Gram-negative septicemia in patients with hematologic malignancies.
The clinical records of 66 consecutive episodes of Gram-negative bacteremia occurring in 60 patients with hematologic malignancies during a 66-month period were reviewed to assess the major prognostic factors. The bacteremia-related mortality was 53%. Overall, Pseudomonas aeruginosa (54%) and Escherichia coli (24%) were the predominant isolates (fatality rate 78 and 31% respectively). The majority of patients (58/66) were granulocytopenic (PMN less than 1000/microliters). Among the 18 patients whose circulating granulocytes increased by one log10 or to above 1000/mmc during therapy, the fatality rate was 39%, as opposed to 70% in the 40 patients without such an increase. Pneumonia-associated bacteremia (56%) had a high fatality rate (73%) compared to isolated bacteremias (27%). Septic shock and inappropriate antibiotic therapy accounted for the highest mortality. Our data suggest that Pseudomonas etiology, persistent neutropenia, associated pneumonia, septic shock and inappropriate antibiotic therapy account for a bad prognosis in Gram-negative bacteremia in hematologic malignancies.
D000380:Agranulocytosis / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000150:complications; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008223:Lymphoma / Q000150:complications*; D011014:Pneumonia / Q000150:complications; D011379:Prognosis; D011552:Pseudomonas Infections / Q000150:complications; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications
D000900:Anti-Bacterial Agents