Outcomes and Associated Factors Among Patients with Multidrug-Resistant Gram-Negative Bacilli Bacteremia at a Tertiary Care Hospital in Thailand

Abstract

Objective: Multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia is a major problem worldwide, including in Thailand. The present study aimed to determine the outcomes and associated factors of MDR GNB bacteremia among adult patients at a tertiary care hospital in Thailand. Materials and Methods: A retrospective cohort study was conducted between January 1, 2017 and December 31, 2020 among patients older than 15 years with laboratory-confirmed GNB bacteremia. Univariate and multivariate logistic regression analyses were used to determine factors significantly associated with MDR bacteremia. Results: Three hundred sixty-four subjects were included in the present study. The most common source of GNB bacteremia was genitourinary tract infection, in 49.2%, and 33.8% of all GNB bacteremia was MDR. The most common causative pathogen was Escherichia coli. The factors significantly positively associated with MDR infection were residing in a long-term care facility (adjusted odds ratio [aOR] 4.25, 95% confidence interval [CI] 1.47 to 12.29, p=0.008), previous hospitalization within 90 days (aOR 3.40, 95% CI 1.62 to 7.16, p=0.010), and having a genitourinary tract infection (aOR 2.33, 95% CI 1.04 to 5.20, p=0.040). There was no significant difference in mortality between the two groups. The median duration of hospital stay among the MDR group was longer compared to that of the non-MDR group in 11 (interquartile range [IQR] 7 to 21.5) versus 10 (IQR 5 to 18) days (p=0.020). The median duration of fever in the MDR group was also longer than that in the non-MDR group at 3 (IQR 2 to 5) versus 3 (IQR 1 to 5) days (p=0.041). The factor significantly associated with survival in the MDR group was having an appropriate empiric antibiotic (aOR 0.07, 95% CI 0.12 to 0.43, p=0.004). Conclusion: Patients admitted to hospital from a long-term care facility, had prior hospitalization within 90 days, or had genitourinary tract infection should receive empiric antibiotics covering MDR GNB pathogens. Further studies are needed to determine whether making these changes will result in improving survival among the study population.