Clinical and Molecular Analyses of Recurrent Gram-Negative Bloodstream Infections

Andrew Bock, Blake M. Hanson, Felicia Ruffin, Joshua B. Parsons, Lawrence P. Park, Batu Sharma-Kuinkel, Michael Mohnasky, Cesar A. Arias, Vance G. Fowler, Joshua T. Thaden

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: The causes and clinical characteristics of recurrent gram-negative bacterial bloodstream infections (GNB-BSI) are poorly understood. Methods: We used a cohort of patients with GNB-BSI to identify clinical characteristics, microbiology, and risk factors associated with recurrent GNB-BSI. Bacterial genotyping (pulsed-field gel electrophoresis [PFGE] and whole-genome sequencing [WGS]) was used to determine whether episodes were due to relapse or reinfection. Multivariable logistic regression was used to identify risk factors for recurrence. Results: Of the 1423 patients with GNB-BSI in this study, 60 (4%) had recurrent GNB-BSI. Non-White race (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.38-4.01; P =. 002), admission to a surgical service (OR, 2.18; 95% CI, 1.26-3.75; P =. 005), and indwelling cardiac device (OR, 2.73; 95% CI, 1.21-5.58; P =. 009) were associated with increased risk for recurrent GNB-BSI. Among the 48 patients with recurrent GNB-BSI whose paired bloodstream isolates underwent genotyping, 63% were due to relapse (30 of 48) and 38% were due to reinfection (18 of 48) based on WGS. Compared with WGS, PFGE correctly differentiated relapse and reinfection in 98% (47 of 48) of cases. Median time to relapse and reinfection was similar (113 days; interquartile range [IQR], 35-222 vs 174 days; IQR, 69-599; P =. 13). Presence of a cardiac device was associated with relapse (relapse: 7 of 27, 26%; nonrelapse: 65 of 988, 7%; P =. 002). Conclusions: In this study, recurrent GNB-BSI was most commonly due to relapse. PFGE accurately differentiated relapse from reinfection when compared with WGS. Cardiac device was a risk factor for relapse.

Original languageEnglish (US)
Pages (from-to)E1285-E1293
JournalClinical Infectious Diseases
Issue number3
StatePublished - Feb 1 2023


  • bacteremia
  • bloodstream infection
  • gram-negative
  • recurrent
  • Recurrence
  • Bacteremia/microbiology
  • Sepsis/complications
  • Humans
  • Risk Factors
  • Gram-Negative Bacterial Infections/diagnosis
  • Retrospective Studies
  • Reinfection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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