Antibiotic therapy and outcome of monomicrobial gram-negative bacteraemia: a 3-year population-based study.
Within the 3-y period 1992-94 a total of 815 episodes of monomicrobial bacteraemia caused by Enterobacteriaceae not including Salmonella were registered in the County of Northern Jutland. The 30-d case fatality rate was 24%, ranging from 21% for Enterobacter spp. (n = 43), 22% for E. coli (n = 577) to 32% for both Klebsiella spp. (n = 138) and a group of miscellaneous enterobacteria (n = 57). In 16% of the bacteraemias, antibiotic treatment was not instituted before notification of positive blood cultures; in 9% empirical antibiotic treatment was inappropriate. Antibiotic regimens mainly included beta-lactams, ampicillin or mecillinam in combination with an aminoglycoside. The following factors were independently associated with case fatality: age > or = 75 y, high comorbidity index, admission to a medical ward or an intensive care unit, nosocomial acquisition, a source of infection outside the urinary tract or an undetermined focus, Klebsiella spp., inappropriate coverage or lack of antibiotic treatment before notification of positive blood culture. It is a matter of concern that in one-sixth of patients the physicians had not responded to the possibility of bacteraemia with institution of empirical antibiotic therapy.
Pedersen
G
G
Department of Medicine M, Aalborg Hospital, Denmark.
Schønheyder
H C
HC
Sørensen
H T
HT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012480:Salmonella Infections / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents