mortality rate of 40% per 1,000 patients-day. ConclusionThe persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1,000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria.