{'fraction_non_alphanumeric': 0.04670912951167728, 'fraction_numerical': 0.0589171974522293, 'mean_word_length': 5.100323624595469, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Changing epidemiology and decreased mortality associated with Carbapenem-resistant Gram-negative bacteria from 2000 - 2017.

BACKGROUND
Carbapenem-resistant Gram-negative bacteria (CRGNB) continue to present a global healthcare crisis. We aimed to identify emerging trends of CRGNB over nearly two decades and describe the impact of CRGNB on patient outcomes.


MATERIALS/METHODS
Patients from whom CRGNB were isolated between 2000 and 2017 were included in the study. Carbapenem resistance was defined by the most recent breakpoints and applied across the study period. Patient demographics, clinical characteristics, and outcomes were retrieved from the electronic health record.


RESULTS
94,888 isolates from 64,422 patients were identified; 9,882 (10%) isolates from 4,038 patients were carbapenem-resistant. Pseudomonas aeruginosa was the most common CRGNB each year. The second most common CRGNB emerged in waves over time. Carbapenem daily defined doses increased in parallel with CRGNB rates (R 2=0.8131). Overall 30-day mortality rate was 19%, which decreased from 24% in 2000 to 17% in 2017 (P=0.003; R 2=0.4330). Among patients with CRGNB bloodstream infections (n=319) overall 30- and 90-day mortality rates were 27% and 38%, respectively. Charlson score (aOR 1.11 per point), ICU residence (aOR 7.32), and severe liver disease (aOR 4.8.4) were independent predictors of 30-day mortality, while receipt of transplantation was associated with lower rates of death (aOR 0.39). Among patients admitted between 2011-2017 (n=2230), 17% died during hospitalization, 32% were transferred to long-term care facilities, and 38% were discharged home.


CONCLUSIONS
CRGNB emerged in waves over time causing high rates of mortality. Despite increasing rates of CRGNB, overall patient outcomes have improved suggesting that recognition and novel therapeutics have made a major impact.