Infection

, Volume 26, Issue 3, pp 155–159

Gram-negative bacteremia in non-neutropenic patients: A 3-year review

  • A. Gikas
  • G. Samonis
  • A. Christidou
  • J. Papadakis
  • D. Kofteridis
  • Y. Tselentis
  • N. Tsaparas
Clinical and Epidemiological Studies Originalia

Summary

The causative organisms, clinical manifestations, factors influencing prognosis, and other epidemiological characteristics of 81 episodes of bacteremia due to gram-negative organisms, in non-neutropenic patients, were studied retrospectively during a 3-year period (1992–1994) at the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece. The gram-negative bacteremia incidence was 2% and the overall mortality 12%. All 81 patients had fever;Escherichia coli was the most frequent organism isolated (from 47 patients −58%) and was associated with shock (9/47), disseminated intravascular coagulation (DIC) (8/47), anuria (5/47), adult respiratory distress syndrome (ARDS) (3/47), and pneumonia (1/47). Other less frequent gram-negative microorganisms wereKlebsiella spp. (ten patients; 12%),Pseudomonas spp. (7; 7%),Salmonella spp. (5; 6%),Enterobacter spp. (5; 6%),Proteus spp. (3; 3.4%),Stenotrophomonas spp. (3; 3.4%), andAcinetobacter spp. (1; 1.2%). ARDS, shock, DIC, anuria, presence of central venous catheter, urinary catheter, unknown origin of infection and inappropriate treatment were significantly associated with a higher death rate. Early initiation of appropriate therapy was the most important intervention that favorably affected the outcome of gram-negative bacteremias in this patient population.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kreger, B. E., Craven, D. E., McCabe, W. R.: Gram-negative bacteremia: IV. Re-evaluation of clinical features and treatment in 612 patients. Am. J. Med. 68 (1980) 344–355.PubMedCrossRefGoogle Scholar
  2. 2.
    Bryan, C. S., Reynolds, K. L., Brenner, E. R.: Analysis of 1186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Rev. Infect. Dis. 5 (1983) 629–638.PubMedGoogle Scholar
  3. 3.
    McGowan, J. E. Jr.,Barnes, M. W., Finland, M.: Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935–1972) with special reference to hospital-acquired cases. J Infect. Dis. 132 (1975) 316–335.PubMedGoogle Scholar
  4. 4.
    Ziegler, E. J., Fisher, C. J., Sprung, C. L., Straube, R. C., Sadoff, J. C., Foulke, G. E., Wortel, C. H., Fink, M. P., Dellinger, R. P., Teng, N. N.: Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. N. Engl. J. Med. 324 (1991) 429–436.PubMedCrossRefGoogle Scholar
  5. 5.
    Bryant, R. E., Hood, A. F., Hood, C. E., Koening, M. G.: Factor affecting mortality of gram-negative bacteremia. Arch. Intern. Med. 127 (1971) 120–128.PubMedCrossRefGoogle Scholar
  6. 6.
    DuPont, H. L., Spink, W. W.: Infections due to gram-negative organisms: an anlaysis of 860 patients with bacteremia at the University of Minnesota Center, 1958–1966. Medicine 48 (1969) 307–332.PubMedCrossRefGoogle Scholar
  7. 7.
    McCabe, W. R., Jackson, G. G.: Gram-negative bacteremia. Arch. Intern. Med. 110 (1962) 92–99.Google Scholar
  8. 8.
    Calandra, T., Cometta, A.: Antibiotic therapy for gram-negative bacteremia. Infectious Disease Clinics of North America 5 (1991) 817–834.PubMedGoogle Scholar
  9. 9.
    Jungkind, D., Millan, J., Allen, S., Duke, J., Hill, E.: Clinical comparison of a new automated infrared blood culture system with the BACTEC 460 system. J. Clin. Microbiol. 23 (1986) 262–266.PubMedGoogle Scholar
  10. 10.
    National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial disk susceptibility test. Approved standard M2–A4. National Committee for Clinical Laboratory Standards, Villanova, PA 1990.Google Scholar
  11. 11.
    Garner, J. S., Jarvis, W. R., Emori, T. G.: CDC definitions for nosocomial infections, 1988. Am. J. Infect. Control 19 (1988) 128–140.CrossRefGoogle Scholar
  12. 12.
    Aube, H., Milan, C., Blettery, B.: Risk factors for septic shock in the early management of bacteremia. Am. J. Med. 93 (1992) 283–288.PubMedCrossRefGoogle Scholar
  13. 13.
    Samonis, G., Anaissie, E., Elting, L., Bodey, G. P.: Review of Citrobacter bacteremia in cancer patients over a sixteen-year period. Eur. J. Clin. Microbiol. Infect. Dis. 10 (1991) 479–485.PubMedCrossRefGoogle Scholar
  14. 14.
    Meunier, F., Zinner, S. H., Caya, H., Calandra, T., Viscoli, C., Klastersky, J., Glauser, M.: Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors. Antimicrob. Agents Chemother. 35 (1991) 873–878.PubMedGoogle Scholar
  15. 15.
    Uzun, O., Akalin, H. E., Hayran, M., Unal, S.: Factors influencing prognosis in bacteremia due to gram-negative organisms: evaluation of 448 episodes in a Turkish university hospital. Clin. Infect. Dis. 15 (1992) 866–873.PubMedGoogle Scholar
  16. 16.
    Eykyn, S. J., Gransden, W. R., Philips, I.: The causative organisms of septicaemia and their epidemiology. J. Antimicrob. Chemother. 25 (1990) (Suppl. C) 41–58.PubMedGoogle Scholar
  17. 17.
    Peduzzi, P., Shatney, C., Sheagren, J., Sprung, C., andThe Veterans Affairs Systemic Sepsis Cooperative Study Group: Predictors of bacteremia and gram-negative bacteremia in patients with sepsis. Arch. Intern. Med. 152 (1992) 529–535.PubMedCrossRefGoogle Scholar
  18. 18.
    Miller, P. J., Wenzel, R. P.: Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections. J. Infect. Dis. 156 (1987) 471–477.PubMedGoogle Scholar
  19. 19.
    Weinstein, M. P., Reller, L. B., Murphy, J. R., Lichtenstein, K. A.: The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations with special reference to factors influencing prognosis. Rev. Infect. Dis. 5 (1983) 54–70.PubMedGoogle Scholar
  20. 20.
    Sonnenblick, M., Carmon, M., Rudenski, B.: Septicemia in the elderly: incidence, etiology and prognostic factors. Isr. J. Med. Sci. 26 (1990) 195–199.PubMedGoogle Scholar
  21. 21.
    Whimbey, E., Kiehn, T. E., Brannon, P., Blevins, A., Armstrong, D.: Bacteremia and fungemia in patients with neoplastic disease. Am. J. Med. 82 (1987) 723–730.PubMedCrossRefGoogle Scholar
  22. 22.
    Leibovich, L., Konisberger, H., Pitlik, S. D., Samra, Z., Drucker, M.: Bacteremia and fungemia of unknown origin in adults. Clin. Infect. Dis. 14 (1992) 436–443.Google Scholar
  23. 23.
    Maki, D. G.: Nosocomial bacteremia: an epidemiologic overview. Am. J. Med. 70 (1981) 719–732.PubMedCrossRefGoogle Scholar
  24. 24.
    Bisbe, J., Gatell, J. M., Puig, J.:Pseudomonas aeruginosa bacteremia: univariate and multivariate analysis of factors influencing the prognosis in 133 episodes. Rev. Infect. Dis. 10 (1988) 629–635.PubMedGoogle Scholar

Copyright information

© MMV Medizin Verlag GmbH München 1998

Authors and Affiliations

  • A. Gikas
    • 1
  • G. Samonis
    • 1
  • A. Christidou
    • 2
  • J. Papadakis
    • 1
  • D. Kofteridis
    • 1
  • Y. Tselentis
    • 2
  • N. Tsaparas
    • 1
  1. 1.Dept. of Internal MedicineUniversity of Crete, Div. of MedicineCreteGreence
  2. 2.Dept. of Clinical Bacteriology, Parasitology and Geographical MedicineUniversity of Crete, Div. of MedicineCreteGreence

Personalised recommendations