Gram-negative bacteremia in non-neutropenic patients: A 3-year review

The causative organisms, clinical manifestations, factors influencing prognosis, and other epidemiological characteristics of 81 episodes of bacteremia due to gram-negative organisms, in non-neutropenic patients, were studied retrospectively during a 3-year period (1992-1994) at the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece. The gram-negative bacteremia incidence was 2% and the overall mortality 12%, All 81 patients had fever; Escherichia coli was the most frequent organism isolated (from 47 patients -58%) and was associated,vith shock (9/47), disseminated intravascular coagulation (DIC) (8/47), anuria (5/47), adult respiratory distress syndrome (ARDS) (3/47), and pneumonia (1/47), Other less frequent gram-negative microorganisms were Klebsiella spp, (ten patients; 12%), Pseudomonas spp, (7; 7%), Salmonella spp. (5; 6%), Enterobacter spp, (5; 6%), Proteus spp, (3; 3.4%), Stenotrophomonas spp, (3; 3.4%), and Acinetobacter spp, (1; 1.2%). ARDS, shock, DIG, anuria, presence of central venous catheter, urinary catheter, unknown origin of infection and inappropriate treatment were significantly associated with a higher death rate. Early initiation of appropriate therapy was the most important intervention that favorably affected the outcome of gram-negative bacteremias in this patient population.