title: [Analysis of prognostic factors for mortality in bacteremia and fungemia at a university hospital. Experience of 10 years].
abstract: OBJECTIVE
  The objective of this study was to determine the prognostic factors in relationship to evolution to death of bacteremia-fungemia (BF) episodes occurred in 1986 and to compare them with the results obtained ten years later in 1996.
  
  
  METHODS
  Prospective study of all BF episodes observed at Hospital Universitario La Princesa, Madrid, during the 1985-1986 and 1996-1997 periods. The same definitions were used for the two study periods. The univariate analysis of results was performed with the chi square test and variables with statistical significance with p < 0.10 in the multivariate analysis with the logistic regression model.
  
  
  RESULTS
  A total of 984 episodes were analyzed. There was an increased incidence per 1,000 admissions from 23.58 to 28.44. A change in the relationship of nosocomial acquisition (55.5%-42.6%) to community-acquired episodes (44.1%-57.4%) and an increase in gram-positive organisms (39%-48.6%) compared with gram-negative organisms (53.4%-41.8%) was observed. The organisms recovered most frequently in both periods were Escherichia coli and coagulase-negative Staphylococcus. An overall decrease of mortality rate from 26.2% down to 15.9% (OR: 4.52) was noted. Independent factors with poor prognosis in the first period included age over 60 years (OR: 4.52), underlying disease (OR: 2.79; more than one OR: 6.53), respiratory source (OR: 3.86), DIC (OR: 4.79), hypotension (OR: 3.19); as for the second period, the corresponding independent factors included age > 60 years (OR: 6.48), nosocomial acquisition (OR: 2.62), DIC (OR: 18.7), hypotension (OR: 3.07), and inadequate surgical treatment (OR: 7.61).
  
  
  CONCLUSIONS
  In the last ten years the incidence of BF episodes has increased. In contrast, mortality rate has decreased. Factors with poor prognosis, including age > 60, DIC, and hypotension, still persist.
authors.affiliation: Servicio de Medicina Interna-Infecciosas, Hospital Universitario de La Princesa, Madrid, Ctra. de Colmenar Viejo, km. 14,600, 28049 Madrid. anogueradoa@nexo.es
authors.forename: A
authors.initials: A
authors.lastname: Noguerado Asensio
authors.forename: J M
authors.initials: JM
authors.lastname: Ruiz Giardin
authors.forename: A
authors.initials: A
authors.lastname: Pizarro Portillo
authors.forename: J
authors.initials: J
authors.lastname: Méndez García
authors.forename: F
authors.initials: F
authors.lastname: la Hulla Pastor
authors.forename: M
authors.initials: M
authors.lastname: Fernández Escribano
authors.forename: F
authors.initials: F
authors.lastname: Hernández Schurman
authors.forename: J V
authors.initials: JV
authors.lastname: San Martín López
authors.forename: I
authors.initials: I
authors.lastname: Hernández Schurman
authors.forename: J
authors.initials: J
authors.lastname: Alvarez Orejón
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez Salvanes
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000401:mortality*; D005260:Female; D016469:Fungemia / Q000401:mortality*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain; D013997:Time Factors