Bloodstream Infections at a Norwegian University Hospital, 1974-1979 and 1988-1989: Changing Etiology, Clinical Features, and Outcome

Abstract

All episodes of bloodstream infection in patients admitted to a Norwegian university hospital in 1974-1979 and in 1988-1989 were analyzed; altogether, there were 1,447 episodes involving 1,286 patients, and 54.3% of all episodes were hospital-acquired. The incidence of bloodstream infection increased between the two periods studied from 4.26/1,000 admissions to 8.71/1,000. Crude mortality rates were 27.6% and 18.8% and attributable mortality rates were 12.3% and 6.9% in the first and second periods, respectively. Patients > 60 years of age accounted for more than half of the bloodstream infections; mortality in this group was significantly higher than that among younger patients (31.4% vs. 13.9%). The frequency of isolation of Enterobacteriaceae decreased from 48% in the first period to 34% in the second, while the rate of isolation of coagulase-negative staphylococci increased from 6.5% to 16.9%. The shift in etiology may be explained in part by the occurrence of significantly more bloodstream infections related to intravascular devices, endocarditis, and skin and wound infections and of significantly fewer episodes related to abdominal or genitourinary disease in the second than in the first period. Almost all isolates of Enterobacteriaceae were susceptible to newer cephalosporins and aminoglycosides. In 1974-1979, 96 (69.1%) of 139 patients with septic shock died; in 1988-1989, the figure was 35 (52.2%) of 67 patients (P = .019). Clinical factors predictive of an adverse outcome were septic shock (odds ratio for first/second period, 12.7/4.6), intensive care treatment (not significant/10.6), malignant disease (4.6/2.6), any underlying disease (4.2/not significant), diabetes mellitus (3.6/not significant), age of> 60 years (not significant/3.0), and pulmonary source of infection (not significant/2.8).

Hospital-Acquired, Laboratory-Confirmed Bloodstream Infection: Increased Hospital Stay and Direct Costs

“…[22][23][24]26 Contrary to other reports, 22,[24][25][26] in our study females (average age, 53.0 years) had a higher death rate (70.0%) than did males (average age, 55.2 years) (52.0%).…”

Usefulness of Presepsin (Soluble CD14 Subtype) as a Diagnostic Marker for Sepsis

“…The mortaility rates from sepsis increased markedly in the 1960s and 1970s 1,3) , but the mortlity rates seem to have decreased during the past 20 years [10][11][12] . Unfortunately, however, the figure in a recent report seems to be the highest 13) .…”

Case mortality in polymicrobial bloodstream infections

“…In Norway, a comparison of hospital records from 1988-1989 to those from 1974-1979 found a doubling in the incidence of bloodstream infections, a shift in their microbiologic composition, "a marked increase" in polymicrobial episodes, and an association of polymicrobial bloodstream infection with nosocomial acquisition and higher mortality; mortality had dropped dramatically between the two periods, but by 60% more among monomicrobial than polymicrobial infections [10]. The comparative data available from Israel in the 1990s showed a case-mortality ratio nearly identical to that in the United States [11,12].…”