ArticleBMC infectious diseases2026
Carbapenem-resistant Gram-negative bacteremia in a medical intensive care unit: predictors, antimicrobial susceptibilities, and its effects on mortality.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Resistance phenotype, infection source, and empirical therapy in ICU-onset gram-negative bloodstream infections: Associations with 30-day mortality.Irish journal of medical science · 2026Article
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3 authors.
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Abstract
backgroundCarbapenem-resistant Gram-negative bacteremia (CR-GNB) is a serious threat to critically ill patients. The present study aimed to (a) uncover drug resistance of pathogens and CR-GNB’s effect on prognosis; and (b) distinguish predictors of CR-GNB among patients from a medical intensive care unit (ICU) setting.
methodsThis was a single-center, retrospective cohort study of all consecutive patients with nosocomial GNB in the medical ICU between January 1, 2015 and February 29, 2024. The predictors of CR-GNB were analyzed by logistic regression. Survivals of patients undergoing CR-GNB or carbapenem-susceptible GNB (CS-GNB) were compared using the Kaplan-Meier method.
resultsSeventy-four episodes of GNB occurred in 67 patients out of 4914 patients, among them, 48 episodes of CR-GNB occurred in 42 (0.9%) patients. The most common primary source of infection leading to CR-GNB was the respiratory tract (accounting for 71.4% of all cases) and Klebsiella pneumoniae (41.7%) the most frequent isolate. Antimicrobial susceptibility testing revealed that CR-GNB isolates exhibited extremely high resistance rates (> 90%) to most tested antibiotics. After excluding intrinsically resistant organisms, the resistance rate was 14.3% for polymyxin B and 48.8% for tigecycline. Most notably, this analysis confirmed that all evaluable isolates of Klebsiella spp. and pseudomonas aeruginosa remained fully susceptible to ceftazidime/avibactam (0% resistance). Among the 67 patients with GNB, the 30-day all-cause mortality was 68.7% (46/67). The mortality was particularly high in the 42 patients with CR-GNB, reaching 81.0% (34/42). Within this high-risk group, 69.0% (29/42) received inappropriate empirical antibiotic therapy, and their mortality was 82.8% (24/29). On multivariate analysis, risk factors for CR-GNB were invasive mechanical ventilation before bacteremia [odds ratio (OR) = 7.680, 95% confidence interval(CI): 1.119–52.709, P = 0.038], carbapenem use > 2 days before GNB (OR = 5.626, 95% CI: 1.074–29.480, P = 0.041), and length of hospitalization ≥ 7 days before bacteremia [OR = 8.683, 95%CI: 2.009–37.538, P = 0.004]. CR-GNB was related to increased 30-day all-cause mortality compared to CS-GNB (P = 0.005). The poor prognosis in patients with CR-GNB was discovered in the analysis of Kaplan-Meier curve compared to those with CS-GNB (P = 0.018).
conclusionsCR-GNB, predicted by prior carbapenem exposure, prior mechanical ventilation and long hospital stay, is characterized by near-pan-drug resistance and confers an over 80% mortality rate in the medical ICU, demanding urgent preventive and diagnostic measures. CLINICAL TRIAL NUMBER: Not applicable.
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