Epidemiology and prognosis of bacteremia: a 10-y study in a community hospital

Abstract

In order to determine the epidemiology and factors influencing the outcome of adult bacteremia in a community hospital, episodes of significant bacteremia were recorded prospectively over a 10-y period (1989-98). The following variables were included: age, sex, etiology, acquisition and source of the bacteremia, risk factors, clinical manifestations, empirical antibiotic treatment and outcome. A total of 798 episodes of bacteremia were recorded (436 in males) and 185 (24%) were hospital-acquired. The most frequent source was the urinary tract, followed by the respiratory tract and primary bacteremia. The crude mortality was 14.4% (n = 111) and related mortality was 8.5% (n = 66). The most frequent etiology was Escherichia coli, followed by Streptococcus pneumoniae and Staphylococcus aureus. Multivariate analysis revealed age > 70 y, nosocomial acquisition, respiratory source, primary bacteremia, septic shock, McCabe groups I and II, leukopenia, inappropriate antibiotic treatment and etiology due to S. aureus as factors associated with crude mortality. Pseudomonas aeruginosa, Proteus spp. and Bacteroides spp. were associated with related mortality. In conclusion, it is possible to modify or eliminate factors influencing the outcome of adult bacteremia. The prevention of nosocomial infection, the use of support therapies in critical patients and appropriate antibiotic treatment are measures that can improve the prognosis of patients with bacteremia.