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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The decade analysed included 15\u2009357 BSI episodes in 12\u2009748 patients; 6216 patients (48.8%) were\u226565 years and 83.7% of episodes had\u22651 comorbidity (12\u2009856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and\u223c34% 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\u2009145\u2009778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      , vancomycin-resistant\n                      <jats:italic>Enterococcus<\/jats:italic>\n                      spp and DTR GNB BSI were 18.9, 1.30, 0.25 and 0.05 per 100\u2009000 beneficiaries, respectively. Over the decade, annual mortality did not significantly increase for any pathogen and decreased by\u223c2% for overall BSI (p=0.024) and\u223c3% for lactose-fermenting GNB BSI (p=0.048).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094861","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T16:57:06Z","timestamp":1741021026000},"page":"e094861","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"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"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-6225","authenticated-orcid":false,"given":"Alexander C","family":"Vostal","sequence":"first","affiliation":[{"name":"Laboratory of Infectious Diseases, National 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