Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study.
<h4>Importance</h4>Patients with Gram-negative bloodstream infections (GN-BSI) are classified as non-immunocompromised (n-IC) or immunocompromised (IC). However, immunosuppressive condition should not be considered univocally.<h4>Objective</h4>To investigate epidemiological c...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0327535 |
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| author | Alice Toschi Renato Pascale Dino Gibertoni Riccardo Pasquali Andrea Grechi Irene Grassi Marta Malosso Ludovica Mangione Cecilia Bonazzetti Beatrice Tazza Matteo Rinaldi Armando Amicucci Caterina Campoli Zeno Pasquini Simone Ambretti Pier Giorgio Cojutti Francesca Bonifazi Pierluigi Viale Maddalena Giannella |
| author_facet | Alice Toschi Renato Pascale Dino Gibertoni Riccardo Pasquali Andrea Grechi Irene Grassi Marta Malosso Ludovica Mangione Cecilia Bonazzetti Beatrice Tazza Matteo Rinaldi Armando Amicucci Caterina Campoli Zeno Pasquini Simone Ambretti Pier Giorgio Cojutti Francesca Bonifazi Pierluigi Viale Maddalena Giannella |
| author_sort | Alice Toschi |
| collection | DOAJ |
| description | <h4>Importance</h4>Patients with Gram-negative bloodstream infections (GN-BSI) are classified as non-immunocompromised (n-IC) or immunocompromised (IC). However, immunosuppressive condition should not be considered univocally.<h4>Objective</h4>To investigate epidemiological characteristics, management and outcome of GN-BSI in IC and non-IC patients.<h4>Methods</h4>Retrospective single-center study of hospitalized patients with GN-BSI conducted over a 7-year period. Patients with GN-BSI were divided in: solid organ transplant (SOT) recipients, patients with hematologic malignancy (HM), patients with metastatic solid cancer (mSC), and non-major IC patients (nm-IC).<h4>Results</h4>3544 patients analysed: 76.7% nm-IC, 6.5% SOT, 8.0% HM and 8.8% mSC. SOT and HM patients were younger (SOT: 56.6 ± 13.1 years; HM: 56.4 ± 14.5; nm-IC: 72.4 ± 16.1; mSC: 68.6 ± 13.1, p < 0.001) and had lower CCI value (SOT: 4.5 ± 2.4; HM: 4.1 ± 2.1; nm-IC: 5.5 ± 2.6; mSC: 9.7 ± 2.5, p < 0.001). Urinary tract infection was the most common source of BSI in nm-IC (nm-IC: 50.1%, HM:15%; SOT: 33.3%; mSC: 25.9%, p < 0.001), intra-abdominal infection was the more frequent source among SOT and mSC (SOT:42.3%; mSC: 49.3%, nm-IC: 27.8%, HM:29%; p < 0.001). Primary BSI was the first cause of GN-BSI in HM (HM: 62.1%; SOT: 18.5%; nm-IC: 17.2%; mSC: 10.6%, p < 0.001). The lowest rate of death was observed in SOT and the highest in mSC (SOT 8.2%; nm-IC 13.4%; HM 14.9%; mSC 19.9%, p < 0.001). Relapse rate was highest in SOT (SOT: 18.8%; HM: 11.8%; NMIC: 7.2%; aST: 7.1%, p < 0.001). Follow-up bloodcultures were associated with a lower mortality only among NMIC (HR = 0.317, 95% CI 0.178-0.563, p < 0.001) and aST (HR = 0.198, 95% CI 0.058-0.673, p = 0.010). The role of treatment duration on relapse was not evident in any group, conversely receiving at least 7 days of treatment was associated with a lower risk of 90-day mortality in SOT and HM patients.<h4>Conclusions</h4>The characteristics and outcome of GN-BSI are peculiar between specific IC categories, therefore a personalized management should be implemented. |
| format | Article |
| id | doaj-art-b2d2d9dde0b04bf3a2ed9ebb90b39cfe |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-b2d2d9dde0b04bf3a2ed9ebb90b39cfe2025-08-20T03:11:45ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01207e032753510.1371/journal.pone.0327535Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study.Alice ToschiRenato PascaleDino GibertoniRiccardo PasqualiAndrea GrechiIrene GrassiMarta MalossoLudovica MangioneCecilia BonazzettiBeatrice TazzaMatteo RinaldiArmando AmicucciCaterina CampoliZeno PasquiniSimone AmbrettiPier Giorgio CojuttiFrancesca BonifaziPierluigi VialeMaddalena Giannella<h4>Importance</h4>Patients with Gram-negative bloodstream infections (GN-BSI) are classified as non-immunocompromised (n-IC) or immunocompromised (IC). However, immunosuppressive condition should not be considered univocally.<h4>Objective</h4>To investigate epidemiological characteristics, management and outcome of GN-BSI in IC and non-IC patients.<h4>Methods</h4>Retrospective single-center study of hospitalized patients with GN-BSI conducted over a 7-year period. Patients with GN-BSI were divided in: solid organ transplant (SOT) recipients, patients with hematologic malignancy (HM), patients with metastatic solid cancer (mSC), and non-major IC patients (nm-IC).<h4>Results</h4>3544 patients analysed: 76.7% nm-IC, 6.5% SOT, 8.0% HM and 8.8% mSC. SOT and HM patients were younger (SOT: 56.6 ± 13.1 years; HM: 56.4 ± 14.5; nm-IC: 72.4 ± 16.1; mSC: 68.6 ± 13.1, p < 0.001) and had lower CCI value (SOT: 4.5 ± 2.4; HM: 4.1 ± 2.1; nm-IC: 5.5 ± 2.6; mSC: 9.7 ± 2.5, p < 0.001). Urinary tract infection was the most common source of BSI in nm-IC (nm-IC: 50.1%, HM:15%; SOT: 33.3%; mSC: 25.9%, p < 0.001), intra-abdominal infection was the more frequent source among SOT and mSC (SOT:42.3%; mSC: 49.3%, nm-IC: 27.8%, HM:29%; p < 0.001). Primary BSI was the first cause of GN-BSI in HM (HM: 62.1%; SOT: 18.5%; nm-IC: 17.2%; mSC: 10.6%, p < 0.001). The lowest rate of death was observed in SOT and the highest in mSC (SOT 8.2%; nm-IC 13.4%; HM 14.9%; mSC 19.9%, p < 0.001). Relapse rate was highest in SOT (SOT: 18.8%; HM: 11.8%; NMIC: 7.2%; aST: 7.1%, p < 0.001). Follow-up bloodcultures were associated with a lower mortality only among NMIC (HR = 0.317, 95% CI 0.178-0.563, p < 0.001) and aST (HR = 0.198, 95% CI 0.058-0.673, p = 0.010). The role of treatment duration on relapse was not evident in any group, conversely receiving at least 7 days of treatment was associated with a lower risk of 90-day mortality in SOT and HM patients.<h4>Conclusions</h4>The characteristics and outcome of GN-BSI are peculiar between specific IC categories, therefore a personalized management should be implemented.https://doi.org/10.1371/journal.pone.0327535 |
| spellingShingle | Alice Toschi Renato Pascale Dino Gibertoni Riccardo Pasquali Andrea Grechi Irene Grassi Marta Malosso Ludovica Mangione Cecilia Bonazzetti Beatrice Tazza Matteo Rinaldi Armando Amicucci Caterina Campoli Zeno Pasquini Simone Ambretti Pier Giorgio Cojutti Francesca Bonifazi Pierluigi Viale Maddalena Giannella Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. PLoS ONE |
| title | Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. |
| title_full | Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. |
| title_fullStr | Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. |
| title_full_unstemmed | Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. |
| title_short | Epidemiological characteristics and management of Gram-negative bacteraemia in different immunocompromised hosts: Observational single-center study. |
| title_sort | epidemiological characteristics and management of gram negative bacteraemia in different immunocompromised hosts observational single center study |
| url | https://doi.org/10.1371/journal.pone.0327535 |
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