Epidemiological Trends of Bloodstream Infections and Risk Factors for MDRO Bloodstream Infections in Critically Ill Patients: An Eight-Year Single-Center Data Analysis

Epidemiological Trends of Bloodstream Infections and Risk Factors for MDRO Bloodstream Infections in Critically Ill Patients: An Eight-Year Single-Center Data Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological Trends of Bloodstream Infections and Risk Factors for MDRO Bloodstream Infections in Critically Ill Patients: An Eight-Year Single-Center Data Analysis Qing Li, Lihong Xu, Shanshan Meng, Haofei Wang, Wenhan Hu, Qingyun Peng, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7445271/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The epidemiological characteristics, pathogen distribution, drug resistance patterns, and their temporal trends in bloodstream infections (BSI), along with the risk factors for BSI caused by multidrug-resistant organisms (MDRO) in critically ill patients, remain unclear. Methods: This single-center retrospective observational study included adult patients with BSI admitted to the Intensive Care Unit (ICU) from January 2013 to December 2020. Clinical data were collected through the hospital’s electronic medical record system. We analyzed the incidence and mortality rates of BSI, the distribution of pathogens and resistance patterns, and their temporal trends in critically ill patients. Risk factors for BSI caused by MDRO were also analyzed. Results: BSI had a 9.32% (955/10249) incidence. The 28-day and ICU mortality rates were 27.9% (266/955) and 26.8% (256/955), respectively, both showing a gradual declining trend. Gram-negative bacteria (GNB) were the predominant pathogens (63.2%, 604/955), followed by Gram-positive bacteria (GPB) (26.1%, 249/955). The distribution of pathogens did not show significant changes over time. Antibiotic exposure (Odds Ratio [OR]: 1.49, 95% Confidence Interval [CI]: 1.05-2.11) and ICU-acquired BSI (OR: 1.72, 95%CI: 1.08-2.73) were independent risk factors, and catheter-related BSI (OR: 0.66, 95%CI: 0.45-0.97) and early appropriate antimicrobial therapy (OR: 0.24, 95%CI: 0.17-0.33) were independent protective factors for BSI caused by MDRO. Conclusions: BSI in critically ill patients has high incidence and mortality rates, primarily caused by GNB and with no significant temporal change. Antibiotic exposure and ICU-acquired BSI are linked to an increased risk, while catheter-related BSI and early appropriate antimicrobial therapy are associated with a reduced risk of BSI caused by MDRO. Bloodstream Infections Critical care Epidemiology Multidrug-Resistant Organisms Risk Factors Figures Figure 1 Figure 2 Background Bloodstream infections (BSI) pose a significant public health challenge globally, especially in patients in Intensive Care Units (ICU). Critically ill patients, often experiencing immune dysfunction and subjected to invasive procedures such as the insertion of various intravascular catheters, are at an increased risk of developing BSI. Previous studies have shown that the incidence of BSI in critically ill patients is approximately 5%, accounting for about 20% of ICU-acquired infections( 1 , 2 ). Furthermore, BSI can progress to sepsis and septic shock, significantly increasing the mortality among critically ill patients, with ICU mortality rates for patients with BSI ranging from 35–50%( 3 , 4 ). Early and appropriate empirical antimicrobial treatment is crucial in reducing mortality rates in BSI patients( 5 , 6 ). But in recent years, with the increased ubiquity of antibiotic use, the incidence of resistant pathogens in BSI among critically ill patients has presented new trends and challenges( 7 ), making the choice of antimicrobial therapy more limited and complex. The etiological agents of BSI in critically ill patients are constantly changing over time. An analysis involving 24,179 patients from U.S. hospitals more than a decade ago indicated that Gram-positive bacteria (GPB) such as coagulase-negative Staphylococci and Staphylococcus aureus were the most common pathogens in hospital-acquired BSI( 8 ). However, recent studies have shown an increasing trend of ICU-acquired BSI caused by Gram-negative bacilli, with carbapenem resistant and extended spectrum Beta-lactamase producing Enterobacterales and Pseudomonas spp. being the most common( 9 , 10 ). The international EUROBACT cohort study also found that nearly 60% of BSI cases were caused by Gram-negative bacteria (GNB)( 11 ). Moreover, the proportion of BSI caused by multidrug-resistant organisms (MDRO) is gradually increasing and is significantly associated with poor outcomes in critically ill patients( 12 – 14 ). Therefore, timely updates and understanding of the epidemiological characteristics and changes in pathogen distribution of BSI are essential for guiding clinical treatment, formulating infection control policies, and optimizing the use of antibiotics. This study aims to provide a comprehensive assessment of the epidemiological characteristics, pathogen distribution, and trends over time in BSI among critically ill patients through an eight-year epidemiological data analysis. This analysis will serve as a basis for empirical antimicrobial therapy for BSI. Additionally, this study will explore risk factors associated with BSI caused by MDRO, aiming to provide data support for formulating prevention strategies for BSI caused by MDRO. Material and methods Study Design This retrospective observational study included patients with BSI admitted to the Department of Critical Care Medicine at the Zhongda Hospital affiliated to Southeast University from January 1, 2013, to December 31, 2020. The hospital is a tertiary teaching hospital with a total of 2,499 inpatient beds, including 98 adult ICU beds. This study aimed to evaluate the epidemiological characteristics and microbiological features of BSI, as well as their trends over time; and to explore the risk factors for BSI caused by MDRO in critically ill patients. This study was approved by the Clinical Research Ethics Committee of the tertiary teaching hospital (2019ZDSYLL120-P01). Given the retrospective nature of the data analysis, the Ethics Committee approved a waiver of informed consent. Study Population This study included all critically ill patients diagnosed with BSI during their ICU stay and excluded patients under the age of 18. The diagnostic criteria for BSI were as follows: 1. Presence of at least one of the following signs or symptoms of infection: fever (> 38°C), chills, hypotension (systolic blood pressure ≤ 90mmHg); 2. One or more positive blood cultures from blood samples collected within 48 hours after the onset of symptoms and the organism is not attributable to an infection at another site. A diagnosis of BSI was made when both criteria were met. For common commensals, a diagnosis of BSI was made only when two or more positive blood cultures were obtained on separate occasions, in accordance with CDC/NHSN surveillance definition( 15 , 16 ). Data Collection Data on positive blood cultures for all ICU patients during the study period were extracted from the Department of Clinical Laboratory at the tertiary teaching hospital. Adult critically ill patients meeting the diagnostic criteria for BSI were included. For patients with multiple episodes of BSI or multiple ICU admissions, only data from the first episode of BSI and the first ICU admission were included. We collected general information on included patients: age, sex, height, weight, comorbidities, timing of BSI, admission date, ICU admission and discharge dates, and hospital discharge date; severity of illness: sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores within 24 hours of ICU admission; risk factors for BSI within two weeks prior to the event: history of gastrointestinal surgery, history of transfusion, history of gastrointestinal bleeding, total parenteral nutrition, exposure to antimicrobial agents; organ failure status: presence of shock, need for mechanical ventilation, acute kidney injury (AKI), need for continuous renal replacement therapy (CRRT) on the day of BSI; infection indicators at the time of bloodstream infection: white blood cell count, hypersensitive C-reactive protein concentration, procalcitonin; presence of catheter-related bloodstream infection; early appropriate antimicrobial therapy; blood culture data: pathogens and susceptibility results; and clinical outcomes: 28-day mortality post-bloodstream infection, ICU mortality, hospital stay, ICU stay. Blood samples were cultured using blood culture bottles. Positive blood culture samples were then inoculated onto blood agar plates, and the plates were incubated for 24 hours to check for bacterial growth. The identified bacteria were further characterized using Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry. Antibiotic susceptibility was tested using the broth microdilution method, following the Clinical and Laboratory Standards Institute guidelines to determine the minimum inhibitory concentration for each antibiotic( 17 ). Definitions of Study Variables The incidence of BSI was calculated as the total number of patients with BSI during the study period divided by the total number of admissions to the ICU, expressed as a percentage. The 28-day mortality is defined as the proportion of patients who die from any cause within 28 days following the identification of BSI. Hospital-acquired BSI was defined as BSI occurring more than 48 hours after hospital admission, whereas ICU-acquired BSI was defined as BSI occurring more than 48 hours after ICU admission. Catheter-related BSI is defined as a laboratory-confirmed bloodstream infection in a patient who has had a central venous catheter in place for more than 48 hours before blood is drawn for culture, and no other source of bacteremia or fungemia can be identified( 18 ). For GPB, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus were defined as MDRO. For GNB, organisms resistant to at least three classes of antibiotics were defined as MDRO( 19 ). GNB resistant to imipenem, meropenem, or ertapenem were defined as carbapenem-resistant GNB (CR-GNB). For fungi, due to the lack of susceptibility testing results, MDRO was not defined in this study. Shock is defined as a state of hypotension requiring vasopressor therapy to maintain a mean blood pressure of 65 mmHg or greater, despite adequate fluid resuscitation( 20 ). AKI is defined as an increase in serum creatinine by ≥ 26.5µmol/L within 48 hours, an increase to ≥ 1.5 times baseline, or urine output < 0.5 mL/kg/hour for 6 hours( 21 ). Early appropriate antimicrobial therapy was defined as the use of antimicrobial agents to which the pathogen isolated from blood cultures, taken within 24 hours of culture, was sensitive. Statistical Methods Continuous variables were described using median (interquartile range), and categorical variables were described using numbers (percentage). For missing data, we first check whether the missing data is missing at random, and then handle it using multiple imputation (Figure S1 ). Differences between groups for continuous variables were compared using t-tests or non-parametric tests, while categorical variables were compared using chi-square tests or Fisher's exact tests. For risk factor analysis, univariate analysis was first performed based on patient grouping, and variables with P < 0.2 in the univariate analysis were included in a multivariable logistic regression model to explore risk factors for MDRO bloodstream infections, CR-GNB bloodstream infections, and ICU mortality among BSI patients. Data analysis and graphing were performed using R (Version 4.0.5) and GraphPad (Version 9.0.2). A P-value < 0.05 was considered statistically significant. Results Clinical Characteristics of Critically Ill Patients with BSI In our screening of 10,249 critically ill patients admitted to the ICU during the study period, after excluding 9,294 non-BSI cases and 3 non-adult patients, a total of 955 patients with BSI were included for analysis. Among these, 249 cases were caused by GPB infections, 604 by GNB infections, 74 by fungal infections, and 28 by mixed-pathogen infections (Figure S2). Additionally, blood cultures from 29 patients were positive, with a possibility of colonizing bacteria. Among these, 22 cases were identified as Staphylococcus epidermidis , 6 as other coagulase-negative staphylococci , and 1 as Aerococcus spp. . The median age of the included patients was 65 years [IQR: 52, 78], with 616 male patients (64.5%). The most common comorbidities were hypertension (475 cases, 49.7%), followed by diabetes (269 cases, 28.2%). The median APACHE II score was 22 [IQR: 16, 28], and the SOFA score was 11 [IQR: 7, 14], with 639 cases (66.9%) experiencing shock and 531 cases (55.6%) receiving mechanical ventilation treatment. The primary risk factors for BSI were the use of broad-spectrum antibiotics (603 cases, 63.1%), followed by blood transfusion treatment (378 cases, 39.6%). Among the included patients, 596 cases (62.4%) were hospital-acquired BSI, 447 cases (46.8%) were ICU-acquired BSI, and 548 patients (57.4%) received initial empirical antimicrobial treatment that covered the pathogens. The 28-day mortality of the BSI patients was 27.9% (266 cases), and the ICU mortality rate was 26.8% (256 cases). Detailed demographic and clinical characteristics of the included patients are presented in Table 1. Incidence and Mortality of BSI in Critically Ill Patients Among ICU patients, the incidence of BSI was 9.32% (955/10249). The rate of hospital-acquired BSI was 5.82% (596/10249), ICU-acquired BSI was 4.36% (447/10249), and community-acquired BSI was 3.50% (359/10249). From 2013 to 2017, the incidence of BSI in ICU patients was 5.9% (59/996), 7.0% (51/726), 8.1% (90/1108), 10.1% (138/1362), and 11.5% (148/1282), showing an upward trend, peaking at 11.5% in 2017. From 2018 to 2020, the incidence of BSI was 9.7% (152/1570), 10.4% (175/1678), and 9.3% (142/1527), showing a slight decrease trend (Fig. 1 A). The 28-day mortality for included BSI patients was 27.9% (266/955), and the ICU mortality was 26.8% (256/955). Between 2013 and 2020, both the 28-day mortality and the ICU mortality for BSI patients showed a gradual decline. The 28-day mortality and ICU mortality for BSI patients in 2013 were 54.2% and 59.3%, respectively, which decreased to 17.6% and 12.0% by 2020, respectively (Table 1 and Fig. 1 B). Table 1. Demographic and Clinical Characteristics of Critically Ill Patients with Bloodstream Infections Characteristics Total (n = 955) 2013 (n = 59) 2014 (n = 51) 2015 (n = 90) 2016 (n = 138) 2017 (n = 148) 2018 (n = 152) 2019 (n = 175) 2020 (n = 142) P -value Age, years 65[52, 78] 75[62, 82] 69[61, 80] 72[58, 79] 64[49, 78] 63[50, 77] 62[49, 74] 64[51, 76] 64[52, 78] 0.001 Male, n(%) 616 (64.5) 39 (66.1) 32 (62.7) 60 (66.7) 95 (68.8) 93 (62.8) 95 (62.5) 122 (70.0) 80 (56.3) 0.323 BMI, kg/m 2 23.7[21.5, 25.7] 23.4[20.8, 24.5] 24.0[20.8, 27.5] 23.4[20.8, 24.6] 24.0[21.4, 25.5] 23.5[21.2, 25.7] 23.7[21.7, 25.9] 23.9[21.6, 25.7] 23.8[21.4, 26.1] 0.403 Comorbid conditions, n(%) COPD 42(4.4) 4(6.8) 4(7.8) 6(6.7) 5(3.6) 6(4.1) 6(3.9) 7(4.0) 4(2.8) 0.714 Coronary heart disease 203(21.3) 17(28.8) 15(29.4) 20(22.2) 26(18.8) 34(23.0) 32(21.1) 35(20.0) 24(16.9) 0.471 Hypertension 475(49.7) 29(49.2) 28(55.0) 45(50.0) 66(47.8) 71(48.0) 69(45.4) 93(53.1) 74(52.1) 0.864 Diabetes 269(28.2) 20(33.9) 17(33.3) 25(27.8) 33(23.9) 40(27.0) 46(30.3) 49(28.0) 39(27.5) 0.853 Malignant tumor 153(16.0) 4(6.8) 11(21.6) 22(24.4) 21(15.2) 22(14.9) 30(19.7) 26(14.9) 17(12.0) 0.064 Liver cirrhosis 30(3.1) 2(3.4) 2(3.9) 7(7.8) 4(2.9) 4(2.7) 4(2.6) 4(2.3) 3(2.1) 0.547 Chronic kidney disease 89(9.3) 3(5.1) 1(2.0) 7(7.8) 18(13.0) 11(7.4) 13(8.6) 23(13.1) 13(9.2) 0.148 Hemodialysis 22(2.3) 3(5.1) 0(0.0) 1(1.1) 3(2.2) 3(2.0) 4(2.6) 5(2.9) 3(2.1) 0.663 Severity of illness APACHE II 22[16, 28] 20[15, 27] 21[16, 26] 22[17, 27] 23[18, 28] 25[20, 31] 21[16, 27] 19[14, 26] 20[15, 27] <0.001 SOFA 11[7, 14] 9[7, 12] 9[5, 12] 9[7, 13] 10[7, 13] 10[7, 13] 12[8, 14] 11[8, 15] 12[9, 16] <0.001 Shock, n(%) 639(66.9) 41(69.5) 19(37.3) 70(77.8) 83(60.1) 108(80.0) 103(67.8) 117(66.9) 98(69.0) <0.001 Mechanical ventilation, n(%) 531(55.6) 29(49.2) 43(84.3) 50(55.6) 84(60.9) 117(79.1) 71(46.7) 73(41.7) 64(45.1) <0.001 AKI, n(%) 366(38.3) 23(39.0) 37(72.5) 48(53.3) 46(33.3) 47(31.8) 57(37.5) 63(36.0) 45(31.7) <0.001 CRRT, n(%) 185(19.4) 20(33.9) 10(19.6) 17(18.9) 33(23.9) 39(26.4) 24(15.8) 25(14.3) 17(12.0) 0.001 CRBSI, n(%) 175(18.3) 11(18.6) 9(17.6) 2(2.2) 14(10.1) 41(27.7) 34(22.4) 40(22.9) 24(16.9) <0.001 Risk factors for BSI, n(%) # Gastrointestinal surgery 112(11.7) 5(8.5) 8(15.7) 13(14.4) 10(7.2) 22(14.9) 19(12.5) 17(9.7) 18(12.7) 0.429 Parenteral nutrition 56(5.9) 19(32.2) 7(13.7) 6(6.7) 3(2.2) 20(13.5) 1(0.7) 0(0.0) 0(0.0) <0.001 Blood transfusion 378(39.6) 21(35.6) 31(60.8) 29(32.2) 42(30.4) 86(58.1) 57(37.5) 60(34.3) 52(36.6) <0.001 Use broad spectrum antibiotics 603(63.1) 46(78.0) 40(78.4) 77(85.6) 117(84.8) 118(79.7) 73(48.0) 77(44.0) 55(38.7) <0.001 Gastrointestinal hemorrhage 101(10.6) 3(5.1) 0(0.0) 13(14.4) 19(13.8) 16(10.8) 13(8.6) 16(9.1) 21(14.8) 0.042 Hospital acquired BSI, n(%) 596(62.4) 41(69.5) 35(68.6) 52(57.8) 94(68.1) 99(66.9) 101(66.4) 97(55.4) 77(54.2) 0.038 ICU acquired BSI, n(%) 447(46.8) 33(55.9) 28(54.9) 30(33.3) 80(58.0) 79(53.4) 72(47.4) 69(39.4) 56(39.4) <0.001 The time from hospital admission to BSI, Days 5[0, 13] 7[2, 19] 7[0, 15] 5[0, 17] 6[0, 12] 5[0, 13] 5[0, 13] 3[0, 10] 3[0, 12] 0.103 The time from ICU admission to BSI, Days 1[0, 8] 3[0, 12] 3[0, 9] 0[0, 7] 3[0, 8] 2[0, 8] 1[0, 10] 0[0, 6] 0[0, 7] 0.059 Infection parameters WBC, ×10 9 /L 11.9[7.5, 18.1] 13.4[8.5, 16.7] 11.9[7.2, 17.4] 12.0[7.4, 16.8] 11.2[7.2, 17.1] 9.8[6.2, 15.3] 12.9[8.1, 20.2] 13.4[9.0, 20.3] 12.5[6.8, 17.4] 0.003 CRP, mg/L 138.4[75.6, 185.0] 109.0[60.5, 169.0] 100.0[65.9, 183.0] 138.4[43.7, 186.0] 119.0[72.1, 164.3] 131.0[62.3, 177.0] 138.4[90.4, 194.3] 138.4[81.8, 191.0] 138.4[95.3, 205.0] 0.016 PCT, ng/mL 4.1[0.6, 14.0] 10.2[3.1, 10.2] 4.2[0.9, 25.0] 5.0[0.5, 20.5] 1.8[0.4, 10.2] 1.5[0.4, 5.8] 5.7[0.5, 18.9] 4.1[0.7, 13.9] 6.2[1.3, 16.3] <0.001 Appropriate antimicrobial treatment, n(%) 548(57.4) 30(50.8) 32(62.7) 63(70.0) 83(60.1) 88(59.5) 82(53.9) 91(52.0) 79(55.6) 0.132 28-day mortality 266(27.9) 32(54.2) 19(37.3) 27(30.0) 45(32.6) 49(33.1) 39(25.7) 30(17.1) 25(17.6) <0.0001 ICU mortality 256(26.8) 35(59.3) 25(49.0) 34(37.8) 48(34.8) 49(33.1) 26(17.1) 22(12.6) 17(12.0) <0.0001 *Continuous variables were described using median [interquartile range], and categorical variables were described using numbers (percentage). #Data on risk factors for bloodstream infection, identified within two weeks prior to the diagnosis of bloodstream infection, were collected. AKI, Acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation; BMI, Body mass index; Bloodstream infection; COPD, Chronic obstructive pulmonary disease; CRBSI, Catheter-related bloodstream infection; CRRT, Continuous renal replacement therapy, CRP, C-reactive protein; ICU, Intensive care unit; PCT, Procalcitonin; SOFA, Sequential Organ Failure Assessment; WBC, White blood cell. Pathogen Distribution and Trends in BSI among Critically Ill Patients In patients with BSI, GNB were the predominant pathogens, accounting for 63.2% (604/955) of the cases. Among these, 447 cases (46.8%) were caused by multidrug-resistant Gram-negative organisms, with CR-GNB constituting 265 cases (27.7%). The primary Gram-negative pathogens causing BSI were Klebsiella pneumonia (180 cases, 18.8%), Escherichia coli (164 cases, 17.2%), and Acinetobacter baumannii (128 cases, 13.4%). GPB were the second most common pathogens, making up 26.1% (249/955) of BSI, with 60 cases (6.3%) being multidrug-resistant. The leading Gram-positive pathogens causing BSI were Staphylococcus aureus (85 cases, 8.9%), Enterococcus (75 cases, 7.9%), and Coagulase-negative staphylococcus (66 cases, 6.9%). Fungal infections accounted for 74 cases (7.7%) of all BSI. The distribution of pathogens in polymicrobial infections is presented in Table S1 . Moreover, from 2013 to 2020, there was no significant change in the distribution of pathogens causing BSI over time (Table 2 and Fig. 2 A). There were no significant differences in the distribution of GPB, GNB, and fungi among hospital-acquired, ICU-acquired, and community-acquired BSI (Fig. 2 B). The proportion of multidrug-resistant GNB in community-acquired BSI (39.6%) was significantly lower than in hospital-acquired (48.7%) and ICU-acquired (53.2%) BSI (P < 0.001). The proportion of CR-GNB in community-acquired BSI (17.0%) was significantly lower than in hospital-acquired (32.4%) and ICU-acquired (38.5%) BSI (P < 0.001). Additionally, the proportion of Escherichia coli in community-acquired BSI (24.8%) was significantly higher than in hospital-acquired (11.6%) and ICU-acquired (8.7%) BSI (P < 0.001); the proportion of Acinetobacter baumannii was significantly lower in community-acquired BSI (5.0%) compared to hospital-acquired (16.9%) and ICU-acquired (21.0%) BSI (P < 0.001) (Table S2). Table 2 Distribution and Temporal Trends of Pathogens in Bloodstream Infections Among Critically Ill Patients Microorganism Total (n = 955) 2013 (n = 59) 2014 (n = 51) 2015 (n = 90) 2016 (n = 138) 2017 (n = 148) 2018 (n = 152) 2019 (n = 175) 2020 (n = 142) P -value Gram-positive bacteria, n(%) 249(26.1) 16(27.1) 13(25.5) 26(28.9) 40(29.0) 42(28.3) 41(27.0) 39(22.3) 32(22.5) 0.812 MDRO, n(%) 60(6.3) 6(10.2) 3(5.9) 4(4.4) 13(9.4) 6(4.1) 11(7.2) 15(8.6) 2(1.4) 0.069 Staphylococcus aureus, n(%) 85(8.9) 8(13.6) 3(5.9) 8(8.9) 14(10.1) 12(8.1) 15(9.9) 18(10.3) 7(4.9) 0.661 MRSA, n(%) 48(5.0) 4(6.8) 3(5.9) 3(3.3) 10(7.2) 3(2.0) 10(6.6) 14(8.0) 1(0.7) 0.012 Enterococcus, n(%) 75(7.9) 5(8.5) 5(9.8) 6(6.7) 11(8.0) 17(11.5) 13(8.6) 9(5.1) 9(6.3) 0.696 VRE, n(%) 12(1.3) 2(3.4) 0(0.0) 1(1.1) 3(2.2) 3(2.0) 1(0.7) 1(0.6) 1(0.7) 0.561 CNS, n(%) 66(6.9) 3(5.1) 4(7.8) 10(11.1) 16(11.6) 9(6.1) 7(4.6) 9(5.1) 8(5.6) 0.253 MR-CNS, n(%) 48(5.0) 1(1.7) 2(3.9) 8(8.9) 11(8.0) 5(3.4) 7(4.6) 6(3.4) 8(5.6) 0.362 Streptococcus, n(%) 42(4.4) 1(1.7) 2(3.9) 5(5.6) 4(2.9) 4(2.7) 11(7.2) 8(4.6) 7(4.9) 0.634 Gram-negative bacteria, n(%) 604(63.2) 37(62.7) 30(58.8) 49(54.4) 86(62.3) 88(59.5) 100(65.8) 115(65.7) 99(69.7) 0.347 MDRO, n(%) 447(46.8) 33(55.9) 27(52.9) 35(38.9) 59(42.8) 63(42.6) 69(45.4) 94(53.7) 67(47.2) 0.163 CR-GNB, n(%) 265(27.7) 16(27.1) 12(23.5) 19(21.1) 34(24.6) 45(30.4) 42(27.6) 56(32.0) 41(28.9) 0.624 Klebsiella pneumoniae, n(%) 180(18.8) 12(20.3) 8(15.7) 16(17.8) 22(15.9) 26(17.6) 29(19.1) 40(22.9) 27(19.0) 0.917 MDR-Klebsiella pneumoniae, n(%) 108(11.3) 10(16.9) 7(13.7) 9(10.0) 7(5.1) 19(12.8) 13(8.6) 27(15.4) 16(11.3) 0.096 CR-Klebsiella pneumoniae, n(%) 83(8.7) 7(11.9) 4(7.8) 6(6.7) 5(3.6) 14(9.5) 9(5.9) 24(13.7) 14(9.9) 0.069 Escherichia coli, n(%) 164(17.2) 10(16.9) 9(17.6) 12(13.0) 22(15.9) 20(13.5) 26(17.1) 35(20.0) 30(21.1) 0.755 MDR-Escherichia coli, n(%) 114(11.9) 9(15.3) 7(13.7) 8(8.9) 15(10.9) 8(5.4) 16(10.5) 31(17.7) 20(14.1) 0.047 CR-Escherichia coli, n(%) 4(0.4) 0(0.0) 1(2.0) 0(0.0) 1(0.7) 0(0.0) 0(0.0) 2(1.1) 1(0.7) 0.555 Acinetobacter baumannii, n(%) 128(13.4) 9(15.3) 5(9.8) 9(10.0) 17(12.3) 21(14.2) 28(18.4) 25(14.2) 14(9.9) 0.557 MDR-Acinetobacter baumannii, n(%) 126(13.2) 9(15.3) 5(9.8) 9(10.0) 17(12.3) 20(13.5) 28(18.4) 24(13.7) 14(9.9) 0.463 CR-Acinetobacter baumannii, n(%) 120(12.6) 7(11.9) 4(7.8) 9(10.0) 16(11.6) 20(13.5) 26(17.1) 24(13.7) 14(9.9) 0.558 Pseudomonas aeruginosa, n(%) 38(4.0) 1(1.7) 2(3.9) 3(3.3) 9(6.5) 7(4.7) 4(2.6) 2(1.1) 10(7.0) 0.183 MDR-Pseudomonas aeruginosa, n(%) 29(3.0) 1(1.7) 2(3.9) 3(3.3) 7(5.1) 4(2.7) 3(2.0) 1(0.6) 8(5.6) 0.586 CR-Pseudomonas aeruginosa, n(%) 13(1.4) 0(0.0) 0(0.0) 1(1.1) 3(2.2) 3(2.0) 1(0.7) 1(0.6) 4(2.8) 0.193 Fungus, n(%) 74(7.7) 4(6.8) 6(11.8) 11(12.2) 8(5.8) 16(10.8) 4(2.6) 16(9.1) 9(6.3) 0.076 Mixed infection, n(%) 28(2.9) 2(3.4) 2(3.9) 4(4.4) 4(2.9) 2(1.4) 7(4.6) 5(2.9) 2(1.4) 0.641 CNS, Coagulase negative staphylococcus; CR-GNB, Carbapenem resistant gram-negative bacteria; MDRO, Multiple Drug Resistant Organism; MRSA, Methicillin-resistant Staphylococcus aureus; MR-CNS, Methicillin-resistant coagulase-negative staphylococcus; VRE, Vancomycin-resistant enterococcus. Risk Factors Analysis for MDRO Bloodstream Infections in Critically Ill Patients Compared to BSI caused by non-MDRO, BSI caused by MDRO had a higher proportion of male patients, patients requiring mechanical ventilation, patients with AKI, patients who received blood transfusions, patients were exposed to antibiotics, and a higher proportion of hospital-acquired and ICU-acquired BSI. The proportion of patients receiving early appropriate antimicrobial therapy was lower in BSI caused by MDRO compared to non-MDRO. Additionally, patients with BSI caused by MDRO had significantly longer ICU stays and higher ICU mortality compared to BSI caused by non-MDRO (Table S3). Multivariate analysis identified antibiotic exposure (OR: 1.49, 95%CI: 1.05–2.11) and ICU-acquired BSI (OR: 1.72, 95%CI: 1.08–2.73) as independent risk factors for BSI caused by MDRO; catheter-related BSI (OR: 0.66, 95%CI: 0.45–0.97) and early appropriate antimicrobial therapy (OR: 0.24, 95%CI: 0.17–0.33) as independent protective factors (Table 3 ). Risk Factors Analysis for CR-GNB Bloodstream Infections in Critically Ill Patients Compared to BSI caused by carbapenem-sensitive GNB (CS-GNB), BSI caused by CR-GNB had a higher proportion of male patients, patients requiring mechanical ventilation and CRRT, a higher proportion of catheter-related BSI, patients who received blood transfusions, patients were exposed to antibiotics, and a higher proportion of hospital-acquired and ICU-acquired BSI. The proportion of patients with diabetes and those receiving early appropriate antimicrobial therapy was lower in BSI caused by CR-GNB compared to CS-GNB. Furthermore, patients with BSI caused by CR-GNB had longer total hospital and ICU stays and higher ICU mortality compared to BSI caused by CS-GNB (Table S4). Multivariate analysis found antibiotic exposure (OR: 1.82, 95%CI: 1.01–3.28) and ICU-acquired BSI (OR: 2.22, 95%CI: 1.04–4.76) as independent risk factors for BSI caused by CR-GNB, while early appropriate antimicrobial therapy (OR: 0.05, 95%CI: 0.03–0.07) served as an independent protective factor (Table S5). Table 3 Risk Factors Associated with Bloodstream Infections Caused by Multidrug-Resistant Organisms Among Critically Ill Patients Risk factors Adjusted OR(95%CI) P value Male 0.93 (0.69,1.27) 0.666 Comorbid conditions COPD 1.77 (0.83,3.77) 0.132 Coronary heart disease 0.72 (0.5,1.03) 0.074 Diabetes 0.91 (0.65,1.27) 0.584 Hemodialysis 0.54 (0.21,1.4) 0.201 Severity of illness APACHE II 1.0096 (0.991,1.0285) 0.315 Mechanical ventilation 0.8 (0.56,1.15) 0.230 AKI 1.26 (0.92,1.73) 0.146 CRBSI 0.66 (0.45,0.97) 0.034 Risk factors for BSI # Blood transfusion 1.03 (0.72,1.47) 0.884 Antibiotic exposure 1.49 (1.05,2.11) 0.024 Hospital acquired BSI 0.84 (0.54,1.3) 0.427 ICU acquired BSI 1.72 (1.08,2.73) 0.023 Early appropriate antimicrobial therapy 0.24 (0.17,0.33) < 0.001 #Data on risk factors for bloodstream infection, identified within two weeks prior to the diagnosis of bloodstream infection, were collected. AKI, Acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation II; BSI, Bloodstream infection; COPD, Chronic obstructive pulmonary disease; CRBSI, Catheter-related bloodstream infection; ICU, Intensive care unit. Risk Factors Analysis for ICU Mortality among Critically Ill Patients with BSI Univariate and multivariate analyses of risk factors for ICU mortality among critically ill patients with BSI identified age (OR: 1.02, 95%CI: 1.01–1.03), APACHE II score (OR: 1.05, 95%CI: 1.03–1.08), shock (OR: 1.65, 95%CI: 1.11–2.44), AKI (OR: 1.70, 95%CI: 1.19–2.42), total parenteral nutrition (OR: 2.03, 95%CI: 1.09–3.75), antibiotic exposure (OR: 1.80, 95%CI: 1.19–2.71), and ICU-acquired BSI (OR: 1.70, 95%CI: 1.01,2.87) as independent risk factors. Body mass index (OR: 0.93, 95%CI: 0.89–0.97), catheter-related BSI (OR: 0.54, 95%CI: 0.34–0.86), and early appropriate antimicrobial therapy (OR: 0.63, 95%CI: 0.44–0.91) were identified as independent protective factors (Table S6 and Table S7). Discussion This study conducted a comprehensive analysis of the epidemiological characteristics, pathogen distribution, drug resistance patterns, and their temporal trends in BSI among critically ill patients. We also analyzed the risk factors associated with BSI caused by MDRO and CR-GNB. The results show that the incidence and mortality rates of BSI remain high in critically ill patients, although they exhibit a gradual decline over time. GNB are the predominant pathogens, with 74% of these being multidrug-resistant GNB and 43.8% being CR-GNB, highlighting the severity of the resistance issue. Throughout the study period, there were no significant changes in the pathogen distribution of BSI among critically ill patients. Additionally, the study identified antibiotic exposure and ICU-acquired BSI as independent risk factors for MDRO bloodstream infections. Interestingly, the early and appropriate antimicrobial treatment is associated with a reduced risk of MDRO and CR-GNB bloodstream infections, underscoring the importance of prudent antibiotic use. The peak incidence of BSI in ICU patients in 2017 could be attributed to several factors, including: ( 1 ) an increase in ICU admissions, with the number of ICU admissions rising from 996 in 2013 to 1282 in 2017, leading to increased pressure on infection control; ( 2 ) hospital-related factors, such as changes in infection control practices or antimicrobial stewardship strategies. Screening for the causes of this peak incidence of BSI may help provide strategies for its prevention. The 28-day mortality and ICU mortality showed a yearly declining trend among BSI patients during the study period. This may reflect improvements in BSI management in medical practice, including more precise pathogen detection, more rational antibiotic use, and more effective infection control measures( 18 , 22 ). However, despite the reduction in mortality, the increasing proportion of MDRO remains a concerning issue( 23 , 24 ). The persistence of MDRO infection suggests that, despite the implementation of various interventions, significant challenges remain in controlling antibiotic resistance( 25 ). The pathogen distribution and resistance trends observed largely align with reports in the existing literature, especially the finding that GNB are the primary pathogens causing BSI in critically ill patients( 26 , 27 ). Notably, our study identified a high proportion of CR-GNB among all BSI cases, which is consistent with global reports on the increase of resistant pathogens( 28 ). However, compared to studies in certain regions, our research found a higher proportion of MDRO( 29 , 30 ), which may reflect differences in resistance patterns across geographical locations or could be related to the specific antibiotic usage patterns and infection control measures. Antibiotic exposure is an independent risk factor for both MDRO and CR-GNB bloodstream infections, which is largely consistent with previous research( 31 ). Interestingly, the association between early and appropriate antimicrobial treatment and a reduced risk of MDRO and CR-GNB bloodstream infections further emphasizes the critical role of prudent antibiotic use and early, accurate pathogen identification to guide antimicrobial therapy( 23 ). The identification of catheter-related BSI as an independent protective factor against MDRO could be explained by the higher proportion of GPB observed in catheter-related BSI. Specifically, Gram-positive pathogens accounted for 40.7% of catheter-related BSI, compared to 26.1% in the overall BSI population. Notably, the multidrug resistance rates of GPB are significantly lower than those of GNB. This could contribute to catheter-related BSI being associated with a lower risk of MDRO infections. Interestingly, catheter-related BSI were more common in CR-GNB infections than in CS-GNB infections. This may be due to the fact that the predominant Gram-negative pathogens in catheter-related BSI were Klebsiella pneumoniae (18.2%) and Acinetobacter baumannii (17.7%), followed by Escherichia coli (4%) and Pseudomonas aeruginosa (2.8%). Notably, Klebsiella pneumoniae and Acinetobacter baumannii showed significantly higher carbapenem resistance rates compared to Escherichia coli (Table 2 ). This difference in resistance patterns may explain why catheter-related BSI were more frequently observed in CR-GNB infections. The findings of this study hold significant clinical implications for formulating empirical antimicrobial treatment guidelines. Especially in the context of observing a high proportion of MDRO and CR-GNB, these results underscore the necessity of considering region-specific resistance patterns when selecting empirical antibiotic treatments( 32 ). Hospitals and healthcare facilities need to regularly update antimicrobial susceptibility data and incorporate this information into the antimicrobial treatment decision-making process to ensure the efficacy and specificity of treatment regimens( 33 ). Additionally, facing the ongoing threat of MDRO, the development and implementation of new antibiotics with greater specificity and lower toxicity become particularly urgent, alongside the need to strengthen education and guidance on the prudent use of existing antimicrobial agents. Based on the risk factors for MDRO bloodstream infections, particularly antibiotic exposure and ICU-acquired BSI, strategies for preventing MDRO bloodstream infections in critically ill patients need appropriate adjustments and optimization. This includes reinforcing infection control measures, such as strict adherence to hand hygiene and aseptic procedures( 34 ), optimizing the management of central venous catheters and other invasive devices( 35 ), and implementing antibiotic stewardship programs to reduce unnecessary use of antibiotics( 36 ). Furthermore, early identification and isolation of patients carrying MDRO, as well as regular training for healthcare workers on antibiotic resistance and infection prevention, are key to reducing the incidence of MDRO bloodstream infections( 37 ). Through these comprehensive preventive measures, it is possible to effectively lower the incidence of MDRO bloodstream infections, mitigate the impact of resistance issues, and thus improve outcomes in critically ill patients. This study has some limitations. First, as a single-center study, its results may be constrained by the specific medical environment and population structure, thus potentially limiting the generalizability to other regions or hospital settings. Second, although all data were manually extracted by the researchers through the electronic medical record system, minimizing data loss and bias to the greatest extent possible, the retrospective design still carries inherent limitations, such as potential missing information and inaccuracies in records, which may affect the accurate assessment of pathogen distribution and risk factors. Therefore, future studies should consider adopting a prospective design and conducting multi-center research to enhance the generalizability and accuracy of the findings. Third, in defining multidrug-resistant GPB, this study only considered MRSA and vancomycin-resistant Enterococcus , excluding other GPB that might exhibit multidrug resistance. This selective definition may lead to an underestimation of the overall resistance among GPB. Fourth, for infections caused by commensal organisms, a total of 67 blood culture-positive cases were identified as commensals, of which 29 had only one positive blood culture. These 29 cases did not align with the CDC/NHSN surveillance definition, which may have led to an overestimation of the bloodstream infection incidence rate. Conclusions BSI are common in critically ill patients, with a gradual decline in mortality over time. GNB are the most prevalent pathogens causing BSI, followed by GPB, with no significant changes in the distribution of pathogens over time. MDRO, especially multidrug-resistant GNB, predominate in BSI. Antibiotic exposure and ICU-acquired BSI are identified as independent risk factors, while early appropriate antimicrobial therapy is an independent protective factor against MDRO bloodstream infections in critically ill patients. These findings provide valuable references for clinicians in formulating empirical antimicrobial treatments and strategies for preventing MDRO bloodstream infections. Abbreviations AKI Acute Kidney Injury APACHE Acute Physiology and Chronic Health Evaluation BSI Bloodstream Infections CA-BSI Community Acquired Bloodstream Infection CDC/NHSN Centers for Disease Control and Prevention/National Healthcare Safety Network CI Confidence Interval CR-GNB Carbapenem-Resistant Gram-Negative Bacteria CRRT Continuous Renal Replacement Therapy GNB Gram-Negative Bacteria GPB Gram-Positive Bacteria ICU Intensive Care Unit ICUA-BSI Intensive Care Unit Acquired Bloodstream Infection MDRO Multidrug-Resistant Organisms MRSA Methicillin-Resistant Staphylococcus aureus OR Odds Ratio SOFA Sequential Organ Failure Assessment. Declarations Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of Zhongda Hospital (Approval No. 2019ZDSYLL120-P01). Given the retrospective nature of the data analysis, the ethics committee approved a waiver of informed consent. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by the National Key R&D Program of China [grant number 2022YFC2304600 and 2023YFC3043510], the National Natural Science Foundation of China [grant number 82272235 and 82472201], the China Postdoctoral Science Foundation [grant number 2022M710685 and 2024T170133], and the Jiangsu Young Scientific and Technological Talents Promotion Project. Author Contribution Q.L conceptualized and designed the study; performed data analysis and interpretation; wrote the manuscript. LH.x contributed to the study design and analysis; helped interpret the clinical data and patient outcomes; reviewed and revised the manuscript. SS.M conducted statistical analysis and helped interpret the data. HF.W collected patient data and managed clinical data. WH.H provided valuable input on data analysis and interpretation. QY.P, C.Z, SH.Y helped with data collection and analysis. W.H and JF.X contributed to the study design, statistical analysis plan, and secondary data validation; revised the manuscript. JL.W provided critical supervision throughout the study, including methodological guidance, data interpretation, and final manuscript revision and approval. YZ.H managed the overall operation of the study, provided resources, and performed the final manuscript revision. All authors read and approved the final manuscript. Acknowledgement We would like to express our sincere gratitude to all the medical staff in the Department of Critical Care Medicine at Zhongda Hospital, Southeast University, for their dedication and commitment to clinical work. Their adherence to standardized treatment has provided strong data support for this research. 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Patterns of microbial resistance in bloodstream infections of hemodialysis patients: a cross-sectional study from Palestine. Sci Rep. 2022;12(1):18003. Iordanou S, Palazis L, Timiliotou-Matsentidou C, Mendris M, Raftopoulos V. When Multidrug-Resistant Organism (MDRO)-Positive ICU Patient Isolation and Cohorting Is Not Feasible. What Comes Next? Cureus. 2021;13(3):e13636. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7445271","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509539962,"identity":"57662417-ad5f-4bd1-af6b-3a7963d745b3","order_by":0,"name":"Qing Li","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Li","suffix":""},{"id":509539964,"identity":"6588fd0c-e7d1-4f89-a30a-ce275d495e95","order_by":1,"name":"Lihong Xu","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Lihong","middleName":"","lastName":"Xu","suffix":""},{"id":509539968,"identity":"c1367b2f-6e8c-453f-819b-5c37bffcb311","order_by":2,"name":"Shanshan Meng","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Meng","suffix":""},{"id":509539972,"identity":"6bbdfcc8-6ce1-4f3e-8ec4-059d12d31974","order_by":3,"name":"Haofei Wang","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Haofei","middleName":"","lastName":"Wang","suffix":""},{"id":509539974,"identity":"255c75b7-2cdb-47ec-92a5-85d7ef4788af","order_by":4,"name":"Wenhan Hu","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Wenhan","middleName":"","lastName":"Hu","suffix":""},{"id":509539976,"identity":"82ca729f-d5aa-4991-b4a1-5f0c0f00e537","order_by":5,"name":"Qingyun Peng","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Qingyun","middleName":"","lastName":"Peng","suffix":""},{"id":509539978,"identity":"20df030f-c067-4c3e-a3ff-37034f3f2f6b","order_by":6,"name":"Chen Zhang","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Zhang","suffix":""},{"id":509539979,"identity":"27f50764-4c3a-48ae-a73f-d4efe65ac097","order_by":7,"name":"Shuhe Yang","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Shuhe","middleName":"","lastName":"Yang","suffix":""},{"id":509539982,"identity":"bb654c3b-7395-4928-96f5-871db7b19b41","order_by":8,"name":"Wei Huang","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Huang","suffix":""},{"id":509539983,"identity":"675dc575-002d-44d1-bfad-724742eba0cc","order_by":9,"name":"Jianfeng Xie","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Jianfeng","middleName":"","lastName":"Xie","suffix":""},{"id":509539985,"identity":"39b175f2-f4e4-468d-8830-cf0cc03ac66d","order_by":10,"name":"Jinlong Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinlong","middleName":"","lastName":"Wang","suffix":""},{"id":509539986,"identity":"7129dff2-a037-4420-b47a-c2f30fac259b","order_by":11,"name":"Yingzi Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYHACNjDJz8x88AFpWiTb2ZINSNNicJ7HTIAo9QbnD7A95qm5Y7f5MIMZA0ONTTRhLQcOsBvzHHuWvO0wQ9oDhmNpuQ0EtRxsYJPmYTucbHaY4bgBY8NhIrQcZgBq+Xc42biZsU2COC3HgFp42w7bGTAzsxGnRfIMA5vk3L7DCRKH2ZgNEojxCx8wxCTefDtsz99//uODDzU2hLUoHOD/AKITwSoTCCkHAXmoofbEKB4Fo2AUjIIRCgDHtzxt25cLEQAAAABJRU5ErkJggg==","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":true,"prefix":"","firstName":"Yingzi","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2025-08-24 09:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7445271/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7445271/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90801312,"identity":"1eda9742-331c-4e02-a670-2b8ec6707a6e","added_by":"auto","created_at":"2025-09-08 10:14:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":850650,"visible":true,"origin":"","legend":"\u003cp\u003eTemporal Trends in the Incidence and Mortality Rates of Bloodstream Infections among Critically Ill Patients\u003c/p\u003e\n\u003cp\u003e(A) Temporal trends in the incidence; (B) Temporal trends in the mortality rates. BSI, bloodstream infection; ICU, intensive care unit. ***indicates p\u0026lt;0.001, ****indicates p\u0026lt;0.0001.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7445271/v1/755180c3b4d2c299ad55d385.png"},{"id":90801309,"identity":"e69e1445-8607-4499-8d4e-9d863b12717d","added_by":"auto","created_at":"2025-09-08 10:14:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":802699,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Pathogens in Bloodstream Infections Among Critically Ill Patients\u003c/p\u003e\n\u003cp\u003e(A) Distribution of pathogens and their trends over time; (B) Distribution of pathogens in hospital-acquired, ICU-acquired, and community-acquired bloodstream infections. CA-BSI, community-acquired bloodstream infection; HA-BSI, hospital-acquired bloodstream infection; ICUA-BSI, intensive care unit-acquired bloodstream infection.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7445271/v1/918106387c381ce57f8cf9e3.png"},{"id":96711419,"identity":"4e099a4d-3e0a-4a2b-93c9-92617f63967b","added_by":"auto","created_at":"2025-11-25 10:11:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2772720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7445271/v1/a34d9f2b-c030-4f8e-a806-b9444b1de862.pdf"},{"id":90802052,"identity":"1e685e60-2754-47b9-ada9-bdedaa1ce691","added_by":"auto","created_at":"2025-09-08 10:22:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1082818,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7445271/v1/5c464f5c392b8a8ee3125338.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological Trends of Bloodstream Infections and Risk Factors for MDRO Bloodstream Infections in Critically Ill Patients: An Eight-Year Single-Center Data Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eBloodstream infections (BSI) pose a significant public health challenge globally, especially in patients in Intensive Care Units (ICU). Critically ill patients, often experiencing immune dysfunction and subjected to invasive procedures such as the insertion of various intravascular catheters, are at an increased risk of developing BSI. Previous studies have shown that the incidence of BSI in critically ill patients is approximately 5%, accounting for about 20% of ICU-acquired infections(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Furthermore, BSI can progress to sepsis and septic shock, significantly increasing the mortality among critically ill patients, with ICU mortality rates for patients with BSI ranging from 35\u0026ndash;50%(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Early and appropriate empirical antimicrobial treatment is crucial in reducing mortality rates in BSI patients(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). But in recent years, with the increased ubiquity of antibiotic use, the incidence of resistant pathogens in BSI among critically ill patients has presented new trends and challenges(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), making the choice of antimicrobial therapy more limited and complex.\u003c/p\u003e\u003cp\u003eThe etiological agents of BSI in critically ill patients are constantly changing over time. An analysis involving 24,179 patients from U.S. hospitals more than a decade ago indicated that Gram-positive bacteria (GPB) such as coagulase-negative \u003cem\u003eStaphylococci\u003c/em\u003e and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e were the most common pathogens in hospital-acquired BSI(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, recent studies have shown an increasing trend of ICU-acquired BSI caused by Gram-negative bacilli, with carbapenem resistant and extended spectrum Beta-lactamase producing \u003cem\u003eEnterobacterales\u003c/em\u003e and \u003cem\u003ePseudomonas spp.\u003c/em\u003e being the most common(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The international EUROBACT cohort study also found that nearly 60% of BSI cases were caused by Gram-negative bacteria (GNB)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Moreover, the proportion of BSI caused by multidrug-resistant organisms (MDRO) is gradually increasing and is significantly associated with poor outcomes in critically ill patients(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Therefore, timely updates and understanding of the epidemiological characteristics and changes in pathogen distribution of BSI are essential for guiding clinical treatment, formulating infection control policies, and optimizing the use of antibiotics.\u003c/p\u003e\u003cp\u003eThis study aims to provide a comprehensive assessment of the epidemiological characteristics, pathogen distribution, and trends over time in BSI among critically ill patients through an eight-year epidemiological data analysis. This analysis will serve as a basis for empirical antimicrobial therapy for BSI. Additionally, this study will explore risk factors associated with BSI caused by MDRO, aiming to provide data support for formulating prevention strategies for BSI caused by MDRO.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis retrospective observational study included patients with BSI admitted to the Department of Critical Care Medicine at the Zhongda Hospital affiliated to Southeast University from January 1, 2013, to December 31, 2020. The hospital is a tertiary teaching hospital with a total of 2,499 inpatient beds, including 98 adult ICU beds. This study aimed to evaluate the epidemiological characteristics and microbiological features of BSI, as well as their trends over time; and to explore the risk factors for BSI caused by MDRO in critically ill patients. This study was approved by the Clinical Research Ethics Committee of the tertiary teaching hospital (2019ZDSYLL120-P01). Given the retrospective nature of the data analysis, the Ethics Committee approved a waiver of informed consent.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThis study included all critically ill patients diagnosed with BSI during their ICU stay and excluded patients under the age of 18. The diagnostic criteria for BSI were as follows: 1. Presence of at least one of the following signs or symptoms of infection: fever (\u0026gt;\u0026thinsp;38\u0026deg;C), chills, hypotension (systolic blood pressure\u0026thinsp;\u0026le;\u0026thinsp;90mmHg); 2. One or more positive blood cultures from blood samples collected within 48 hours after the onset of symptoms and the organism is not attributable to an infection at another site. A diagnosis of BSI was made when both criteria were met. For common commensals, a diagnosis of BSI was made only when two or more positive blood cultures were obtained on separate occasions, in accordance with CDC/NHSN surveillance definition(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData on positive blood cultures for all ICU patients during the study period were extracted from the Department of Clinical Laboratory at the tertiary teaching hospital. Adult critically ill patients meeting the diagnostic criteria for BSI were included. For patients with multiple episodes of BSI or multiple ICU admissions, only data from the first episode of BSI and the first ICU admission were included. We collected general information on included patients: age, sex, height, weight, comorbidities, timing of BSI, admission date, ICU admission and discharge dates, and hospital discharge date; severity of illness: sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores within 24 hours of ICU admission; risk factors for BSI within two weeks prior to the event: history of gastrointestinal surgery, history of transfusion, history of gastrointestinal bleeding, total parenteral nutrition, exposure to antimicrobial agents; organ failure status: presence of shock, need for mechanical ventilation, acute kidney injury (AKI), need for continuous renal replacement therapy (CRRT) on the day of BSI; infection indicators at the time of bloodstream infection: white blood cell count, hypersensitive C-reactive protein concentration, procalcitonin; presence of catheter-related bloodstream infection; early appropriate antimicrobial therapy; blood culture data: pathogens and susceptibility results; and clinical outcomes: 28-day mortality post-bloodstream infection, ICU mortality, hospital stay, ICU stay.\u003c/p\u003e\u003cp\u003eBlood samples were cultured using blood culture bottles. Positive blood culture samples were then inoculated onto blood agar plates, and the plates were incubated for 24 hours to check for bacterial growth. The identified bacteria were further characterized using Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry. Antibiotic susceptibility was tested using the broth microdilution method, following the Clinical and Laboratory Standards Institute guidelines to determine the minimum inhibitory concentration for each antibiotic(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eDefinitions of Study Variables\u003c/h3\u003e\n\u003cp\u003eThe incidence of BSI was calculated as the total number of patients with BSI during the study period divided by the total number of admissions to the ICU, expressed as a percentage. The 28-day mortality is defined as the proportion of patients who die from any cause within 28 days following the identification of BSI.\u003c/p\u003e\u003cp\u003eHospital-acquired BSI was defined as BSI occurring more than 48 hours after hospital admission, whereas ICU-acquired BSI was defined as BSI occurring more than 48 hours after ICU admission. Catheter-related BSI is defined as a laboratory-confirmed bloodstream infection in a patient who has had a central venous catheter in place for more than 48 hours before blood is drawn for culture, and no other source of bacteremia or fungemia can be identified(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor GPB, methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) and vancomycin-resistant \u003cem\u003eEnterococcus\u003c/em\u003e were defined as MDRO. For GNB, organisms resistant to at least three classes of antibiotics were defined as MDRO(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). GNB resistant to imipenem, meropenem, or ertapenem were defined as carbapenem-resistant GNB (CR-GNB). For fungi, due to the lack of susceptibility testing results, MDRO was not defined in this study.\u003c/p\u003e\u003cp\u003eShock is defined as a state of hypotension requiring vasopressor therapy to maintain a mean blood pressure of 65 mmHg or greater, despite adequate fluid resuscitation(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). AKI is defined as an increase in serum creatinine by \u0026ge;\u0026thinsp;26.5\u0026micro;mol/L within 48 hours, an increase to \u0026ge;\u0026thinsp;1.5 times baseline, or urine output\u0026thinsp;\u0026lt;\u0026thinsp;0.5 mL/kg/hour for 6 hours(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Early appropriate antimicrobial therapy was defined as the use of antimicrobial agents to which the pathogen isolated from blood cultures, taken within 24 hours of culture, was sensitive.\u003c/p\u003e\n\u003ch3\u003eStatistical Methods\u003c/h3\u003e\n\u003cp\u003eContinuous variables were described using median (interquartile range), and categorical variables were described using numbers (percentage). For missing data, we first check whether the missing data is missing at random, and then handle it using multiple imputation (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Differences between groups for continuous variables were compared using t-tests or non-parametric tests, while categorical variables were compared using chi-square tests or Fisher's exact tests. For risk factor analysis, univariate analysis was first performed based on patient grouping, and variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariate analysis were included in a multivariable logistic regression model to explore risk factors for MDRO bloodstream infections, CR-GNB bloodstream infections, and ICU mortality among BSI patients. Data analysis and graphing were performed using R (Version 4.0.5) and GraphPad (Version 9.0.2). A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eClinical Characteristics of Critically Ill Patients with BSI\u003c/h2\u003e\u003cp\u003eIn our screening of 10,249 critically ill patients admitted to the ICU during the study period, after excluding 9,294 non-BSI cases and 3 non-adult patients, a total of 955 patients with BSI were included for analysis. Among these, 249 cases were caused by GPB infections, 604 by GNB infections, 74 by fungal infections, and 28 by mixed-pathogen infections (Figure S2). Additionally, blood cultures from 29 patients were positive, with a possibility of colonizing bacteria. Among these, 22 cases were identified as \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e, 6 as other \u003cem\u003ecoagulase-negative staphylococci\u003c/em\u003e, and 1 as \u003cem\u003eAerococcus spp.\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe median age of the included patients was 65 years [IQR: 52, 78], with 616 male patients (64.5%). The most common comorbidities were hypertension (475 cases, 49.7%), followed by diabetes (269 cases, 28.2%). The median APACHE II score was 22 [IQR: 16, 28], and the SOFA score was 11 [IQR: 7, 14], with 639 cases (66.9%) experiencing shock and 531 cases (55.6%) receiving mechanical ventilation treatment. The primary risk factors for BSI were the use of broad-spectrum antibiotics (603 cases, 63.1%), followed by blood transfusion treatment (378 cases, 39.6%). Among the included patients, 596 cases (62.4%) were hospital-acquired BSI, 447 cases (46.8%) were ICU-acquired BSI, and 548 patients (57.4%) received initial empirical antimicrobial treatment that covered the pathogens. The 28-day mortality of the BSI patients was 27.9% (266 cases), and the ICU mortality rate was 26.8% (256 cases). Detailed demographic and clinical characteristics of the included patients are presented in Table\u0026nbsp;1.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIncidence and Mortality of BSI in Critically Ill Patients\u003c/h3\u003e\n\u003cp\u003eAmong ICU patients, the incidence of BSI was 9.32% (955/10249). The rate of hospital-acquired BSI was 5.82% (596/10249), ICU-acquired BSI was 4.36% (447/10249), and community-acquired BSI was 3.50% (359/10249). From 2013 to 2017, the incidence of BSI in ICU patients was 5.9% (59/996), 7.0% (51/726), 8.1% (90/1108), 10.1% (138/1362), and 11.5% (148/1282), showing an upward trend, peaking at 11.5% in 2017. From 2018 to 2020, the incidence of BSI was 9.7% (152/1570), 10.4% (175/1678), and 9.3% (142/1527), showing a slight decrease trend (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe 28-day mortality for included BSI patients was 27.9% (266/955), and the ICU mortality was 26.8% (256/955). Between 2013 and 2020, both the 28-day mortality and the ICU mortality for BSI patients showed a gradual decline. The 28-day mortality and ICU mortality for BSI patients in 2013 were 54.2% and 59.3%, respectively, which decreased to 17.6% and 12.0% by 2020, respectively (Table\u0026nbsp;1 and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;1. Demographic and Clinical Characteristics of Critically Ill Patients with Bloodstream Infections\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;955)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;148)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65[52, 78]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75[62, 82]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69[61, 80]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72[58, 79]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e64[49, 78]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63[50, 77]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62[49, 74]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e64[51, 76]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e64[52, 78]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e616 (64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (66.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (62.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95 (68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e93 (62.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95 (62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e122 (70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e80 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.323\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.7[21.5, 25.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.4[20.8, 24.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.0[20.8, 27.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.4[20.8, 24.6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.0[21.4, 25.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.5[21.2, 25.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23.7[21.7, 25.9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e23.9[21.6, 25.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e23.8[21.4, 26.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.403\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbid conditions, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42(4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7(4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4(2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.714\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203(21.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34(23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e32(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e35(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e24(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.471\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e475(49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28(55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66(47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71(48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e69(45.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e93(53.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e74(52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.864\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e269(28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25(27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33(23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40(27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46(30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e49(28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e39(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalignant tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e153(16.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22(24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21(15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22(14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30(19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e26(14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e17(12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver cirrhosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4(2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3(2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.547\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic kidney disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89(9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11(7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e23(13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e13(9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemodialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3(2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeverity of illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPACHE II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22[16, 28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20[15, 27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21[16, 26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22[17, 27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23[18, 28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25[20, 31]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21[16, 27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e19[14, 26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e20[15, 27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSOFA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11[7, 14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9[7, 12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9[5, 12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9[7, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10[7, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10[7, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12[8, 14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11[8, 15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e12[9, 16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShock, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e639(66.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(69.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70(77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83(60.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e108(80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e103(67.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e117(66.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e98(69.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanical ventilation, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e531(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43(84.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e84(60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e117(79.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e71(46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e73(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e64(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAKI, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e366(38.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(72.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48(53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47(31.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e63(36.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e45(31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRRT, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e185(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17(18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33(23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39(26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24(15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e25(14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e17(12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRBSI, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e175(18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(18.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14(10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41(27.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e34(22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e40(22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e24(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factors for BSI, n(%)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGastrointestinal surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112(11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13(14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22(14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e17(9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e18(12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.429\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParenteral nutrition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e378(39.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(60.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29(32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86(58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e60(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e52(36.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse broad spectrum antibiotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e603(63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(78.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40(78.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77(85.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e117(84.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e118(79.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e73(48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e77(44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e55(38.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGastrointestinal hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101(10.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13(14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19(13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16(9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e21(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital acquired BSI, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e596(62.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(69.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(57.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94(68.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e99(66.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e101(66.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e97(55.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e77(54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU acquired BSI, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e447(46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80(58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79(53.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e72(47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e69(39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e56(39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe time from hospital admission to BSI, Days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5[0, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7[2, 19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7[0, 15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5[0, 17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6[0, 12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5[0, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5[0, 13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3[0, 10]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3[0, 12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe time from ICU admission to BSI, Days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1[0, 8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3[0, 12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3[0, 9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0[0, 7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3[0, 8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2[0, 8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1[0, 10]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0[0, 6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0[0, 7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection parameters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.9[7.5, 18.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.4[8.5, 16.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.9[7.2, 17.4]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.0[7.4, 16.8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.2[7.2, 17.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.8[6.2, 15.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12.9[8.1, 20.2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e13.4[9.0, 20.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e12.5[6.8, 17.4]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP, mg/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138.4[75.6, 185.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109.0[60.5, 169.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100.0[65.9, 183.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e138.4[43.7, 186.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e119.0[72.1, 164.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e131.0[62.3, 177.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e138.4[90.4, 194.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e138.4[81.8, 191.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e138.4[95.3, 205.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCT, ng/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.1[0.6, 14.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.2[3.1, 10.2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2[0.9, 25.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.0[0.5, 20.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.8[0.4, 10.2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.5[0.4, 5.8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.7[0.5, 18.9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.1[0.7, 13.9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.2[1.3, 16.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAppropriate antimicrobial treatment, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e548(57.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32(62.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63(70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83(60.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e88(59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e82(53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e91(52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e79(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28-day mortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e266(27.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27(30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e49(33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39(25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e30(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e25(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU mortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e256(26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25(49.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34(37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e49(33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e22(12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e17(12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e\u003cp\u003e*Continuous variables were described using median [interquartile range], and categorical variables were described using numbers (percentage).\u003c/p\u003e\u003cp\u003e#Data on risk factors for bloodstream infection, identified within two weeks prior to the diagnosis of bloodstream infection, were collected.\u003c/p\u003e\u003cp\u003eAKI, Acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation; BMI, Body mass index; Bloodstream infection; COPD, Chronic obstructive pulmonary disease; CRBSI, Catheter-related bloodstream infection; CRRT, Continuous renal replacement therapy, CRP, C-reactive protein; ICU, Intensive care unit; PCT, Procalcitonin; SOFA, Sequential Organ Failure Assessment; WBC, White blood cell.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePathogen Distribution and Trends in BSI among Critically Ill Patients\u003c/h2\u003e\u003cp\u003eIn patients with BSI, GNB were the predominant pathogens, accounting for 63.2% (604/955) of the cases. Among these, 447 cases (46.8%) were caused by multidrug-resistant Gram-negative organisms, with CR-GNB constituting 265 cases (27.7%). The primary Gram-negative pathogens causing BSI were \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e (180 cases, 18.8%), \u003cem\u003eEscherichia coli\u003c/em\u003e (164 cases, 17.2%), and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (128 cases, 13.4%). GPB were the second most common pathogens, making up 26.1% (249/955) of BSI, with 60 cases (6.3%) being multidrug-resistant. The leading Gram-positive pathogens causing BSI were \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (85 cases, 8.9%), \u003cem\u003eEnterococcus\u003c/em\u003e (75 cases, 7.9%), and Coagulase-negative \u003cem\u003estaphylococcus\u003c/em\u003e (66 cases, 6.9%). Fungal infections accounted for 74 cases (7.7%) of all BSI. The distribution of pathogens in polymicrobial infections is presented in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. Moreover, from 2013 to 2020, there was no significant change in the distribution of pathogens causing BSI over time (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThere were no significant differences in the distribution of GPB, GNB, and fungi among hospital-acquired, ICU-acquired, and community-acquired BSI (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The proportion of multidrug-resistant GNB in community-acquired BSI (39.6%) was significantly lower than in hospital-acquired (48.7%) and ICU-acquired (53.2%) BSI (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The proportion of CR-GNB in community-acquired BSI (17.0%) was significantly lower than in hospital-acquired (32.4%) and ICU-acquired (38.5%) BSI (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the proportion of \u003cem\u003eEscherichia coli\u003c/em\u003e in community-acquired BSI (24.8%) was significantly higher than in hospital-acquired (11.6%) and ICU-acquired (8.7%) BSI (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); the proportion of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e was significantly lower in community-acquired BSI (5.0%) compared to hospital-acquired (16.9%) and ICU-acquired (21.0%) BSI (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table S2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution and Temporal Trends of Pathogens in Bloodstream Infections Among Critically Ill Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicroorganism\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;955)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;148)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGram-positive bacteria, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e249(26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26(28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42(28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41(27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e39(22.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e32(22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.812\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDRO, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13(9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e15(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2(1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaphylococcus aureus, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85(8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14(10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12(8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18(10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMRSA, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10(6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e14(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnterococcus, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75(7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17(11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e9(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.696\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVRE, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.561\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCNS, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66(6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10(11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16(11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9(6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8(5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMR-CNS, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5(3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6(3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8(5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.362\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStreptococcus, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42(4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGram-negative bacteria, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e604(63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(62.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49(54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86(62.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e88(59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100(65.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e115(65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e99(69.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.347\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDRO, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e447(46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35(38.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59(42.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63(42.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e69(45.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e94(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e67(47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCR-GNB, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e265(27.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34(24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e42(27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e56(32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e41(28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.624\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlebsiella pneumoniae, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e180(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22(15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29(19.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e40(22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e27(19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDR-Klebsiella pneumoniae, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108(11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19(12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e27(15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e16(11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCR-Klebsiella pneumoniae, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14(9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEscherichia coli, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164(17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22(15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e35(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e30(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDR-Escherichia coli, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114(11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8(5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16(10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e31(17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e20(14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCR-Escherichia coli, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.555\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcinetobacter baumannii, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128(13.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17(12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21(14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28(18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e25(14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDR-Acinetobacter baumannii, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126(13.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17(12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28(18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.463\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCR-Acinetobacter baumannii, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120(12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16(11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.558\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePseudomonas aeruginosa, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9(6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7(4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e10(7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDR-Pseudomonas aeruginosa, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8(5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.586\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCR-Pseudomonas aeruginosa, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4(2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.193\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFungus, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74(7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16(9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e9(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixed infection, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2(1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2(1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e\u003cp\u003eCNS, Coagulase negative staphylococcus; CR-GNB, Carbapenem resistant gram-negative bacteria; MDRO, Multiple Drug Resistant Organism; MRSA, Methicillin-resistant Staphylococcus aureus; MR-CNS, Methicillin-resistant coagulase-negative staphylococcus; VRE, Vancomycin-resistant enterococcus.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eRisk Factors Analysis for MDRO Bloodstream Infections in Critically Ill Patients\u003c/h2\u003e\u003cp\u003eCompared to BSI caused by non-MDRO, BSI caused by MDRO had a higher proportion of male patients, patients requiring mechanical ventilation, patients with AKI, patients who received blood transfusions, patients were exposed to antibiotics, and a higher proportion of hospital-acquired and ICU-acquired BSI. The proportion of patients receiving early appropriate antimicrobial therapy was lower in BSI caused by MDRO compared to non-MDRO. Additionally, patients with BSI caused by MDRO had significantly longer ICU stays and higher ICU mortality compared to BSI caused by non-MDRO (Table S3). Multivariate analysis identified antibiotic exposure (OR: 1.49, 95%CI: 1.05\u0026ndash;2.11) and ICU-acquired BSI (OR: 1.72, 95%CI: 1.08\u0026ndash;2.73) as independent risk factors for BSI caused by MDRO; catheter-related BSI (OR: 0.66, 95%CI: 0.45\u0026ndash;0.97) and early appropriate antimicrobial therapy (OR: 0.24, 95%CI: 0.17\u0026ndash;0.33) as independent protective factors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eRisk Factors Analysis for CR-GNB Bloodstream Infections in Critically Ill Patients\u003c/h2\u003e\u003cp\u003eCompared to BSI caused by carbapenem-sensitive GNB (CS-GNB), BSI caused by CR-GNB had a higher proportion of male patients, patients requiring mechanical ventilation and CRRT, a higher proportion of catheter-related BSI, patients who received blood transfusions, patients were exposed to antibiotics, and a higher proportion of hospital-acquired and ICU-acquired BSI. The proportion of patients with diabetes and those receiving early appropriate antimicrobial therapy was lower in BSI caused by CR-GNB compared to CS-GNB. Furthermore, patients with BSI caused by CR-GNB had longer total hospital and ICU stays and higher ICU mortality compared to BSI caused by CS-GNB (Table S4). Multivariate analysis found antibiotic exposure (OR: 1.82, 95%CI: 1.01\u0026ndash;3.28) and ICU-acquired BSI (OR: 2.22, 95%CI: 1.04\u0026ndash;4.76) as independent risk factors for BSI caused by CR-GNB, while early appropriate antimicrobial therapy (OR: 0.05, 95%CI: 0.03\u0026ndash;0.07) served as an independent protective factor (Table S5).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk Factors Associated with Bloodstream Infections Caused by Multidrug-Resistant Organisms Among Critically Ill Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdjusted OR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93 (0.69,1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.666\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbid conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.77 (0.83,3.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.72 (0.5,1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91 (0.65,1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.584\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemodialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.54 (0.21,1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeverity of illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPACHE II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0096 (0.991,1.0285)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanical ventilation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.8 (0.56,1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAKI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.26 (0.92,1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.146\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRBSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.66 (0.45,0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factors for BSI\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.03 (0.72,1.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntibiotic exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.49 (1.05,2.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital acquired BSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84 (0.54,1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU acquired BSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.72 (1.08,2.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly appropriate antimicrobial therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.24 (0.17,0.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e#Data on risk factors for bloodstream infection, identified within two weeks prior to the diagnosis of bloodstream infection, were collected.\u003c/p\u003e\u003cp\u003eAKI, Acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation II; BSI, Bloodstream infection; COPD, Chronic obstructive pulmonary disease; CRBSI, Catheter-related bloodstream infection; ICU, Intensive care unit.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRisk Factors Analysis for ICU Mortality among Critically Ill Patients with BSI\u003c/h2\u003e\u003cp\u003eUnivariate and multivariate analyses of risk factors for ICU mortality among critically ill patients with BSI identified age (OR: 1.02, 95%CI: 1.01\u0026ndash;1.03), APACHE II score (OR: 1.05, 95%CI: 1.03\u0026ndash;1.08), shock (OR: 1.65, 95%CI: 1.11\u0026ndash;2.44), AKI (OR: 1.70, 95%CI: 1.19\u0026ndash;2.42), total parenteral nutrition (OR: 2.03, 95%CI: 1.09\u0026ndash;3.75), antibiotic exposure (OR: 1.80, 95%CI: 1.19\u0026ndash;2.71), and ICU-acquired BSI (OR: 1.70, 95%CI: 1.01,2.87) as independent risk factors. Body mass index (OR: 0.93, 95%CI: 0.89\u0026ndash;0.97), catheter-related BSI (OR: 0.54, 95%CI: 0.34\u0026ndash;0.86), and early appropriate antimicrobial therapy (OR: 0.63, 95%CI: 0.44\u0026ndash;0.91) were identified as independent protective factors (Table S6 and Table S7).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study conducted a comprehensive analysis of the epidemiological characteristics, pathogen distribution, drug resistance patterns, and their temporal trends in BSI among critically ill patients. We also analyzed the risk factors associated with BSI caused by MDRO and CR-GNB. The results show that the incidence and mortality rates of BSI remain high in critically ill patients, although they exhibit a gradual decline over time. GNB are the predominant pathogens, with 74% of these being multidrug-resistant GNB and 43.8% being CR-GNB, highlighting the severity of the resistance issue. Throughout the study period, there were no significant changes in the pathogen distribution of BSI among critically ill patients. Additionally, the study identified antibiotic exposure and ICU-acquired BSI as independent risk factors for MDRO bloodstream infections. Interestingly, the early and appropriate antimicrobial treatment is associated with a reduced risk of MDRO and CR-GNB bloodstream infections, underscoring the importance of prudent antibiotic use.\u003c/p\u003e\u003cp\u003eThe peak incidence of BSI in ICU patients in 2017 could be attributed to several factors, including: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) an increase in ICU admissions, with the number of ICU admissions rising from 996 in 2013 to 1282 in 2017, leading to increased pressure on infection control; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) hospital-related factors, such as changes in infection control practices or antimicrobial stewardship strategies. Screening for the causes of this peak incidence of BSI may help provide strategies for its prevention.\u003c/p\u003e\u003cp\u003eThe 28-day mortality and ICU mortality showed a yearly declining trend among BSI patients during the study period. This may reflect improvements in BSI management in medical practice, including more precise pathogen detection, more rational antibiotic use, and more effective infection control measures(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, despite the reduction in mortality, the increasing proportion of MDRO remains a concerning issue(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The persistence of MDRO infection suggests that, despite the implementation of various interventions, significant challenges remain in controlling antibiotic resistance(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe pathogen distribution and resistance trends observed largely align with reports in the existing literature, especially the finding that GNB are the primary pathogens causing BSI in critically ill patients(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Notably, our study identified a high proportion of CR-GNB among all BSI cases, which is consistent with global reports on the increase of resistant pathogens(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, compared to studies in certain regions, our research found a higher proportion of MDRO(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), which may reflect differences in resistance patterns across geographical locations or could be related to the specific antibiotic usage patterns and infection control measures.\u003c/p\u003e\u003cp\u003eAntibiotic exposure is an independent risk factor for both MDRO and CR-GNB bloodstream infections, which is largely consistent with previous research(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Interestingly, the association between early and appropriate antimicrobial treatment and a reduced risk of MDRO and CR-GNB bloodstream infections further emphasizes the critical role of prudent antibiotic use and early, accurate pathogen identification to guide antimicrobial therapy(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe identification of catheter-related BSI as an independent protective factor against MDRO could be explained by the higher proportion of GPB observed in catheter-related BSI. Specifically, Gram-positive pathogens accounted for 40.7% of catheter-related BSI, compared to 26.1% in the overall BSI population. Notably, the multidrug resistance rates of GPB are significantly lower than those of GNB. This could contribute to catheter-related BSI being associated with a lower risk of MDRO infections.\u003c/p\u003e\u003cp\u003eInterestingly, catheter-related BSI were more common in CR-GNB infections than in CS-GNB infections. This may be due to the fact that the predominant Gram-negative pathogens in catheter-related BSI were \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (18.2%) and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (17.7%), followed by \u003cem\u003eEscherichia coli\u003c/em\u003e (4%) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (2.8%). Notably, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e showed significantly higher carbapenem resistance rates compared to Escherichia coli (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This difference in resistance patterns may explain why catheter-related BSI were more frequently observed in CR-GNB infections.\u003c/p\u003e\u003cp\u003e The findings of this study hold significant clinical implications for formulating empirical antimicrobial treatment guidelines. Especially in the context of observing a high proportion of MDRO and CR-GNB, these results underscore the necessity of considering region-specific resistance patterns when selecting empirical antibiotic treatments(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Hospitals and healthcare facilities need to regularly update antimicrobial susceptibility data and incorporate this information into the antimicrobial treatment decision-making process to ensure the efficacy and specificity of treatment regimens(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additionally, facing the ongoing threat of MDRO, the development and implementation of new antibiotics with greater specificity and lower toxicity become particularly urgent, alongside the need to strengthen education and guidance on the prudent use of existing antimicrobial agents.\u003c/p\u003e\u003cp\u003eBased on the risk factors for MDRO bloodstream infections, particularly antibiotic exposure and ICU-acquired BSI, strategies for preventing MDRO bloodstream infections in critically ill patients need appropriate adjustments and optimization. This includes reinforcing infection control measures, such as strict adherence to hand hygiene and aseptic procedures(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), optimizing the management of central venous catheters and other invasive devices(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), and implementing antibiotic stewardship programs to reduce unnecessary use of antibiotics(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Furthermore, early identification and isolation of patients carrying MDRO, as well as regular training for healthcare workers on antibiotic resistance and infection prevention, are key to reducing the incidence of MDRO bloodstream infections(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Through these comprehensive preventive measures, it is possible to effectively lower the incidence of MDRO bloodstream infections, mitigate the impact of resistance issues, and thus improve outcomes in critically ill patients.\u003c/p\u003e\u003cp\u003eThis study has some limitations. First, as a single-center study, its results may be constrained by the specific medical environment and population structure, thus potentially limiting the generalizability to other regions or hospital settings. Second, although all data were manually extracted by the researchers through the electronic medical record system, minimizing data loss and bias to the greatest extent possible, the retrospective design still carries inherent limitations, such as potential missing information and inaccuracies in records, which may affect the accurate assessment of pathogen distribution and risk factors. Therefore, future studies should consider adopting a prospective design and conducting multi-center research to enhance the generalizability and accuracy of the findings. Third, in defining multidrug-resistant GPB, this study only considered MRSA and vancomycin-resistant \u003cem\u003eEnterococcus\u003c/em\u003e, excluding other GPB that might exhibit multidrug resistance. This selective definition may lead to an underestimation of the overall resistance among GPB. Fourth, for infections caused by commensal organisms, a total of 67 blood culture-positive cases were identified as commensals, of which 29 had only one positive blood culture. These 29 cases did not align with the CDC/NHSN surveillance definition, which may have led to an overestimation of the bloodstream infection incidence rate.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBSI are common in critically ill patients, with a gradual decline in mortality over time. GNB are the most prevalent pathogens causing BSI, followed by GPB, with no significant changes in the distribution of pathogens over time. MDRO, especially multidrug-resistant GNB, predominate in BSI. Antibiotic exposure and ICU-acquired BSI are identified as independent risk factors, while early appropriate antimicrobial therapy is an independent protective factor against MDRO bloodstream infections in critically ill patients. These findings provide valuable references for clinicians in formulating empirical antimicrobial treatments and strategies for preventing MDRO bloodstream infections.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAKI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute Kidney Injury\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAPACHE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute Physiology and Chronic Health Evaluation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBSI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBloodstream Infections\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCA-BSI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCommunity Acquired Bloodstream Infection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCDC/NHSN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCenters for Disease Control and Prevention/National Healthcare Safety Network\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCR-GNB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCarbapenem-Resistant Gram-Negative Bacteria\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContinuous Renal Replacement Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGNB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGram-Negative Bacteria\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGPB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGram-Positive Bacteria\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICUA-BSI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit Acquired Bloodstream Infection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMDRO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultidrug-Resistant Organisms\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMethicillin-Resistant Staphylococcus aureus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSOFA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSequential Organ Failure Assessment.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of Zhongda Hospital (Approval No. 2019ZDSYLL120-P01). Given the retrospective nature of the data analysis, the ethics committee approved a waiver of informed consent.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis study was supported by the National Key R\u0026amp;D Program of China [grant number 2022YFC2304600 and 2023YFC3043510], the National Natural Science Foundation of China [grant number 82272235 and 82472201], the China Postdoctoral Science Foundation [grant number 2022M710685 and 2024T170133], and the Jiangsu Young Scientific and Technological Talents Promotion Project.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eQ.L conceptualized and designed the study; performed data analysis and interpretation; wrote the manuscript. LH.x contributed to the study design and analysis; helped interpret the clinical data and patient outcomes; reviewed and revised the manuscript. SS.M conducted statistical analysis and helped interpret the data. HF.W collected patient data and managed clinical data. WH.H provided valuable input on data analysis and interpretation. QY.P, C.Z, SH.Y helped with data collection and analysis. W.H and JF.X contributed to the study design, statistical analysis plan, and secondary data validation; revised the manuscript. JL.W provided critical supervision throughout the study, including methodological guidance, data interpretation, and final manuscript revision and approval. YZ.H managed the overall operation of the study, provided resources, and performed the final manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our sincere gratitude to all the medical staff in the Department of Critical Care Medicine at Zhongda Hospital, Southeast University, for their dedication and commitment to clinical work. Their adherence to standardized treatment has provided strong data support for this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKallel H, Houcke S, Resiere D, Roy M, Mayence C, Mathien C, et al. Epidemiology and Prognosis of Intensive Care Unit-Acquired Bloodstream Infection. Am J Trop Med Hyg. 2020;103(1):508\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTimsit JF, Rupp\u0026eacute; E, Barbier F, Tabah A, Bassetti M. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med. 2020;46(2):266\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdrie C, Garrouste-Orgeas M, Ibn Essaied W, Schwebel C, Darmon M, Mourvillier B, et al. Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. J Infect. 2017;74(2):131\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVall\u0026eacute;s J, Palomar M, Alv\u0026aacute;rez-Lerma F, Rello J, Blanco A, Garnacho-Montero J, et al. Evolution over a 15-year period of clinical characteristics and outcomes of critically ill patients with community-acquired bacteremia. Crit Care Med. 2013;41(1):76\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376(23):2235\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee CC, Lee CH, Yang CY, Hsieh CC, Tang HJ, Ko WC. Beneficial effects of early empirical administration of appropriate antimicrobials on survival and defervescence in adults with community-onset bacteremia. Crit Care (London England). 2019;23(1):363.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKern WV, Rieg S. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol infection: official publication Eur Soc Clin Microbiol Infect Dis. 2020;26(2):151\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect diseases: official publication Infect Dis Soc Am. 2004;39(3):309\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmanati A, Sajedianfard S, Khajeh S, Ghasempour S, Mehrangiz S, Nematolahi S, et al. Bloodstream infections in adult patients with malignancy, epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance. BMC Infect Dis. 2021;21(1):636.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSch\u0026ouml;neweck F, Schmitz RPH, Ri\u0026szlig;ner F, Scherag A, L\u0026ouml;ffler B, Pletz MW, et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study (AlertsNet). Antimicrob Resist Infect Control. 2021;10(1):132.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med. 2012;38(12):1930\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, et al. Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med. 2015;41(5):776\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapadimitriou-Olivgeris M, Fligou F, Bartzavali C, Zotou A, Spyropoulou A, Koutsileou K, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients: risk factors and predictors of mortality. Eur J Clin Microbiol Infect Dis. 2017;36(7):1125\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStewardson AJ, Marimuthu K, Sengupta S, Allignol A, El-Bouseary M, Carvalho MJ, et al. Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study. Lancet Infect Dis. 2019;19(6):601\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoran TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGouel-Cheron A, Swihart BJ, Warner S, Mathew L, Strich JR, Mancera A, et al. Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals. Crit Care Med. 2022;50(12):1725\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeinstein MP, Lewis JS 2. The Clinical and Laboratory Standards Institute Subcommittee on Antimicrobial Susceptibility Testing: Background, Organization, Functions, and Processes. J Clin Microbiol. 2020;58(3):e01864\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. N Engl J Med. 2023;389(12):1121\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFriedman ND, Levit D, Taleb E, Marcus G, Michaeli L, Broide M, et al. Towards a Definition for Health Care-Associated Infection. Open Forum Infect Dis. 2018;5(6):ofy116.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Critical care (London, England). 2013;17(1):204.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuetti N, Timsit JF. Management and Prevention of Central Venous Catheter-Related Infections in the ICU. Semin Respir Crit Care Med. 2019;40(4):508\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Laroche M, Fellous L, Salomon E, Saadeh D, Duran C, Bouchand F, et al. Bloodstream infections in older population: epidemiology, outcome, and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis. 2021;40(8):1665\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePace E, Bracco C, Magnino C, Badinella Martini M, Serraino C, Brignone C, et al. Multidrug-Resistant Bloodstream Infections in Internal Medicine: Results from a Single-Center Study. South Med J. 2022;115(5):333\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnaya-Baz B, Maldonado N, Palacios-Baena ZR, Palomo V, Pezzani MD, Chiesi S, et al. Systematic literature review of the burden and outcomes of infections due to multidrug-resistant organisms in Europe: the ABOUT-MDRO project protocol. BMJ open. 2020;10(5):e030608.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe Y, Xu J, Shang X, Fang X, Gao C, Sun D, et al. Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study. Front Cell Infect Microbiol. 2022;12:962470.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarduno A, Mart\u0026iacute;n-Loeches I. Efficacy and appropriateness of novel antibiotics in response to antimicrobial-resistant gram-negative bacteria in patients with sepsis in the ICU. Expert Rev anti-infective therapy. 2022;20(4):513\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMontrucchio G, Costamagna A, Pierani T, Petitti A, Sales G, Pivetta E, et al. Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score. Pathogens. 2022;11(7):718.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S. Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital. J Intensive Care Med. 2022;37(4):565\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShendi AM, Wallis G, Painter H, Harber M, Collier S. Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single-center experience. Transpl Infect Dis. 2018;20(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCekin ZK, Oncul A, Bayraktar B. Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality. Sisli Etfal Hastan Tip Bul. 2023;57(3):416\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, et al. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018;42(1):5\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu S, Huang G, de St Maurice A, Lehman D, Graber CJ, Goetz MB et al. The Impact of Rapid Species Identification on Management of Bloodstream Infections: What's in a Name? Mayo Clinic proceedings. 2020;95(11):2509-24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHansen S, Schwab F, Zingg W, Gastmeier P. Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 - Results of the PROHIBIT study. Euro Surveill. 2018;23(21):1700513.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurnham JP, Rojek RP, Kollef MH. Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection. Med (Baltim). 2018;97(42):e12782.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbuTaha SA, Al-Kharraz T, Belkebir S, Abu Taha A, Zyoud SH. Patterns of microbial resistance in bloodstream infections of hemodialysis patients: a cross-sectional study from Palestine. Sci Rep. 2022;12(1):18003.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIordanou S, Palazis L, Timiliotou-Matsentidou C, Mendris M, Raftopoulos V. When Multidrug-Resistant Organism (MDRO)-Positive ICU Patient Isolation and Cohorting Is Not Feasible. What Comes Next? Cureus. 2021;13(3):e13636.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bloodstream Infections, Critical care, Epidemiology, Multidrug-Resistant Organisms, Risk Factors","lastPublishedDoi":"10.21203/rs.3.rs-7445271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7445271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The epidemiological characteristics, pathogen distribution, drug resistance patterns, and their temporal trends in bloodstream infections (BSI), along with the risk factors for BSI caused by multidrug-resistant organisms (MDRO) in critically ill patients, remain unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This single-center retrospective observational study included adult patients with BSI admitted to the Intensive Care Unit (ICU) from January 2013 to December 2020. Clinical data were collected through the hospital’s electronic medical record system. We analyzed the incidence and mortality rates of BSI, the distribution of pathogens and resistance patterns, and their temporal trends in critically ill patients. Risk factors for BSI caused by MDRO were also analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e BSI had a 9.32% (955/10249) incidence. The 28-day and ICU mortality rates were 27.9% (266/955) and 26.8% (256/955), respectively, both showing a gradual declining trend. Gram-negative bacteria (GNB) were the predominant pathogens (63.2%, 604/955), followed by Gram-positive bacteria (GPB) (26.1%, 249/955). The distribution of pathogens did not show significant changes over time. Antibiotic exposure (Odds Ratio [OR]: 1.49, 95% Confidence Interval [CI]: 1.05-2.11) and ICU-acquired BSI (OR: 1.72, 95%CI: 1.08-2.73) were independent risk factors, and catheter-related BSI (OR: 0.66, 95%CI: 0.45-0.97) and early appropriate antimicrobial therapy (OR: 0.24, 95%CI: 0.17-0.33) were independent protective factors for BSI caused by MDRO.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e BSI in critically ill patients has high incidence and mortality rates, primarily caused by GNB and with no significant temporal change. Antibiotic exposure and ICU-acquired BSI are linked to an increased risk, while catheter-related BSI and early appropriate antimicrobial therapy are associated with a reduced risk of BSI caused by MDRO.\u003c/p\u003e","manuscriptTitle":"Epidemiological Trends of Bloodstream Infections and Risk Factors for MDRO Bloodstream Infections in Critically Ill Patients: An Eight-Year Single-Center Data Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-08 10:14:51","doi":"10.21203/rs.3.rs-7445271/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec7cf04b-b043-4ec2-a6e3-02300137e988","owner":[],"postedDate":"September 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T06:38:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-08 10:14:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7445271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7445271","identity":"rs-7445271","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}