Impact of Baseline Characteristics on Future Episodes of Bloodstream Infections: Multistate Model in Septic Patients with Bloodstream Infections
Document Type
Article
Publication Title
Clinical Infectious Diseases
Abstract
Background: Looking only at the index infection, studies have described risk factors for infections caused by resistant bacteria. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We also hypothesized that baseline risk factors may influence subsequent blood culture results. Methods: All adult septic patients with positive blood cultures over a 7-year period were included in the study. Baseline risk factors were recorded. We followed all survivors longitudinally and recorded subsequent blood culture results. We separated states into bacteremia caused by gram-positive cocci, susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. Detrimental transitions were considered when transitioning to a culture with a higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was used to determine risk factors associated with detrimental transitions. Results: A total of 990 patients survived and experienced at least 1 transition, with a total of 4282 transitions. Inappropriate antibiotics, previous antibiotic exposure, and index bloodstream infection caused by either rGNB or Candida spp. were associated with detrimental transitions. Double antibiotic therapy (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected against detrimental transitions. Conclusion: Baseline characteristics that include prescribed antibiotics can identify patients at risk for subsequent bloodstream infections caused by resistant bacteria. By altering the initial treatment, we could potentially influence future bacteremic states.
First Page
3103
Last Page
3109
DOI
10.1093/cid/ciz1206
Publication Date
12-15-2020
Recommended Citation
Guillamet, M. Cristina Vazquez; Vazquez, Rodrigo; Noe, Jonas; Micek, Scott T.; Fraser, Victoria J.; and Kollef, Marin H., "Impact of Baseline Characteristics on Future Episodes of Bloodstream Infections: Multistate Model in Septic Patients with Bloodstream Infections" (2020). Pharmacy Practice Faculty Publications. 29.
https://doi.org/10.1093/cid/ciz1206
https://collections.uhsp.edu/pharm-practice_pubs/29