Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Mortality Due to Multi-Drug Resistant Gram Negative Bacteremia in an Endemic Region: No Better than Toss a Coin

Olga Tsachouridou
* ORCID logo ,
Dimitrios Pilalas
,
Sideris Nanoudis
ORCID logo ,
Athanasios Antoniou
,
Isidora Bakaimi
,
Theofilos Chrysanthidis
,
Konstantinos Markakis
,
Angeliki Kassomenaki
,
Paraskevi Mantzana
ORCID logo ,
Efthymia Protonotariou
,
Lemonia Skoura
,
Symeon Metallidis
Version 1 : Received: 8 May 2023 / Approved: 11 May 2023 / Online: 11 May 2023 (13:34:03 CEST)

A peer-reviewed article of this Preprint also exists.

Tsachouridou, O.; Pilalas, D.; Nanoudis, S.; Antoniou, A.; Bakaimi, I.; Chrysanthidis, T.; Markakis, K.; Kassomenaki, A.; Mantzana, P.; Protonotariou, E.; Skoura, L.; Metallidis, S. Mortality Due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better Than a Toss of a Coin. Microorganisms 2023, 11, 1711. Tsachouridou, O.; Pilalas, D.; Nanoudis, S.; Antoniou, A.; Bakaimi, I.; Chrysanthidis, T.; Markakis, K.; Kassomenaki, A.; Mantzana, P.; Protonotariou, E.; Skoura, L.; Metallidis, S. Mortality Due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better Than a Toss of a Coin. Microorganisms 2023, 11, 1711.

Abstract

The incidence of multidrug-resistant (MDR) bloodstream infections (BSI) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilitate and improve patient management. Data from patients with MDR GNB bacteremia at a university tertiary hospital were assessed over a 12-month period. 157 episodes of MDR GNB BSI were included in the study. Overall mortality rate was 50,3 percent. Rapid molecular diagnostic tests were used in 94% of BSI episodes. In univariate analysis, age (OR 1.05 (95% CI 1.03, 1.08) p<0.001), Charlson Comorbidity Index (OR 1.51 (95% CI 1.25, 1.83) p<0.001), Procalcitonin≥1(OR 3.67 (CI 95% 1.73, 7.79) p<0.001) and monotherapy with tigecycline (OR 3.64 (95% CI 1.13, 11.73) p=0.030) were the only factors associated with increased overall mortality. Surprisingly, time to appropriate antimicrobial treatment had no impact on mortality. MDR pathogen isolation, other than Klebsiella pneumoniae and Acinetobacter baumanii was associated with decreased mortality (OR 0.35 (95% CI 0.16, 0.79) p=0.011). In multivariate analysis though the only significant factor for mortality was Procalcitonin≥1(OR 2.84 (95% CI 1.13, 7.11) p=0.025). In conclusion, in an endemic area, mortality rates in MDR BSI remain high. High procalcitonin was the only variable that predicted death. The use of rapid diagnostics did not improve mortality rate.

Keywords

Gram-negative bacilli bacteremia; multidrug resistance; 28-day mortality; procalcitonin; rapid molecular diagnostics

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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