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- Title
Clinical and Molecular Analyses of Recurrent Gram-Negative Bloodstream Infections.
- Authors
Bock, Andrew; Hanson, Blake M; Ruffin, Felicia; Parsons, Joshua B; Park, Lawrence P; Sharma-Kuinkel, Batu; Mohnasky, Michael; Arias, Cesar A; Fowler, Vance G; Thaden, Joshua T
- Abstract
Background The causes and clinical characteristics of recurrent gram-negative bacterial bloodstream infections (GNB-BSI) are poorly understood. Methods We used a cohort of patients with GNB-BSI to identify clinical characteristics, microbiology, and risk factors associated with recurrent GNB-BSI. Bacterial genotyping (pulsed-field gel electrophoresis [PFGE] and whole-genome sequencing [WGS]) was used to determine whether episodes were due to relapse or reinfection. Multivariable logistic regression was used to identify risk factors for recurrence. Results Of the 1423 patients with GNB-BSI in this study, 60 (4%) had recurrent GNB-BSI. Non-White race (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.38–4.01; P =.002), admission to a surgical service (OR, 2.18; 95% CI, 1.26–3.75; P =.005), and indwelling cardiac device (OR, 2.73; 95% CI, 1.21–5.58; P =.009) were associated with increased risk for recurrent GNB-BSI. Among the 48 patients with recurrent GNB-BSI whose paired bloodstream isolates underwent genotyping, 63% were due to relapse (30 of 48) and 38% were due to reinfection (18 of 48) based on WGS. Compared with WGS, PFGE correctly differentiated relapse and reinfection in 98% (47 of 48) of cases. Median time to relapse and reinfection was similar (113 days; interquartile range [IQR], 35–222 vs 174 days; IQR, 69–599; P =.13). Presence of a cardiac device was associated with relapse (relapse: 7 of 27, 26%; nonrelapse: 65 of 988, 7%; P =.002). Conclusions In this study, recurrent GNB-BSI was most commonly due to relapse. PFGE accurately differentiated relapse from reinfection when compared with WGS. Cardiac device was a risk factor for relapse.
- Subjects
PREVENTION of bloodborne infections; DISEASE relapse prevention; CATHETER-related infections; SEQUENCE analysis; CONFIDENCE intervals; MICROBIOLOGY; ELECTROPHORESIS; MULTIVARIATE analysis; MOLECULAR biology; GENOME-wide association studies; GENOTYPES; DESCRIPTIVE statistics; RESEARCH funding; GRAM-negative bacterial diseases; LOGISTIC regression analysis; ODDS ratio; DATA analysis software; LONGITUDINAL method; CATHETERS; DISEASE risk factors
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 3, pe1285
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac638