Evidence map›Paper›PMID 40032367›Full record

ArticleBMJ open2025

Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study.

Alexander C Vostal, Melissa Grance, John H Powers, Sameer S Kadri, Sarah Warner, Uzo Chukwuma, Carlos Morales, Charlotte Lanteri, M Leigh Carson, Beth Poitras and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Alexander C VostalLaboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA alexander.vostal@nih.gov.ORCID http://orcid.org/0000-0002-5618-6225
Melissa GranceInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
John H PowersClinical Research Directorate, National Cancer Institute Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA.
Sameer S KadriCritical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
Sarah WarnerCritical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
Uzo ChukwumaDefense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA.
Carlos MoralesInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Charlotte LanteriInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
M Leigh CarsonInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Beth PoitrasDefense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA.
Nicholas SeligaDefense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA.
Dean FollmannOffice of Biostatistics Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
Jing WangClinical Monitoring Research Program Directorate, National Cancer Institute Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA.
Edward ParmeleeInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Katrin MendeInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Funding

NIAID NIH HHS Y01 AI005072
6 · The paper itself

Abstract

objectiveTo describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up.

designRetrospective cohort study.

settingClinical and demographic data collected from the MHS Data Repository and collated with microbiological data obtained from the Defense Centers for Public Health-Portsmouth. MAIN OUTCOMES AND MEASURES: Demographic data and diagnosis codes preceding BSI episodes and during hospitalisations were collected. Inpatient admission data identified acute clinical diagnoses, intensive care unit (ICU) admission and mortality. BSI pathogens were evaluated for AMR, including difficult-to-treat resistance (DTR). Crude mortality trends were assessed.

resultsThe decade analysed included 15 357 BSI episodes in 12 748 patients; 6216 patients (48.8%) were≥65 years and 83.7% of episodes had≥1 comorbidity (12 856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and∼34% had concurrent urinary tract infections. Pathogen distribution was 53% and 47% for Gram-positive bacteria and Gram-negative bacilli (GNB), respectively. Inpatient mortality was 4.4%, and at 1 year was 23.4%; 0.5% (16 of 2977) of deaths were associated with DTR GNB. Among an average 8 145 778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant

conclusionsIn the global US MHS, the mortality burden associated with BSI was substantial (approximately one in four dying at 1 year), relatively unchanged over a decade, and associated with older age and comorbidities. First-line treatment options remained available for 99.7% of BSIs. Population-level improvements in BSI survival might be maximally influenced by focusing on prevention, early detection, prompt antibiotics and other novel therapies not contingent on in vitro activity.

Indexed as

Anti-Bacterial AgentsBacteremiaDrug Resistance, BacterialAdolescentAdultAgedFemaleHospitalizationHumansMaleMiddle AgedMilitary HealthRetrospective StudiesUnited StatesYoung AdultAnti-Bacterial AgentsAdult intensive & critical careEpidemiologyMICROBIOLOGY

Identifiers

PMID40032367
PMCPMC11877242

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.