Observational studyEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2025
Gram-negative bloodstream infections: where can we do better? A retrospective cohort study.
Observational study in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeGram-negative bloodstream infections (GN-BSI) significantly impact hospital admissions, presenting major health challenges. Despite guidelines advocating de-escalation, oralization, and appropriate treatment durations, real-world clinical management remains unclear.
methodsThis retrospective observational study assessed GN-BSI management at a tertiary care hospital, comparing uncomplicated (uGN-BSI) and complicated (cGN-BSI) cases from January to December 2022. It focused on identifying risk factors for suboptimal therapy, defined as failure to adopt the narrowest effective spectrum suggested by susceptibility reports within 24 h of result availability.
resultsAmong 194 patients studied, 52.1% had uGN-BSI which were predominantly caused by Escherichia coli (54.6%) with a urinary tract source, while cGN-BSI showed higher rates of AmpC producers (22.6%) and Pseudomonas aeruginosa (8.6%). Treatment durations deviated by a median of + 2 days (interquartile 0-5) for cGN-BSI. Missed opportunities for oralization were higher in uGN-BSI (76.2%) than in cGN-BSI (55.9%). Average time to oralization was 5.5 days in uGN-BSI versus 6.5 days in cGN-BSI. Rates of optimal treatment initiation within 24 h post-antibiogram were low (uGN-BSI: 22.8%, cGN-BSI: 26.9%). Third-generation cephalosporine resistant isolates (OR 0.3, CI95% 0.1-0.9) and AmpC-producers (OR 0.3, CI95% 0.1-0.8) were least associated with suboptimal therapy, while urinary tract sources in uGN-BSI trended to pose higher risk. cGN-BSI patients had fewer missed oralization opportunities than uGN-BSI patients, with a protective trend in the multivariate (OR 0.5, CI95% 0.2-1).
conclusionGN-BSI management frequently does not meet guideline standards, especially in de-escalation and oralization. uGN-BSI could benefit from antibiotic stewardship interventions, whereas cGN-BSI requires tailored strategies, including individualized ID consultations.
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