ArticleIrish journal of medical science2026
Resistance phenotype, infection source, and empirical therapy in ICU-onset gram-negative bloodstream infections: Associations with 30-day mortality.
Article in Irish journal of medical science, 2026. 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
backgroundICU-onset gram-negative bloodstream infections carry high mortality, rising antimicrobial resistance, and empirical treatment challenges.
aimsTo evaluate resistance phenotypes, empirical therapy appropriateness, infection source, and invasive ICU exposures in these infections.
methodsThis single-centre retrospective cohort included adults with gram-negative bloodstream infection occurring ≥ 48 h after ICU admission between January 2021 and December 2025. Clinical characteristics, pathogen distribution, carbapenem and colistin resistance, empirical therapy appropriateness, and factors associated with 30-day mortality were analysed.
resultsOverall, 352 patients were included; mean age was 70.3 ± 15.9 years and 58.5% were male. The most common sources were pneumonia (33.5%), urinary tract infection (25.3%), and catheter-related bloodstream infection (14.5%). The leading pathogens were Klebsiella spp. (26.7%), Acinetobacter baumannii (21.0%), and Pseudomonas aeruginosa (21.0%). Carbapenem and colistin resistance were detected in 50.8% and 33.8% of isolates, respectively. Carbapenem resistance was independently associated with longer pre-bacteraemia ICU stay, primary bacteraemia, and mechanical ventilation, whereas colistin resistance was associated with age ≥ 65 years. Thirty-day mortality was 57.9%. Older age (OR 1.017; p = 0.046), catheter-related source (OR 3.388; p = 0.002), previous cerebrovascular event (OR 2.061; p = 0.030), and carbapenem resistance (OR 1.872; p = 0.043) were independently associated with mortality, whereas appropriate empirical therapy was protective (OR 0.404; p = 0.003).
conclusionIn ICU-onset gram-negative bloodstream infections, carbapenem resistance, catheter-related source, older age, and previous cerebrovascular event were associated with increased 30-day mortality, while appropriate empirical therapy was associated with improved survival. These findings support risk-based empirical treatment decisions guided by patient characteristics, infection source, invasive support exposure, and the anticipated likelihood of resistant pathogens.
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