The significance of serum-sensitive bacilli in gram-negative bacteremia.
Clinical findings from 76 patients (median age 67 years) with gram-negative bacteremia were analysed and related to the sensitivity of the blood isolates to the bactericidal activity of normal human serum. 28 strains (37%) were resistant, an equal number intermediately sensitive and 20 markedly sensitive (26%). No correlation was found between serum sensitivity and origin of the bacteremia, presence of fever or blood granulocyte count. The frequency of shock in immunocompromised patients with serum-resistant strains was 60% (6/10); in those with intermediately or markedly sensitive strains it was 44% (8/18). In the non-immunocompromised patients with resistant strains the frequency of shock was 33 (6/18) versus 10% (3/30) in those without such strains. Thus the risk of developing shock with gram-negative bacteremia seems to depend on both parasite and host factors, although in this study only the latter were statistically significant. We conclude that serum-sensitive strains can invade the blood stream in spite of the serum bactericidal activity and cause severe disease in some patients.
D000328:Adult; D000368:Aged; D001419:Bacteria / Q000276:immunology*; D001431:Bacteriological Techniques; D001770:Blood Bactericidal Activity; D002954:Citrobacter / Q000276:immunology; D004756:Enterobacteriaceae Infections / Q000276:immunology; D004927:Escherichia coli Infections / Q000276:immunology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011512:Proteus Infections / Q000276:immunology; D018805:Sepsis / Q000276:immunology*; D012772:Shock, Septic / Q000276:immunology