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

Abstract

All cases of bacteremia caused solely by Escherichia 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.

Febrile-Range Hyperthermia Augments Neutrophil Accumulation and Enhances Lung Injury in Experimental Gram-Negative Bacterial Pneumonia

“…However, this association is lost in patients with higher disease acuity (11). In two retrospective clinical studies of patients with bacteremia and sepsis, treatment with the antipyretic agent, acetaminophen, was associated with improved survival, although actual core temperatures were not mentioned in the report (12,13). Studies in animal models in which febrile-range hyperthermia (FRH) 3 was achieved by increasing ambient temperature generally support the concept that a temperature increase to febrile levels is protective during infections (14 -22).…”

Fever control and its impact on outcomes: What is the evidence?

“…In fact, treatment with antipyretics has been shown to prolong the course of Plasmodium falciparum, varicella and rhinovirus infections in humans [9][10][11]. Febrile patients with community acquired pneumonia, Escherichia coli bacteremia and Pseudomonas aeruginosa sepsis have improved survival over afebrile patients [12][13][14]. Survival is higher in mice with Klebsiella pneumoniae peritonitis that have their temperature raised from normal to febrile levels [15].…”

Acute Bacterial Meningitis: Focused Update on Pathophysiology and Treatment Among Adults in "African Meningitis Belt" of North-Western Nigeria

“…In patients with communicating hydrocephalus who are awake and can be monitored clinically, invasive measures such as repetitive lumbar punctures or placement of an external lumbar drain can be considered but might not be necessary. [33,34] …”