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Prognostic factors associated with improved outcome ofEscherichia coli bacteremia in a Finnish university hospital

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Abstract

All cases of bacteremia caused solely byEscherichia coli in 1977–1979, 1987–1989, and 1993–1994 in a Finnish university hospital were reviewed retrospectively to determine the clinical manifestations, the outcome, and the prognostic factors. In 332 episodes, mortality during the month after the first positive blood culture was 17%. This figure diminished during the study period from 23% in the 1970s to 9% in the 1990s (p=0.028). Mortality was lowest among patients treated with a combination of antibiotics, 7% versus 18% among those treated otherwise (p=0.034). The use of acetaminophen increased during the study period from 18 to 55%. Mortality among patients who received acetaminophen within a period < 24 h to 48 h of the first positive blood culture was 10% versus 22% among others (p=0.002). Logistic regression analysis showed six factors predictive of a fatal outcome: pneumonia, no known focus, shock, CNS disorder, thromboembolism, and rapidly fatal underlying disease. Appropriate antibiotic therapy predicted survival. In the analysis, replacement of appropriate antibiotic therapy by acetaminophen revealed that this drug was significantly associated with survival.

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References

  1. Finland M: Changing ecology of bacterial infections as related to antibacterial therapy. Journal of Infectious Diseases 1970, 122: 419–431.

    Google Scholar 

  2. Scheckler WE: Septicemia in a community hospital 1970 through 1973. JAMA 1977, 237: 1938–1941.

    Google Scholar 

  3. Roberts FJ: A review of positive blood cultures: identification and source of microorganisms and patterns of sensitivity to antibiotics. Reviews of Infectious Diseases 1980, 2: 329–339.

    Google Scholar 

  4. Young SEJ: Bacteraemia 1975–1980: a survey of cases reported to the PHLS Communicable Disease Surveillance Centre. Journal of Infection 1982, 5: 19–26.

    Google Scholar 

  5. Weinstein MP, Relter LB, Murphy JR, Lichtenstein KA: The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Reviews of Infectious Diseases 1983, 5: 35–53.

    Google Scholar 

  6. Ispahani P: An analysis of community and hospital-acquired bacteraemia in a large teaching hospital in the United Kingdom. Quarterly Journal of Medicine 1987, New Series 63: 427–440.

    Google Scholar 

  7. Eykyn SJ, Gransden R, Phillips I: The causative organisms of septicemia and their epidemiology. Journal of Antimicrobial Chemotherapy 1990, 25, Supplement C: 41–58.

    Google Scholar 

  8. Roberts FJ, Geere IW, Coldman A: A three-year study of positive blood cultures, with emphasis on prognosis. Reviews of Infectious Diseases 1991, 13: 34–46.

    Google Scholar 

  9. Geerdes HF, Ziegler D, Lode H, Hund M, Loehr A, Fangmann W, Wagner J: Septicemia in 980 patients at a university hospital in Berlin: prospective studies during selected years between 1979 and 1989. Clinical Infectious Diseases 1992, 15: 991–1002.

    Google Scholar 

  10. Haug JB, Harthug S, Kalager T, Digranes A, Solberg CO: Bloodstream infections at a Norwegian university hospital, 1974–1979 and 1988–1989: changing etiology, clinical features, and outcome. Clinical Infectious Diseases 1993, 19: 246–256.

    Google Scholar 

  11. Banerjee NE, Emori TG, Culver DH, Gayness RP, Jarvis WR, Horan T, Edwards JR, Tolson J, Henderson T, Martone WJ: Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. National Nosocomial Infections Surveillance System. American Journal of Medicine 1991, 91, Supplement 3B: 86–89.

    Google Scholar 

  12. McCabe WR, Jackson GG: Gram-negative bacteraemia. Archives of Internal Medicine 1962, 110: 847–864.

    Google Scholar 

  13. McGowan JE, Barnes MW, Finland M: Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935–1972), with special reference to hospital acquired cases. Journal of Infectious Diseases 1975, 132: 316–335.

    Google Scholar 

  14. Gransden WR, Eykyn SJ: Bacteremia due toEscherichia coli: a study of 861 episodes. Reviews of Infectious Diseases 1990, 12: 1008–1018.

    Google Scholar 

  15. Weischer M, Kolmos HJ: Retrospective 6-year study of enterobacter bacteraemia in a Danish university hospital. Journal of Hospital Infection 1992, 20: 15–24.

    Google Scholar 

  16. Uzun Ö, Akalin HE, Hayran M, Ünal S: Factors influencing prognosis in bacteremia due to gram-negative organisms: evaluation of 448 episodes in a Turkish university hospital. Clinical Infectious Diseases 1992, 15: 866–873.

    Google Scholar 

  17. Altemeier WA, Todd JC, Inge WW: Gram-negative septicemia: a growing threat. Annals of Surgery 1967, 166: 530–542.

    Google Scholar 

  18. Kreger BE, Craven DO, Carling PC, McCabe WR: Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. American Journal of Medicine 1980, 68: 332–343.

    Google Scholar 

  19. McCue JD: Improved mortality in gram-negative bacillary bacteremia. Archives of Internal Medicine 1984, 145: 1212–1216.

    Google Scholar 

  20. Bryant RE, Hood AF, Hood CE, Koenig MG: Factors affecting mortality of gram-negative rod bacteremia. Archives of Internal Medicine 1971, 127: 120–128.

    Google Scholar 

  21. McHenry MC, Gavan TL, Hawk WA, Ma C: Gram-negative bacteremia: variable clinical course and useful prognostic factors. Cleveland Clinic Quarterly 1975, 42: 15–32.

    Google Scholar 

  22. Weinstein MP, Murphy JR, Reller LB, Lichtenstein KA: 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. Reviews of Infectious Diseases 1983, 5: 54–70.

    Google Scholar 

  23. Bryan CS, Reynolds KL, Brenner ER: Analysis of 1, 186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Reviews of Infectious Diseases 1983, 5: 629–638.

    Google Scholar 

  24. National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial susceptibility testing. Approved Standard M100-S5NCCLS, Villanova, PA, 1994.

  25. Hosmer DW Jr, Lemeshow S: Applied logistic regression. Wiley-Interscience, New York, 1989.

    Google Scholar 

  26. Dixon WJ (ed): BMDP statistical software manual. University of California Press, Los Angeles, 1992.

    Google Scholar 

  27. Kuikka A, Valtonen VV: Improved outcome ofStaphylococcus aureus bacteremia. Infectious Diseases in Clinical Practice 1994, 3: 282–287.

    Google Scholar 

  28. Young LS: Sepsis syndrome. In: Mandell GL, Bennett JE, Dolin R (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York, 1995, p. 690–705.

    Google Scholar 

  29. Okusawa S, Gelfand JA, Ikejima T, Connolly RJ, Dinarello CA: Interleukin 1 induces shock-like stage in rabbits. Synergism with tumor necrosis factor and the effects of cyclooxygenase inhibition. Journal of Clinical Investigation 1988, 81: 1162–1172.

    Google Scholar 

  30. Carey PD, Jenkins JK, Byrne K, Walsh CJ, Fowler AA, Sugerman HJ: The neutrophil respiratory burst and tissue injury in septic acute lung injury: the effect of cyclooxygenase inhibition in swine. Surgery 1992, 112: 45–55.

    Google Scholar 

  31. Abramson S, Korchak H, Ludewig R, Edelson H, Haines K, Levin RI, Herman R, Rider L, Kimmel S, Weissman G: Modes of action of aspirin-like drugs. Proceedings of the National Academy of Sciences of the USA 1985, 82: 7227–7231.

    Google Scholar 

  32. Seppälä E, Nissilä M, Isomäki H, Wuorela H, Vapaatalo H: Effects of non-steroidal anti-inflammatory drugs and prednisolone on synovial fluid white cells, prostaglandin E2, leukotriene B4 and cyclic AMP in patients with rheumatoid arthritis. Scandinavian Journal of Rheumatology 1990, 19: 71–75.

    Google Scholar 

  33. Weissmann G: Prostaglandins as modulators rather than mediators of inflammation. Journal of Lipid Mediators 1993, 6: 275–286.

    Google Scholar 

  34. Mollner S, Beck K, Pfeuffer T: Acylation of adenyl cyclase catalyst is important for enzymic activity. FEBS Letters 1995, 371: 241–244.

    Google Scholar 

  35. Lozada ES, Gouaux J, Franki N, Appel GB, Hays RM: Studies of the mode of action of the sulfonylureas and phenylacetamides in enhancing the effect of vasopressin. Journal of Clinical Endocrinology 1972, 34: 704–712.

    Google Scholar 

  36. Shalabi EA: Acetaminophen inhibits the human polymorphonuclear leukocyte function in vitro. Immunopharmacology 1992, 24: 37–45.

    Google Scholar 

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Authors and Affiliations

  1. Haartman Institute, Department of Bacteriology and Immunology, University of Helsinki, PO Box 21, 00014, Finland

    A. Kuikka & A. Sivonen

  2. Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland

    A. Kuikka, A. Emelianova & V. V. Valtonen

Authors
  1. A. Kuikka
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  2. A. Sivonen
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  3. A. Emelianova
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  4. V. V. Valtonen
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Kuikka, A., Sivonen, A., Emelianova, A. et al. Prognostic factors associated with improved outcome ofEscherichia coli bacteremia in a Finnish university hospital. Eur. J. Clin. Microbiol. Infect. Dis. 16, 125–134 (1997). https://doi.org/10.1007/BF01709471

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