{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:54:05Z","timestamp":1772643245225,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Gram-positive bacterial bloodstream infections (GPB-BSI) are associated with high mortality in elderly ICU patients, yet prognostic factors remain understudied. Acute gastrointestinal injury (AGI), a common complication in critical illness, may exacerbate outcomes through gut-organ crosstalk. This study investigates the prognostic impact of AGI severity on 30-day mortality in elderly ICU patients with GPB-BSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single-center retrospective cohort study analyzed 117 ICU patients aged \u226560\u202fyears with culture-confirmed GPB-BSI (2018\u20132024). Data on demographics, microbiology, comorbidities, organ dysfunction, and antimicrobial therapy were collected. Multivariable Cox regression and ROC analyses assessed associations between AGI, clinical variables, and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 30-day mortality rate was 50.4% (59\/117). AGI severity independently predicted mortality: Grades I-II (aHR\u202f=\u202f2.80, 95% CI\u202f=\u202f1.05\u202f~\u202f7.46) and Grades III-IV (aHR\u202f=\u202f6.89, 95%CI\u202f=\u202f2.34\u202f~\u202f20.29). A combined SOFA-AGI score improved prognostic accuracy compared to SOFA score(AUC = 0.749 vs 0.729). Coagulase-negative staphylococci (60.3%) dominated isolates, predominantly hospital-acquired (79.4%) and catheter-related (47.0%). High resistance to penicillins (92.1%), fluoroquinolones (79.4%), and macrolides (77.0%) contrasted with retained susceptibility to linezolid (96.8%), tigecycline (92.9%), and vancomycin (94.4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AGI severity is an independent predictor of mortality in elderly GPB-BSI patients. The diagnostic accuracy for mortality improves when gastrointestinal dysfunction assessment is incorporated into the SOFA score. These findings underscore the critical need for enhanced clinical attention to gastrointestinal function protection in geriatric critical ill patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1634980","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T05:27:51Z","timestamp":1758605271000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The association between acute gastrointestinal injury and mortality in elderly patients with gram-positive bacterial bloodstream infection in the intensive care unit: a retrospective 7-year study from a research hospital in China"],"prefix":"10.3389","volume":"12","author":[{"given":"Yuanqi","family":"Liang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chulong","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingting","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tailin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1004199","DOI":"10.1371\/journal.pmed.1004199","article-title":"The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis","volume":"20","author":"Allel","year":"2023","journal-title":"PLoS Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1080\/23744235.2023.2243327","article-title":"Epidemiology, time course, and risk factors for hospital-acquired bloodstream infections in a cohort of 14,884 patients before and during the COVID-19 pandemic","volume":"55","author":"Taddei","year":"2023","journal-title":"Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1080\/21505594.2015.1134072","article-title":"Bloodstream infections in the Intensive Care Unit","volume":"7","author":"Bassetti","year":"2016","journal-title":"Virulence"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/s00134-020-05950-6","article-title":"Bloodstream infections in critically ill patients: an expert statement","volume":"46","author":"Timsit","year":"2020","journal-title":"Intensive Care Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"S184","DOI":"10.1093\/infdis\/jiz606","article-title":"Early- and Late-Onset Bloodstream Infections in the Intensive Care Unit: A Retrospective 5-Year Study of Patients at a University Hospital in China","volume":"221","author":"Xie","year":"2020","journal-title":"J Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1097\/CCM.0000000000005662","article-title":"Epidemiology of ICU-onset bloodstream infection: prevalence, pathogens, and risk factors among 150,948 ICU patients at 85 U.S. hospitals","volume":"50","author":"Gouel-Cheron","year":"2022","journal-title":"Crit Care Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1097\/CCM.0b013e31828c26b5","article-title":"Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality","volume":"41","author":"Piton","year":"2013","journal-title":"Crit Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/ajcn\/nqac113","article-title":"Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: risk factors, natural history, and clinical implications. 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