What factors aggravate death risk in patients with gram-negative bloodstream infections?

Skin, respiratory, and gastrointestinal infections worsen the mortality risk among patient with gram-negative bloodstream infections (GNBSI), a recent study has found.

The study included 1,113 patients (median age 74 years, 52.7 percent men) with laboratory-confirmed Escherichia coli, Klebsiella, or Pseudomonas aeruginosa GNBSIs. A total of 153 in-hospital deaths were reported during the study period, yielding a mortality rate of 13.75 percent. Older men and those who had had prior hospitalization history were more likely to die.

Multivariable logistic regression analysis revealed that GNBSI patients with a primary gastrointestinal focus saw a twofold increase in the likelihood of in-hospital death (odds ratio [OR], 2.61, 95 percent confidence interval [CI], 1.22–5.58).

The same was true for skin (OR, 3.61, 95 percent CI, 1.24–10.54) and respiratory (OR, 3.73, 95 percent CI, 2.05–6.76) infections, both of which aggravated death risk by nearly four times. Increasing age was likewise significantly correlated, augmenting death risk by 4 percent per additional year (OR, 1.04, 95 percent CI, 1.02–1.05).

Other notable risk factors included being on dialysis at the time of GNBSI (OR, 3.28, 95 percent CI, 1.06–10.14), having a vascular device (OR, 2.41, 95 percent CI, 1.01–5.74), and being discharged from the hospital within 28 days before the GNBSI (OR, 1.55, 95 percent CI, 1.01–2.38).

“Completion of larger-scale, multicentre studies that validate the results of this study, a risk prediction model for patients with laboratory-confirmed GNBSI could be developed in order to assess the risk of mortality within hospital settings,” the researchers said.