Non-fermentative gram-negative bloodstream infection in northern Italy: a multicenter cohort study

Renato Pascale,Anna Marchese,Pierluigi Viale,Linda Bussini,Cristina Costa,Francesco Giuseppe De Rosa,Matteo Bassetti,Daniele Roberto Giacobbe,Silvia Corcione,Maddalena Giannella,Michele Bartoletti,Livia Pancaldi,Tommaso Lupia,Claudio Viscoli,Simone Ambretti

doi:10.1186/s12879-021-06496-8

Abstract

BackgroundThe management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. In this study the aim is to analyse a large cohort of patients with NFGN-BSI recruited in the northern Italy to describe epidemiology, etiological and susceptibility pattern, therapeutic management and outcome.MethodsMulticentre retrospective cohort study of patients hospitalised at three large teaching hospitals in northern Italy in a fourth year period.Results355 BSI episodes were analyzed, due to P. aeruginosa (72.7%), A. baumannii (16.6%), and Stenotrophomonas maltophilia (10.7%). Overall, 21.4% of isolates were defined as DTR, highest rate among A. baumannii (64.4%). All-cause 30-day mortality rate was 17.5%. Rates of XDR or DTR A. baumannii isolation were significantly higher in non-surviving patients. Independent risk factors for 30-day mortality were: age (HR 1.03, 95%CI 1.00–1.04, p = 0.003), septic shock (HR 2.84, 95%CI 1.67–4.82, p < 0.001) and BSI due to Acinetobacter baumannii (HR 2.23, 95%CI 1.27–3.94, p = 0.005).ConclusionThe overall prevalence of DTR was high in the NFGN BSI cohort analyzied, mainly among Acinetobacter baumannii episodes (64.4%). Acinetobacter baumannii is showed to be an independent predictor of mortality. These evidences marked the urgent need of new therapeutic options against this pathogen.Trial registration number: 79/2017/O/OssN. Approved: March14th, 2017.

Highlights

The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges
We analysed a large cohort of patients with NFGN-BSI recruited in three regions of northern Italy to describe the current epidemiology, etiological and susceptibility pattern distribution, therapeutic management and outcome
At multivariate analysis adjusted for difficult to treat resistance” (DTR), Stenotrophomonas maltophilia BSI, Acinetobacter baumanni BSI, Pseudomonas aeruginosa BSI, active empiric therapy, active targeted therapy and source control, the independent risk factors for all-cause 30-day mortality were: age, septic shock and BSI due to Acinetobacter baumannii

Summary

Introduction

The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. The knowledge of local epidemiology, etiological distribution in terms of causative agents and antibiotic resistance, therapeutic approach and factors associated with poor outcome are useful to guide infection control and antimicrobial stewardship policies and to inform clinicians regarding the best treatment approach [4]. With this premise, we analysed a large cohort of patients with NFGN-BSI recruited in three regions of northern Italy to describe the current epidemiology, etiological and susceptibility pattern distribution, therapeutic management and outcome

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Results

Discussion

Conclusion