To quantify the global and regional burden of bloodstream infections associated with and attributable to carbapenem-resistant Gram-negative bacteria. We extracted data from the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation database, which includes the estimated burden of 23 pathogens and 88 pathogen-drug combinations across 12 major infectious syndromes globally in 2019. The number and rate of deaths, as well as disability-adjusted life-years linked to bloodstream infections, were systematically analyzed. In 2019, bloodstream infections accounted for approximately 2.91 (95% UI, 1.74-4.53) million deaths globally, with Gram-negative bacteria responsible for 51.1% of these fatalities. An estimated 391,800 (95% UI 221,500-631,400) deaths were associated with carbapenem resistance, constituting 26.3% of all bloodstream infection-related deaths. The highest burden of carbapenem resistance was seen in South Asia, East Asia, and Eastern Europe, while the lowest burden was in Sub-Saharan Africa. Notably, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the leading carbapenem-resistant pathogens contributing to mortality. Our findings underscore the significant global burden of bloodstream infections caused by carbapenem-resistant Gram-negative bacteria, with notable regional disparities. There is an urgent need for enhanced surveillance, improved infection prevention and control measures, and better access to first-line antibiotics, particularly in high-burden regions.

Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27–1.83, p = 0.486), clinical cure (OR, 1.09, 95% CI 0.48–2.54, p = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39–2.53, p = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36–1.99, p = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant K. pneumoniae and A. baumannii.

Introduction Stenotrophomonas maltophilia is an opportunistic pathogen associated with various nosocomial infections and is known for its intrinsic multidrug resistance. This study aims to provide a comprehensive overview of the epidemiology and resistance patterns of S. maltophilia in China from 2014 to 2021. Methods Data were extracted from the China Antimicrobial Resistance Surveillance System (CARSS) and the Blood Bacterial Resistance Investigation Collaborative System (BRICS), encompassing 1412 medical institutions across 31 provinces in China. We analyzed the prevalence of S. maltophilia in clinical isolates, focusing on specific patient populations and departments, as well as resistance profiles to recommended first-line antibiotics, including sulfamethoxazole-trimethoprim, levofloxacin, and minocycline. Results A total of 514,768 S. maltophilia strains were analyzed. The overall prevalence of S. maltophilia among all clinical bacterial isolates remained stable at approximately 2.1%, with higher rates observed in intensive care units and elderly patients. Resistance rates to sulfamethoxazole-trimethoprim decreased from 9.8% in 2014 to 7.5% in 2021. In contrast, resistance to levofloxacin showed a slight upward trend, increasing from 8.5% in 2014 to 9.5% in 2021. Meanwhile, minocycline resistance remained low, fluctuating marginally from 2.7% in 2014 to 1.7% in 2021. Conclusions This study highlights the stable prevalence of S. maltophilia in clinical settings in China and the overall low resistance rates to recommended first-line antibiotics. However, alarmingly high resistance rates were observed in specific specimen types, particularly in blood cultures, suggesting that minocycline may be the only reliable therapeutic option among the six tested antibiotics for treating such infections in China. Continuous surveillance and effective infection control measures are essential to manage S. maltophilia infections, particularly in vulnerable populations. Future research should focus on measuring the true burden of these infections and monitoring the susceptibility of the newly introduced antibiotics, such as cefiderocol.

Purpose: This study aimed to assess and predict the global and regional burden of candidemia. Methods: We extracted data on the estimated burden of candidemia from 1990 to 2021 from the MICROBE database. The number of deaths, age-standardized mortality of rate(ASMR) and disability-adjusted life-years(DALYs) associated with candidemia, were systematically analyzed. The burden of candidemia over the next 30 years was predicted using the Bayesian age-period-cohort model with integrated nested Laplace approximations. Results: In 2021, candidemia accounted for approximately 174,716 deaths(95% UI, 159,876–189,556) globally, with an ASMR of 2.28 (95% UI, 2.06–2.50) per 100k population. The highest burden of candidemia was observed in Southern, Western, and Eastern Sub-Saharan Africa, while the lowest burden occurred in High-income Asia Pacific, Australasia, and Western Europe. Males and older adults exhibited a higher disease burden, while the under-5 age group also demonstrated a substantial burden. Projections indicated that the mortality rate of candidemia was expected to decline to 1.72 per 100k(95% UI: 1.45–2.00) by 2050. Conclusions: Our findings underscore the significant global burden of candidemia, with notable regional disparities. Addressing this burden requires enhanced surveillance, robust antifungal stewardship programs, targeted interventions for high-risk populations, and improved diagnostic and therapeutic capabilities to mitigate the impact of antifungal resistance and reduce mortality.