Bacteremic nosocomial pneumonia caused by Gram-negative bacilli: results from the nationwide ALARICO study in Italy

期刊论文
发表日期：

2024年12月6日

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Giusy Tiseo,
Valentina Galfo,
Sergio Carbonara,
Andrea Marino,
Giovanni Di Caprio,
Anna Carretta,
Alessandra Mularoni,
Michele Fabiano Mariani,
Alberto Enrico Maraolo,
Riccardo Scotto,
Lidia Dalfino,
Lorenzo Corbo,
Margherita Macera,
Alice Annalisa Medaglia,
Maria Luca d’Errico,
Claudia Gioè,
Christian Sgroi,
Rosa Fontana Del Vecchio,
Giancarlo Ceccarelli,
Antonio Albanese,
Calogero Buscemi,
Simona Talamanca,
Giuseppe Foti,
Giulio De Stefano,
Antonina Franco,
Carmelo Iacobello,
Salvatore Corrao,
Domenico Morana,
Filippo Pieralli,
Ivan Gentile,
Teresa Santantonio,
Antonio Cascio,
Nicola Coppola,
Bruno Cacopardo,
Mario Venditti,
Francesco Menichetti,
Marco Falcone

摘要

Purpose

To describe the clinical characteristics and outcomes of patients with nosocomial pneumonia (NP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) and to compare them to patients with NP caused by carbapenem-susceptible (CS)-GNB.

Methods

Prospective observational multicenter study including patients with bacteremic NP caused by GNB from the ALARICO Network (June 2018-January 2020). The primary outcome measure was 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated.

Results

Overall, 167 patients with GNB NP were included: 101 with bacteremic NP caused by CR-GNB (n = 39 by KPC-producing Klebsiella pneumoniae, n = 29 by carbapenem-resistant Acinetobacter baumannii, n = 28 by carbapenem-resistant Pseudomonas aeruginosa, n = 5 by MBL-producing Klebsiella pneumoniae) and 66 cases of bacteremic CS-GNB NP. Thirty-day mortality rate was higher in patients with NP caused by CR-GNB compared to those with NPcaused by CS-GNB (46.5% vs 30.3%, p = 0.036). On multivariable analysis, age (HR 1.044, 95% CI 1.021–1.067, p < 0.001), hematological malignancy (HR 4.307, 95% CI 1.924–9.643, p < 0.001) and septic shock (HR 3.668, 95% CI 2.001–6.724, p < 0.001) were factors independently associated with 30-day mortality, while the receipt of adequate antibiotic therapy within 24 h from infection onset (HR 0.495, 95% CI 0.252–0.969, p = 0.04) was a protective factor. Carbapenem resistance was not associated with increased risk of mortality (HR 1.075, 95% CI 0.539–2.142, p = 0.837).

Conclusions

Patients with bacteremic NP caused by CR-GNB have high mortality rate. Strategies to reduce the time from infection to the administration of adequate antibiotic therapy should be implemented in patients with NP.