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Life sciences · Journal article
Frontiers in Cellular and Infection Microbiology · August 31, 2026
Well-designed and adequately powered for the question it asks.
This single-centre retrospective cohort of 2027 bloodstream gram-negative bacilli isolates over 11 years found that difficult-to-treat resistance (DTR)—not changing organism prevalence—independently predicted 30-day in-hospital mortality after adjustment for age, comorbidity, and clinical factors. The association was consistent across Enterobacterales and non-fermenting GNB, with a dose–response pattern as active first-line therapeutic options declined.
Retrospective cohort study. Hospitalized patients aged 12 years or older with blood cultures positive for Enterobacterales or non-fermenting gram-negative bacilli at a 500-bed tertiary hospital in Southern Saudi Arabia.. Intervention: Difficult-to-treat resistance (DTR) phenotype and carbapenem resistance status in gram-negative bloodstream isolates.. Compared with: Non-DTR isolates; graded comparison by number of retained active first-line agents.. n = 2,027. Single centre: 500-bed tertiary hospital in Southern Saudi Arabia..
Among 2027 isolate-episodes, 73.4% were Enterobacterales and 26.6% were non-fermenting GNB; Klebsiella pneumoniae was dominant at 37.6% and increased at 4.8% average annual percentage change. Carbapenem resistance reached 46.9% and DTR reached 36.0%, with sharpest increases among Enterobacterales. Overall 30-day in-hospital mortality was 36.5%.
No absolute risk difference or number needed to harm reported for DTR effect on mortality. Overall 30-day in-hospital mortality was 36.5%.
This study supports resistance phenotype-based surveillance and stewardship targeting DTR in gram-negative bloodstream infections, as DTR—independent of organism species—is strongly associated with worse clinical outcomes. Clinicians and infection prevention teams should prioritize detection and containment of DTR strains and therapeutic strategies to preserve active agent options.
Rigorous retrospective cohort study with large sample, multivariate adjustment, and hard clinical outcome (30-day mortality) directly linked to a well-defined resistance phenotype across two major gram-negative pathogen classes.
As stated by the source record.
Quoted from the source exactly as published.
This study supports resistance phenotype-based surveillance and stewardship targeting DTR in gram-negative bloodstream infections, as DTR—independent of organism species—is strongly associated with worse clinical outcomes. Clinicians and infection prevention teams should prioritize detection and containment of DTR strains and therapeutic strategies to preserve active agent options.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Introduction Antimicrobial resistance among bloodstream gram-negative bacilli is a major driver of infectious-disease mortality, yet broad resistance labels can obscure clinically important heterogeneity. We aimed to characterise long-term organism and resistance trends, including difficult-to-treat resistance (DTR), among bloodstream gram-negative bacilli and to estimate their association with 30-day in-hospital mortality. Methods We conducted a retrospective cohort study of hospitalized patients aged 12 years or older with blood cultures yielding Enterobacterales or non-fermenting gram-negative bacilli (GNB) at a 500-bed tertiary hospital in Southern Saudi Arabia from 1 January 2013 to 27 August 2024. Duplicates within 14 days were excluded; trends were analyzed with segmented binomial regression and mortality with modified Poisson regression adjusted for age, sex, intensive-care status, infection source, healthcare-associated infection, COVID-19 era, calendar year and Elixhauser comorbidity score. Results Among 2027 isolate-episodes from 1695 patients, 1487 (73.4%) were Enterobacterales and 540 (26.6%) non-fermenting GNB. The organism mix was broadly stable, but Klebsiella pneumoniae was dominant (37.6%) and increased (average annual percentage change (AAPC) +4.8%). Fluoroquinolone and extended-spectrum cephalosporin resistance declined among Enterobacterales, whereas carbapenem resistance (46.9%) and DTR (36.0%) rose, most sharply among Enterobacterales. Thirty-day in-hospital mortality was 36.5%. DTR was independently associated with higher mortality among Enterobacterales (adjusted risk ratio 1.35; 95% CI 1.15 to 1.59) and non-fermenting GNB (1.31; 1.09 to 1.57), with a graded increase as active first-line agents were lost. Discussion In this surveillance cohort, escalating carbapenem resistance and DTR, rather than a shifting organism mix, were associated with worse outcomes, supporting surveillance based on treatment-option phenotypes and prioritization of stewardship and infection-prevention efforts against high-risk GNB.
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