Epidemiology, Clinical Outcomes, and Mortality Impact of Carbapenem-Resistant Gram-Negative Bloodstream Infections in a Quaternary Indian Hospital: A Cohort Study
Anup R Warrier
ABSTRACT
Bloodstream infections (BSI) constitute a substantial clinical and public health concern, particularly within tertiary and quaternary care settings where multidrug-resistant (MDR) gram-negative organisms are increasingly prevalent. This manuscript presents a detailed, single-center, retrospective cohort analysis from a high-acuity quaternary hospital in South India, evaluating 433 consecutive adult BSI episodes over a six-month interval. In addition, this study synthesizes findings from a systematic review of global literature on the attributable mortality of MDR gram-negative bacteremia. Institutional data revealed a predominance of gram-negative and MDR organisms, high rates of ICU admissions (76.4%), prolonged hospital and ICU stays, and an in-hospital mortality rate of 29.3%. Adjusted mortality for carbapenem-resistant gram-negative bacilli (GNB) BSI was 38.9%, compared to 26.3% in non-carbapenem-resistant cases. The global literature consistently demonstrates that MDR gram-negative BSI increases mortality risk (attributable mortality 5–73%, with odds ratios frequently exceeding 2). Key determinants of outcome include severity at presentation, appropriateness of initial therapy, comorbidity burden, adequacy of source control, and the clinical setting (ICU or nosocomial). These findings underscore the urgent need for robust local stewardship, enhanced infection prevention strategies, rapid diagnostics, and evidence-based empirical guidelines. This integrated analysis highlights the critical need for coordinated strategies to address the escalating burden of MDR BSI in India and worldwide [1-7]
