Bacteremia at a Danish University Hospital during a Twenty-five-year Period (1968-1892)

Abstract

In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. Enterobacteriaceae dominated as causative agents (57%), following by Gram-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia was found in 8% of the episodes. The incidence of Enterobacteriaceae bacteremia culminated in the middle (1978-82) of the period (4.7/1,000 admissions) and decreased during the last decade. Gram-positive bacteremia increased throughout the period (from 1.8 to 2.9; p < 0.001), due mainly to increasing incidences of bacteremia caused by non-hemolytic streptococci, Streptococcus pneumoniae and coagulase-negative staphylococci. Bacteroides fragilis accounted for a rising incidence of anaerobic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were available for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with indwelling catheters, mainly bladder catheters (28%) and i.v. lines (7%). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently malignancies (20%) and diabetes mellitus (7%). The mortality rate related to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the first 2 days after the first positive blood culture was obtained. Logistic regression analysis defined 7 variables that independently influenced the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antibiotic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of diabetes on mortality among patients with community-acquired bacteremia

“…20 Previous studies on hospital surveillance of positive blood cultures combining community-and hospitalacquired bacteremia showed that age, malignancy, higher comorbidity score, hypotension, body temperature, and site of infection independently influenced the mortality among bacteremic patients. 4,21,22 We confirmed that these factors also were associated with mortality in sole community-acquired bacteremia. When physicians treat bacteremic patients admitted from the ED (most of them are community-acquired bacteremia), these factors may be more important than diabetes in evaluation of the risk of short-term mortality.…”

Increasing Bacteremia Due to Coagulase-Negative Staphylococci: Fiction or Reality?

“…9,10,14,17,22,24,36 The percentage of blood cultures positive for CNS and representing true bacteremia was very constant and similar both in time and numbers between the United States and Europe (mean, 18%; range, 6%-31%). 7,9,14,17,22,36,37…”

“…2 Since then, several studies have reported trends of increasing incidence and severity of CNS bacteremia both in the United States 3-6 and in Europe. [7][8][9][10][11] It is a well-established observation that CNS bacteremias are associated with the use of indwelling devices such as central venous, peripheral venous, or hemodialysis catheters and prosthetic material. 12,13 Two properties of CNS may explain this: the ability to adhere to foreign bodies and artificial surfaces due to adhesins, and the production of extracellular glycocalyx (slime).…”

Are Antimicrobial-Impregnated Catheters Effective? Replace the Water and Grab Your Washcloth, Because We Have a Baby to Wash

“…However, and given the concerns about serious grampositive bacterial infections other than those due to CONS, it would be difficult to imagine a scenario in which a patient with signs and symptoms of infection and with 1 of 4 blood cultures yielding grampositive cocci (identification pending) would be denied antimicrobial therapy for gram-positive bacterial infection while awaiting identification of the organism. Such a common clinical presentation would thus be considered to denote CRBSI due to CONS, despite evidence indicating that the likelihood of this blood isolate causing infection is only 2% [18] and that the overwhelming majority of such CONS blood isolates represent contamination [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. In view of these concerns, we respectfully urge the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention panel (Atlanta, GA) [16] to revise the guidelines for the prevention of CRBSI so that only objective, EBM-supported definitions of CRBSI are used.…”