Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study
Objective To describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-03-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/3/e094861.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850233760382976000 |
|---|---|
| author | Jing Wang Carlos Morales Dean Follmann John H Powers Alexander C Vostal Melissa Grance Sameer S Kadri Sarah Warner Uzo Chukwuma Charlotte Lanteri M Leigh Carson Beth Poitras Nicholas Seliga Edward Parmelee Katrin Mende |
| author_facet | Jing Wang Carlos Morales Dean Follmann John H Powers Alexander C Vostal Melissa Grance Sameer S Kadri Sarah Warner Uzo Chukwuma Charlotte Lanteri M Leigh Carson Beth Poitras Nicholas Seliga Edward Parmelee Katrin Mende |
| author_sort | Jing Wang |
| collection | DOAJ |
| description | Objective To describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up.Design Retrospective cohort study.Setting Clinical and demographic data collected from the MHS Data Repository and collated with microbiological data obtained from the Defense Centers for Public Health-Portsmouth.Participants: 12 748 MHS beneficiaries diagnosed with 15 357 bacterial BSIs (2010–2019).Main outcome(s) and measure(s) Demographic data and diagnosis codes preceding BSI episodes and during hospitalisations were collected. Inpatient admission data identified acute clinical diagnoses, intensive care unit (ICU) admission and mortality. BSI pathogens were evaluated for AMR, including difficult-to-treat resistance (DTR). Crude mortality trends were assessed.Results The decade analysed included 15 357 BSI episodes in 12 748 patients; 6216 patients (48.8%) were≥65 years and 83.7% of episodes had≥1 comorbidity (12 856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and∼34% had concurrent urinary tract infections. Pathogen distribution was 53% and 47% for Gram-positive bacteria and Gram-negative bacilli (GNB), respectively. Inpatient mortality was 4.4%, and at 1 year was 23.4%; 0.5% (16 of 2977) of deaths were associated with DTR GNB. Among an average 8 145 778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp and DTR GNB BSI were 18.9, 1.30, 0.25 and 0.05 per 100 000 beneficiaries, respectively. Over the decade, annual mortality did not significantly increase for any pathogen and decreased by∼2% for overall BSI (p=0.024) and∼3% for lactose-fermenting GNB BSI (p=0.048).Conclusions In the global US MHS, the mortality burden associated with BSI was substantial (approximately one in four dying at 1 year), relatively unchanged over a decade, and associated with older age and comorbidities. First-line treatment options remained available for 99.7% of BSIs. Population-level improvements in BSI survival might be maximally influenced by focusing on prevention, early detection, prompt antibiotics and other novel therapies not contingent on in vitro activity. |
| format | Article |
| id | doaj-art-3b26ac7be24b4a96917cb4bf07bb5dc7 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-3b26ac7be24b4a96917cb4bf07bb5dc72025-08-20T02:02:51ZengBMJ Publishing GroupBMJ Open2044-60552025-03-0115310.1136/bmjopen-2024-094861Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort studyJing Wang0Carlos Morales1Dean Follmann2John H Powers3Alexander C Vostal4Melissa Grance5Sameer S Kadri6Sarah Warner7Uzo Chukwuma8Charlotte Lanteri9M Leigh Carson10Beth Poitras11Nicholas Seliga12Edward Parmelee13Katrin Mende1411 Clinical Monitoring Research Program Directorate, National Cancer Institute Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA10 Office of Biostatistics Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA4 Clinical Research Directorate, National Cancer Institute Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA1 Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA5 Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA6 Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, Maryland, USA8 Defense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA8 Defense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA8 Defense Centers for Public Health-Portsmouth, Portsmouth, Virginia, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USAObjective To describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up.Design Retrospective cohort study.Setting Clinical and demographic data collected from the MHS Data Repository and collated with microbiological data obtained from the Defense Centers for Public Health-Portsmouth.Participants: 12 748 MHS beneficiaries diagnosed with 15 357 bacterial BSIs (2010–2019).Main outcome(s) and measure(s) Demographic data and diagnosis codes preceding BSI episodes and during hospitalisations were collected. Inpatient admission data identified acute clinical diagnoses, intensive care unit (ICU) admission and mortality. BSI pathogens were evaluated for AMR, including difficult-to-treat resistance (DTR). Crude mortality trends were assessed.Results The decade analysed included 15 357 BSI episodes in 12 748 patients; 6216 patients (48.8%) were≥65 years and 83.7% of episodes had≥1 comorbidity (12 856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and∼34% had concurrent urinary tract infections. Pathogen distribution was 53% and 47% for Gram-positive bacteria and Gram-negative bacilli (GNB), respectively. Inpatient mortality was 4.4%, and at 1 year was 23.4%; 0.5% (16 of 2977) of deaths were associated with DTR GNB. Among an average 8 145 778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp and DTR GNB BSI were 18.9, 1.30, 0.25 and 0.05 per 100 000 beneficiaries, respectively. Over the decade, annual mortality did not significantly increase for any pathogen and decreased by∼2% for overall BSI (p=0.024) and∼3% for lactose-fermenting GNB BSI (p=0.048).Conclusions In the global US MHS, the mortality burden associated with BSI was substantial (approximately one in four dying at 1 year), relatively unchanged over a decade, and associated with older age and comorbidities. First-line treatment options remained available for 99.7% of BSIs. Population-level improvements in BSI survival might be maximally influenced by focusing on prevention, early detection, prompt antibiotics and other novel therapies not contingent on in vitro activity.https://bmjopen.bmj.com/content/15/3/e094861.full |
| spellingShingle | Jing Wang Carlos Morales Dean Follmann John H Powers Alexander C Vostal Melissa Grance Sameer S Kadri Sarah Warner Uzo Chukwuma Charlotte Lanteri M Leigh Carson Beth Poitras Nicholas Seliga Edward Parmelee Katrin Mende Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study BMJ Open |
| title | Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study |
| title_full | Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study |
| title_fullStr | Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study |
| title_full_unstemmed | Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study |
| title_short | Demographics, epidemiology, mortality and difficult-to-treat resistance patterns of bacterial bloodstream infections in the global US Military Health System from 2010 to 2019: a retrospective cohort study |
| title_sort | demographics epidemiology mortality and difficult to treat resistance patterns of bacterial bloodstream infections in the global us military health system from 2010 to 2019 a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/15/3/e094861.full |
| work_keys_str_mv | AT jingwang demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT carlosmorales demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT deanfollmann demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT johnhpowers demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT alexandercvostal demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT melissagrance demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT sameerskadri demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT sarahwarner demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT uzochukwuma demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT charlottelanteri demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT mleighcarson demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT bethpoitras demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT nicholasseliga demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT edwardparmelee demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy AT katrinmende demographicsepidemiologymortalityanddifficulttotreatresistancepatternsofbacterialbloodstreaminfectionsintheglobalusmilitaryhealthsystemfrom2010to2019aretrospectivecohortstudy |