Shift in risk factors for mortality by period of the bloodstream infection timeline

Abstract

Background: This study was designed to determine changes in risk factors on the prognosis of patients during each period of the bloodstream infection (BSI) timeline. Methods: Through an integrated study of multivariable regressions with machine learning techniques, the risk factors for mortality during each period of BSI were analyzed. Results: A total of 302,303 inpatients who underwent blood cultures during 2011–2021 were enrolled. More than 8 % of BSI cases progressed to subsequent BSI, and risk factors were identified as gut colonization with vancomycin-resistant enterococci (aOR 1.82; 95 % CI 1.47–2.24), intensive care unit admission (aOR 3.37; 95 % CI 3.35–4.28), and current cancer chemotherapy (aOR 1.54; 95 % CI 1.36–1.74). The mean SOFA score of the deceased patients during the first 7 days was 10.6 (SD 4.3), which was significantly higher than those on days 8–30 (7.0 ± 4.2) and after Day 30 (4.0 ± 3.5). BSIs caused by Acinetobacter baumannii and Candida albicans were more likely to result in deaths of patients for all time periods (all, P < 0.001). BSIs caused by Enterococcus faecalis and Enterococcus faecium were associated with a poor outcome in the period after Day 30 (both, P < 0.001). Nonsusceptible phenotypes to β-lactam/β-lactamase inhibitors of Escherichia coli and Klebsiella pneumoniae influenced the prognoses of patients with BSI in terms of high mortality rates during both days 8–30 and after Day 30. Conclusion: Influence of microbiological factors on mortality, including BSI-causative microorganisms and their major antimicrobial resistance, was emphasized in both periods of days 8–30 and after Day 30.

Keywords

• Bloodstream infection
• Subsequent bloodstream infection
• Risk factors
• Mortality
• Vancomycin-resistant enterococci