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Mortality risk factors and fulminant sub-phenotype in anaerobic bacteremia: a 10-year retrospective, multicenter, observational cohort study

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

During the last decade, the incidence of anaerobic bacteremia (AB) has been increasing. Patients with AB may develop complex underlying diseases, which can occasionally be accompanied by fatal or fulminant outcomes. However, the risk factors for AB-related mortality remain unclear. Herein, we sought to elucidate the risk factors for AB-related mortality.

Methods

In this multicenter, retrospective, observational study, we enrolled patients with culture-proven AB from six tertiary hospitals in Japan, between January 2012 and December 2021. Data on patient and infection characteristics, laboratory findings, treatment, and outcome were collected, and their associations with mortality were analyzed.

Results

A total of 520 participants were included. The 30-day mortality in the study cohort was 14.0% (73 patients), and malignant tumors were frequently observed comorbidities in 48% of the entire cohort. Multivariable logistic regression analysis showed a Charlson comorbidity score of > 6, serum creatinine level of > 1.17 mg/dL, and hypotension to be independent risk factors for 30-day mortality in AB (odds ratios [ORs] 2.12, 2.25, and 5.12, respectively; p < 0.05), whereas drainage significantly reduced this risk (OR, 0.28; p < 0.0001). Twelve patients (2.3% of the whole cohort and 16.4% of the deceased patients) presented with extremely rapid progression leading to fatal outcome, consistent with “fulminant AB.”

Conclusions

This study identified acute circulatory dysfunction and performance of drainage as independent predictive factors for 30-day AB-related mortality and revealed the existence of a fulminant AB sub-phenotype. Our findings could serve as a practical guide to predict the clinical outcomes of AB.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Gajdács M, Urbán E (2020) Relevance of anaerobic bacteremia in adult patients: a never-ending story? Eur J Microbiol Immunol 10(2):64–75

    Article  Google Scholar 

  2. Brook I (2012) Anaerobic bacteria in upper respiratory tract and head and neck infections: microbiology and treatment. Anaerobe 18(2):214–220

    Article  PubMed  Google Scholar 

  3. Bouza E, Reig M, Garcia de la Torre M, Rodríguez-Créixems M, Romero J, Cercenado E et al (1985) Retrospective analysis of two hundred and twelve cases of bacteremia due to anaerobic microorganisms. Eur J Clin Microbiol 4(3):262–267

    Article  CAS  PubMed  Google Scholar 

  4. Brook I (2010) The role of anaerobic bacteria in bacteremia. Anaerobe 16(3):183–189

    Article  CAS  PubMed  Google Scholar 

  5. Urbán E (2012) Five-year retrospective epidemiological survey of anaerobic bacteraemia in a university hospital and review of the literature. Eur J Microbiol Immunol 2(2):140–147

    Article  Google Scholar 

  6. Lassmann B, Gustafson DR, Wood CM, Rosenblatt JE (2007) Reemergence of anaerobic bacteremia. Clin Infect Dis 44(7):895–900

    Article  PubMed  Google Scholar 

  7. Zouggari Y, Lelubre C, Lali SE, Cherifi S (2022) Epidemiology and outcome of anaerobic bacteremia in a tertiary hospital. Eur J Intern Med 105:63–68

    Article  PubMed  Google Scholar 

  8. Vena A, Muñoz P, Alcalá L, Fernandez-Cruz A, Sanchez C, Valerio M et al (2015) Are incidence and epidemiology of anaerobic bacteremia really changing? Eur J Clin Microbiol Infect Dis 34(8):1621–1629

    Article  CAS  PubMed  Google Scholar 

  9. Cobo F, Aliaga L, Expósito-Ruiz M, Navarro-Marí JM (2020) Anaerobic bacteraemia: a score predicting mortality. Anaerobe 64:102219

    Article  CAS  PubMed  Google Scholar 

  10. Blairon L, De Gheldre Y, Delaere B, Sonet A, Bosly A, Glupczynski Y (2006) A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital. Clin Microbiol Infect 12(6):527–532

    Article  CAS  PubMed  Google Scholar 

  11. Umemura T, Hamada Y, Yamagishi Y, Suematsu H, Mikamo H (2016) Clinical characteristics associated with mortality of patients with anaerobic bacteremia. Anaerobe 39:45–50

    Article  PubMed  Google Scholar 

  12. Kovács K, Nyul A, Lutz Z, Mestyán G, Gajdács M, Urbán E et al (2022) Incidence and clinical characteristics of anaerobic bacteremia at a University Hospital in Hungary: a 5-year retrospective observational study. Antibiotics (Basel) 11(10):1326

    Article  PubMed  Google Scholar 

  13. Tan TY, Ng LS, Kwang LL, Rao S, Eng LC (2017) Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital. Anaerobe 43:69–74

    Article  PubMed  Google Scholar 

  14. Goldstein EJ (1996) Anaerobic bacteremia. Clin Infect Dis 23(Suppl 1):S97-101

    Article  PubMed  Google Scholar 

  15. Giamarellou H (2000) Anaerobic infection therapy. Int J Antimicrob Agents 16(3):341–346

    Article  CAS  PubMed  Google Scholar 

  16. Suzaki A, Hayakawa S (2023) Clinical and microbiological features of fulminant Haemolysis caused by Clostridium perfringens bacteraemia: unknown pathogenesis. Microorganisms 11(4):824

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Suzaki A, Ohtani K, Komine-Aizawa S, Matsumoto A, Kamiya S, Hayakawa S (2021) Pathogenic characterization of Clostridium perfringens strains isolated from patients with massive intravascular hemolysis. Front Microbiol 12:713509

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mirza NN, McCloud JM, Cheetham MJ (2009) Clostridium septicum sepsis and colorectal cancer - a reminder. World J Surg Oncol 7:73

    Article  PubMed  PubMed Central  Google Scholar 

  19. King M, Hurley H, Davidson KR, Dempsey EC, Barron MA, Chan ED et al (2020) The link between Fusobacteria and colon cancer: a fulminant example and review of the evidence. Immune Netw 20(4):e30

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tsai YT, Lee KM, Lu PL, Hsieh MH, Chen TC, Chen YH et al (2021) First case report of Anaerobiospirillum succiniciproducens bacteremia in an HIV-infected patient in Taiwan - Molecular identification from a positive blood culture bottle. Anaerobe 69:102327

    Article  CAS  PubMed  Google Scholar 

  21. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682

    Article  PubMed  Google Scholar 

  22. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286(14):1754–1758

    Article  CAS  PubMed  Google Scholar 

  24. Stabler S, Titécat M, Duployez C, Wallet F, Loïez C, Bortolotti P et al (2020) Clinical relevance of Clostridium bacteremia: an 8-year retrospective study. Anaerobe 63:102202

    Article  CAS  PubMed  Google Scholar 

  25. Gillet Y, Henry T, Vandenesch F (2018) Fulminant staphylococcal infections. Microbiol Spectr 6(5). https://doi.org/10.1128/microbiolspec.GPP3-0036-2018

  26. Chuang YY, Huang YC, Lin TY (2005) Toxic shock syndrome in children: epidemiology, pathogenesis, and management. Paediatr Drugs 7(1):11–25

    Article  PubMed  Google Scholar 

  27. Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM, Englender SJ (1993) The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. JAMA 269(3):384–389

    Article  CAS  PubMed  Google Scholar 

  28. Kumamoto KS, Vukich DJ (1998) Clinical infections of Vibrio vulnificus: a case report and review of the literature. J Emerg Med 16(1):61–66

    Article  CAS  PubMed  Google Scholar 

  29. Bisharat N, Omari H, Lavi I, Raz R (2001) Risk of infection and death among post-splenectomy patients. J Infect 43(3):182–186

    Article  CAS  PubMed  Google Scholar 

  30. Storm JC, Ford BA, Streit JA (2013) Myocardial infection due to Fusobacterium nucleatum. Diagn Microbiol Infect Dis 77(4):373–375

    Article  PubMed  Google Scholar 

  31. Akagi Fukushima E, Bhargava A (2021) Unusual case of necrotizing pneumonia caused by Fusobacterium nucleatum complicating influenza a virus infection. Anaerobe 69:102342

    Article  CAS  PubMed  Google Scholar 

  32. Esaiassen E, Hjerde E, Cavanagh JP, Simonsen GS, Klingenberg C, Norwegian Study Group on Invasive Bifidobacterial Infections (2017) Bifidobacterium bacteremia: clinical characteristics and a genomic approach to assess pathogenicity. J Clin Microbiol 55(7):2234–2248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Boman J, Nilson B, Sunnerhagen T, Rasmussen M (2022) True infection or contamination in patients with positive Cutibacterium blood cultures-a retrospective cohort study. Eur J Clin Microbiol Infect Dis 41(7):1029–1037

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kullar R, Goldstein EJC, Johnson S, McFarland LV (2023) Lactobacillus bacteremia and probiotics: a review. Microorganisms 11(4):896

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Tanaka Kaori, Division of Anaerobe Research, Life Science Research Center, Gifu University, Gifu, Japan, for her help on classification of anaerobes.

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Authors and Affiliations

  1. Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan

    Kentaro Nagaoka, Y. Takegoshi, Y. Murai, H. Kawasuji & Y. Yamamoto

  2. Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan

    N. Iwanaga, T. Takazono & H. Mukae

  3. Department of Infection Control, Toyama Nishi General Hospital, Toyama, Japan

    M. Miura

  4. Department of Infection Control, Kamiichi General Hospital, Toyama, Japan

    Y. Sato

  5. Department of Infection Control, Takaoka City Hospital, Toyama, Japan

    Y. Hatakeyama & H. Ito

  6. Department of Infection Control, Toyama City Hospital, Toyama, Japan

    Y. Kato, N. Shibayama, Y. Terasaki & T. Fujimura

  7. Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan

    K. Kosai & K. Yanagihara

  8. Center for Clinical Research, Toyama University Hospital, Toyama, Japan

    A. Sugano

  9. Department of Microbiology, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan

    Y. Morinaga

Authors
  1. Kentaro Nagaoka
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  2. N. Iwanaga
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  3. Y. Takegoshi
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  4. Y. Murai
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Contributions

Conceptualization, Nagaoka. K. and Yamamoto. Y.; methodology, Nagaoka. K.; software, Nagaoka. K.; validation, Nagaoka. K. and Iwanaga. N.; formal analysis, Nagaoka. K with support from Sugano A.; investigation, Nagaoka K., Iwanaga N, Takegoshi Y, Murai Y, Kawasuji H, Miura M, Sato Y, Hatakeyama Y, Kato Y, Shibayama N, Kosai K.; resources, Nagaoka K. and Yamamoto Y.; data curation, Nagaoka K. and Iwanaga N.; writing—original draft preparation, Nagaoka K.; writing—review and editing, Nagaoka K., Sugano A., Morinaga Y. and Yamamoto Y.; visualization, Nagaoka K.; supervision, Morinaga Y. and Yamamoto Y.; project administration, Miura M., Sato Y., Ito H., Terasaki T., Fujimura T., Takazono T., Yanagihara K., Mukae H., and Yamamoto Y. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Kentaro Nagaoka.

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Ethics approval

This study had been approved by the Ethical Review Board of the University of Toyama (R2022085), and written informed consent was waived owing to the nature of the study design.

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The authors declare no competing interests. All authors have submitted the ICMJE form for Disclosure of Potential Conflicts of Interest.

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Nagaoka, K., Iwanaga, N., Takegoshi, Y. et al. Mortality risk factors and fulminant sub-phenotype in anaerobic bacteremia: a 10-year retrospective, multicenter, observational cohort study. Eur J Clin Microbiol Infect Dis 43, 459–467 (2024). https://doi.org/10.1007/s10096-023-04743-1

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