Source of infection and other factors associated with case fatality in community-acquired bacteremia—a Danish population-based cohort study from 1992 to 1997

Pedersen, Gert Frølund; Schønheyder, Henrik Carl; Sørensen, Henrik Toft

doi:10.1046/j.1469-0691.2003.00599.x

Cited by 76 publications

(93 citation statements)

References 40 publications

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“…This result is also similar to another study. 12 Moreover, Pedersen et al 20 reported a 30-day mortality rate of 13% to 15% in patients with primary bacteremia. The incidence (13.2%) and the mortality rate (15.9%) of primary bacteremia in our study were close to those of this previous report.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality of Bacteremic Patients in the Emergency Department

Lin

Tsai

Lai

et al. 2009

Academic Emergency Medicine

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Objectives: Patients with bacteremia have a high mortality and generally require urgent treatment. The authors conducted a study to describe bacteremic patients in emergency departments (EDs) and to identify risk factors for mortality.Methods: Bacteremic patients in EDs were identified retrospectively at a university hospital from January 2007 to December 2007. Demographic characteristics, underlying illness, clinical conditions, microbiology, and the source of bacteremia were collected and analyzed for their association with 28-day mortality.Results: During the study period, 621 cases (50.2% male) were included, with a mean (±SD) age of 62.8 (±17.4) years. The most common underlying disease was diabetes mellitus (39.3%). Escherichia coli (39.2%) was the most frequently isolated pathogen. The most common source of bacteremia was urinary tract infection (41.2%), followed by primary bacteremia (13.2%). The overall 28-day mortality rate was 12.6%. Multivariate stepwise logistic regression analysis showed age > 60 years (odds ratio Conclusions: Bacteremic patients in the ED have a high mortality, particularly with these risk factors. It is important for physicians to recognize the factors that potentially contribute to mortality of bacteremic patients in the ED.[ACADEMIC EMERGENCY MEDICINE 2009; 16:749-755 ª

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality of Bacteremic Patients in the Emergency Department

Lin

Tsai

Lai

et al. 2009

Academic Emergency Medicine

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“…Empirical antibiotic therapy was considered appropriate when an antibiotic, that had in vitro activity against the causative organism, was given during the first 48 h. If the isolates were resistant or if the dose or the route of administration was insufficient, treatment was considered to be inappropriate (Pedersen et al, 2003;Schonheyder and Sogaard, 2010;Lim et al, 2014).…”

Section: Variables and Definitionsmentioning

confidence: 99%

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

Gan

Zhu

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

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“…Bacteremia is a serious condition with an overall in-hospital mortality above 20% (15,19). Early administration of appropriate empirical antibiotic treatment has repeatedly been associated with improved survival in patients with bacteremia (5,15,27), yet up to 40% of all patients with bacteremia receive inadequate antibiotic treatment until the first notification of a positive blood culture (5,6,22,24).…”

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confidence: 99%

“…At this time, 12 to 20% of the patients may not have started antibiotic treatment, and in another 30 to 45% of patients, the Gram stain result is followed by a change in the empirical treatment (2,7,19,22,24). The Gram stain report has been shown to have a much greater impact on antimicrobial treatment than provision of cultural identification and antimicrobial susceptibility test results (17,22), and recently Hautala et al (12) reported that combining Gram stain results with information on whether the infection was hospital or community acquired could further improve the appropriateness of the antibiotic treatment.…”

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confidence: 99%

First Notification of Positive Blood Cultures and the High Accuracy of the Gram Stain Report

2007

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When blood cultures turn positive, the attending physicians are usually notified immediately about Gram stain findings. However, information on the accuracy of Gram staining is very limited. We examined the accuracy of preliminary blood culture reports provided by a regional laboratory in an observational study including the years 1996, 2000 to 2001, and 2003. We used data from computer files and technicians' laboratory notes. The study was restricted to cultures with one morphological type. Using cultural identification as a reference, we estimated the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) for the following defined morphological groups: gram-positive cocci in clusters, gram-positive cocci in chains or diplococci, gram-positive rods, gram-negative cocci, gram-negative rods, and yeasts. We further evaluated the Gram stain and wet mount findings for the most frequent bacterial species/groups. We obtained 5,893 positive blood cultures and the following results for the defined groups: sensitivity, range of 91.3 to 99.7%; specificity, 98.9 to 100%; PPV, 94.6 to 100%; and NPV, 99.0 to 100%. The sensitivity for the most frequent species was in the range 91.3 to 100%, with nonhemolytic streptococci having the lowest value (sensitivity, 91.3%; 95% confidence interval, 86.2 to 94.9%). Wet mount reports were less accurate (sensitivity of 30 to 70% for species with peritrichous motility), and Enterobacteriaceae (notably Salmonella spp.) accounted for 25% of the reports stating polar motility. In conclusion, we demonstrated a high accuracy of Gram stain reports, whereas wet mount microscopy was generally less accurate.

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Source of infection and other factors associated with case fatality in community-acquired bacteremia—a Danish population-based cohort study from 1992 to 1997

Abstract: As an undetermined source of infection was strongly associated with CFR, physicians should be aware of the significance of identifying and eliminating a source of infection, and more efforts should be directed at timely and appropriate empirical antibiotic therapy.

Cited by 76 publications

References 40 publications

Risk Factors for Mortality of Bacteremic Patients in the Emergency Department

Risk Factors for Mortality of Bacteremic Patients in the Emergency Department

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

First Notification of Positive Blood Cultures and the High Accuracy of the Gram Stain Report

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