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Journal of Infection

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The burden of bacteremic and non-bacteremic Gram-negative infections: A prospective multicenter cohort study in a low-resistance country - 08/12/20

Doi : 10.1016/j.jinf.2020.10.001 
J.W. Timotëus Deelen a, ⁎ , Wouter C. Rottier a, Cornelis H. van Werkhoven a, Sjoukje H.S. Woudt b, Anton G.M. Buiting c, J. Wendelien Dorigo-Zetsma d, Jan A.J.W. Kluytmans f, Paul D. van der Linden e, Steven F.T. Thijsen g, Bart J.M. Vlaminckx h, Annemarie J.L. Weersink i, Heidi S.M. Ammerlaan a, j, Marc J.M. Bonten a, k
on behalf of the

ISIS-AR study groupl, 1

  J.W.T. Cohen Stuart, Noordwest Ziekenhuisgroep, Department of Medical Microbiology, AlkmaarD.C. Melles, Meander Medical Center, Department of Medical Microbiology, AmersfoortD.W. Notermans, Amsterdam UMC, Academic Medical Center, Department of Medical Microbiology, AmsterdamK. van Dijk, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Control, AmsterdamD.J. Kaersenhout, Atalmedial, Department of Medical Microbiology, AmsterdamM.L. van Ogtrop, Onze Lieve Vrouwe Gasthuis, Department of Medical Microbiology, AmsterdamB.F.M. Werdmuller, Public Health Service, Public Health Laboratory, AmsterdamG.J. Blaauw, Gelre Hospitals, Department of Medical Microbiology and Infection prevention, ApeldoornB.M.W. Diederen, Bravis Hospital, Department of Medical Microbiology, Bergen op ZoomJ.M. Aguilar Diaz, J. Alblas, W. Altorf-van der Kuil, L. Blijboom, R.D. van Gaalen, S.C. de Greeff, S. Groenendijk, R. Hertroys, E.J. Kuijper, J.C. Monen, D.W. Notermans, W. van den Reek, A.F. Schoffelen, C.C.H. Wielders, S.H.S. Woudt, center for Infectious Diseases, Department Epidemiology and Surveillance. National Institute for Public Health and the Environment (RIVM), BilthovenW. van den Bijllaardt, Microvida Amphia, Laboratory for Microbiology and Infection Control, BredaE.M. Kraan, IJsselland hospital, Department of Medical Microbiology, Capelle a/d IJsselE.E. Mattsson, Reinier de Graaf Groep, Department of Medical Microbiology, DelftJ.M. da Silva, Deventer Hospital, Department of Medical Microbiology, DeventerE. de Jong, Slingeland Hospital, Department of Medical Microbiology, DoetinchemH.M.E. Frénay, Albert Schweitzer Hospital, Department of Medical Microbiology, DordrechtB. Maraha, Albert Schweitzer Hospital, Department of Medical Microbiology, DordrechtA.J. van Griethuysen, Gelderse Vallei Hospital, Department of Medical Microbiology, EdeG.J. van Asselt, SHL-Groep, Etten-LeurA. Demeulemeester, SHL-Groep, Etten-LeurB.B. Wintermans, Admiraal De Ruyter Hospital, Department of Medical Microbiology, GoesM. van Trijp, Groene Hart Hospital, Department of Medical Microbiology and Infection Prevention, GoudaOtt, Certe, Department of Medical Microbiology, GroningenE. Bathoorn, University of Groningen, University Medical Center, Department of Medical Microbiology, GroningenM. Lokate, University of Groningen, University Medical Center, Department of Medical Microbiology, GroningenJ. Sinnige, Regional Laboratory of Public Health, HaarlemD.C. Melles, St Jansdal Hospital, Department of Medical Microbiology, HarderwijkE.I.G.B. de Brauwer, Zuyderland Medical center, Department of Medical Microbiology and Infection Control, HeerlenW. Silvis, Laboratory of Medical Microbiology and Public Health, HengeloL.J. Bakker, CBSL, Tergooi Hospital, Department of Medical Microbiology, HilversumJ.W. Dorigo-Zetsma, CBSL, Tergooi Hospital, Department of Medical Microbiology, HilversumB. Ridwan, Westfriesgasthuis, Department of Medical Microbiology, HoornK. Waar, Izore center for Infectious Diseases Friesland, LeeuwardenA.T. Bernards, Leiden University Medical Center, Department of Medical Microbiology, LeidenS.P. van Mens, Maastricht University Medical center, Department of Medical Microbiology, MaastrichtN. Roescher, St Antonius Hospital, Department of Medical Microbiology and Immunology, NieuwegeinM.H. Nabuurs-Franssen, Canisius Wilhelmina Hospital, Department of Medical Microbiology and Infectious Diseases, NijmegenE. Kolwijck, Radboud University Medical Center, Department of Medical Microbiology, NijmegenB.M.W. Diederen, Bravis Hospital, Department of Medical Microbiology, RoosendaalL. Bode, Erasmus University Medical Center, Department of Medical Microbiology, RotterdamM. van Rijn, Ikazia Hospital, Department of Medical Microbiology, RotterdamS. Dinant, Maasstad Hospital, Department of Medical Microbiology, RotterdamO. Pontesilli, Maasstad Hospital, Department of Medical Microbiology, RotterdamP. de Man, Sint Franciscus Gasthuis, Department of Medical Microbiology, RotterdamM.A. Leversteijn-van Hall, Haaglanden Medical center/ Alrijne Hospital, Department of Medical Microbiology and Infection Control, 's-GravenhageE.P.M. van Elzakker, Haga Hospital, Department of Medical Microbiology, 's-GravenhageA.E. Muller, MCH Westeinde Hospital, Department of Medical Microbiology, 's-GravenhageN.H. Renders, Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, 's-HertogenboschD.W. van Dam, Zuyderland Medical center, Department of Medical Microbiology and Infection Control, Sittard-GeleenB.M.W. Diederen, ZorgSaam Hospital Zeeuws-Vlaanderen, Department of Medical Microbiology, TerneuzenA.G.M. Buiting, St. Elisabeth Hospital, Department of Medical Microbiology, TilburgA.L.M. Vlek, Diakonessenhuis, Department of Medical Microbiology and Immunology, UtrechtE.A. Reuland, Saltro Diagnostic center, Department of Medical Microbiology, UtrechtA. Troelstra, University Medical Center Utrecht, Department of Medical Microbiology, UtrechtI.T.M.A. Overdevest, PAMM, Department of Medical Microbiology, VeldhovenR.W. Bosboom, Rijnstate Hospital, Laboratory for Medical Microbiology and Immunology, VelpT.A.M. Trienekens, VieCuri Medical Center, Department of Medical Microbiology, VenloG.J.H.M. Ruijs, Isala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, ZwolleM.J.H.M. Wolfhagen, Isala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle

a Julius Center for Health Sciences and Primary Care, Huispostnummer STR 6.131, Postbus 85500, 3508 GA Utrecht, the Netherlands 
b Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands 
c Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg/Waalwijk, the Netherlands 
d Central Laboratory for Bacteriology and Serology, the Netherlands 
e Department of Clinical Pharmacy, Tergooi Hospitals, Hilversum, the Netherlands 
f Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands 
g Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands 
h Department of Medical Microbiology and Immunology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands 
i Laboratory for Medical Microbiology and Immunology, Meander Medical Center, Amersfoort, the Netherlands 
j Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands 
k Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands 
l Members of the ISIS-AR Study Groupt, the Netherlands 

⁎Corresponding author.

Highlights

•
There is a large burden of Gram-negative infections in a low-resistance country.
•
Non-bacteraemic Gram-negative infections form a major part of the burden.
•
Strategies to reduce mortality should focus on reducing community infections.

Le texte complet de cet article est disponible en PDF.

Abstract

Objectives There is a global increase in infections caused by Gram-negative bacteria. The majority of research is on bacteremic Gram-negative infections (GNI), leaving a knowledge gap on the burden of non-bacteremic GNI. Our aim is to describe characteristics and determine the burden of bacteremic and non-bacteremic GNI in hospitalized patients in the Netherlands.

Methods We conducted a prospective cohort study of patients in eight hospitals with microbiologically confirmed GNI, between June 2013 and November 2015. In each hospital the first five adults meeting the eligibility criteria per week were enrolled. We estimated the national incidence and mortality of GNI by combining the cohort data with a national surveillance database for antimicrobial resistance.

Results 1,954 patients with GNI were included of which 758 (39%) were bloodstream infections (BSI). 243 GNI (12%) involved multi-drug resistant pathogens. 30-day mortality rate was 11.1% (n = 217) Estimated national incidences of non-bacteremic GNI and bacteremic GNI in hospitalized adults were 74 (95% CI 58 – 89) and 86 (95% CI 72–100) per 100,000 person years, yielding estimated annual numbers of 30-day all-cause mortality deaths of 1,528 (95% CI 1,102–1,954) for bacteremic and 982 (95% CI 688 – 1,276) for non-bacteremic GNI.

Conclusion GNI form a large mortality burden in a low-resistance country. A third of the associated mortality occurs after non-bacteremic GNI.

Le texte complet de cet article est disponible en PDF.

Keywords : Burden, Gram-negative infection, Bloodstream infection, Antibiotic resistance, Mortality


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Vol 81 - N° 6

P. 895-901 - décembre 2020 Retour au numéro
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