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Purpose <p>Gram-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.</p> Methods <p>This 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&#xa0;h of result availability.</p> Results <p>Among 194 patients studied, 52.1% had uGN-BSI which were predominantly caused by <i>Escherichia coli</i> (54.6%) with a urinary tract source, while cGN-BSI showed higher rates of AmpC producers (22.6%) and <i>Pseudomonas aeruginosa</i> (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&#xa0;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).</p> Conclusion <p>GN-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.</p>

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Gram-negative bloodstream infections: where can we do better? A retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月9日

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  • Manouc Guit,
  • Konstantin Tanida,
  • Nicole Degel-Brossmann,
  • Martin Christner,
  • Martin Aepfelbacher,
  • Holger Rohde,
  • Flaminia Olearo

摘要

Purpose

Gram-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.

Methods

This 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.

Results

Among 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).

Conclusion

GN-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.