Characterization of Diversity in wbeT Region of the O-Antigen Biosynthesis Gene Cluster in Ogawa and Inaba Serotypes of Vibrio cholerae

Abstract

Background: S. aureus (SA), P. aeruginosa (PA), enterococcus spp (EC). and candida spp (CA). are among the most important causes of nBSI and are associated with high rates of morbidity and mortality. Methods: We performed a historical cohort study to evaluate the clinical course of 268 randomly selected adult patients with nBSIs due to SA (81), PA (77), CA (60), EC (50) at the Medical College of Virginia Hospitals, using serial SIRS and APACHE II scores. Comparison was made between patients with BSI due to different species. Results: The patients had a mean age of 52 years and a mean hospital stay prior to BSI of 22 days. 60% of patients required ICU care prior to BSI. The mean APACHE II score was 17 on the day of BSI. Antimicrobial therapy within the first 24 hours was considered appropriate in 67% of patients. Septic shock occurred in 31% of patients, and severe sepsis in an additional 16%. Overall crude mortality was 39%. Inflammatory response and clinical course were similar between patients with BSI due to different species, but was more severe in patients with an APACHE II score >20 at the onset of BSI (p < 0.001). Outcome was significantly worse in patients with BSI due to PA or CA (p = 0.004). In univariate analysis, progression to septic shock was correlated with high overall mortality (p20 at the onset of BSI (p < 0.001). In multivariate analysis, only APACHE II score at the onset of BSI (p = 0.001) and systemic inflammatory response (p = 0.01) independently predicted overall mortality. Conclusions: Clinical course and mortality in patients with BSI were predicted by systemic inflammatory response and APACHE II score, but did not correlate with the causative pathogen.