Incidence, Risk Factors, Mortality Rate, and Impact of Multidrug-Resistant Gram-Negative Bloodstream Infections in Photharam Hospital

Abstract

Objective: This purpose aimed at studying the incidence, risk factors, other associated variables of multidrug-resistant gram-negative bacteremia, and also the mortality rate including other outcomes: number of days and cost during stay in the hospital related to the condition. These data are for the physicians’ decision, treatment, and/or control of risk factors; in order to effectively reduce the multidrug-resistant bacteremia, mortality rate, and other impacts.    

Methods: The retrospective data were collected from medical records of patients, aged 15 and over, who were hospitalized in Photharam Hospital between January 1, 2020, and December 31, 2020 with diagnosis of gram-negative bacteremia caused by Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Salmonella spp.. Antimicrobial susceptibility test results were reviewed. Patients were divided into two groups: multidrug-resistant and non-multidrug-resistant infections. The data were analyzed to show the correlation between multidrug resistance and other important associated variables including death and number of days and cost during stay in the hospital. Patients receiving palliative care were excluded from this study.

Results: Among 212 patients with gram-negative bacteremia, 172 were non-multidrug-resistant and 40 were multidrug-resistant infections, 19 and 12 died respectively, totaling 31 deaths (14.6%). Patients with drug-resistant infections died 30%, and most of them had underlying diseases such as diabetes (39.2%), coronary heart disease (22.2%), and chronic renal disease (19.3%). Community-acquired infections and hospital-acquired infections were 82.5% and 17.5% respectively. In hospital-acquired infections, the multidrug-resistant infections (50%) were significantly higher than the non-multidrug-resistant infections (9.9%); but the ratio was not different in community-acquired infections. Multidrug -resistant infections were found mostly in the urinary tract (57.5%) and respiratory tract (22.5%). The risk factors that significantly increased the chance of multidrug-resistant infections were hospital-acquired infections, history of infections in the bloodstream or receiving intravenous antibiotics or receiving a nasogastric tube or urinary catheter. The risk factors that increased the chance of death among patients infected with gram-negative bacteremia were multidrug-resistant infections, quick SOFA that more than or equal to 2 according to the evaluation criteria, patients with low blood pressure, hospital-acquired infection, and inappropriate empirical antibiotics within 24 and 72 hours.

Conclusion:  Risk factors for multidrug resistance were hospital-acquired infections, previous ICU, prior intravenous antibiotics use, prior bloodstream infections. More risk factors of multidrug resistance were the placement of feeding tubes, urine catheters, ventilators, and central venous catheters. MDR increases mortality, the number of hospital stays and expenses.