title: Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia.
abstract: BACKGROUND
  Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients.
  
  
  METHODS
  The study involved 149 patients (79 male and 70 female) with bacteraemia caused by Staphylococcus aureus (S. aureus) (41 patients), Streptococcus pneumoniae (Str. pneumoniae) (42 patients), beta-hemolytic streptococcae (beta-hml str.) (23 patients) and Eschericia coli (E. coli) (43 patients). Underlying diseases, alcohol and tobacco consumption and body mass index (BMI) were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10-14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model.
  
  
  RESULTS
  Nineteen patients (12.8%) died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3), smoking (p < 0.001, RR 16.9; 95% CI 2.1 to 133.5), alcohol abuse (p = 0.008, RR 3.9; 95% CI 1.3 to 11.28), COPD (p = 0.01, RR 8.4; 95% CI 1.9 to 37.1) and rheumatoid arthritis (p = 0.045, RR 5.9; 95% CI 1.2 to 28.8) to be significantly associated with case fatality in bacteraemia in univariate model. The median BMI was significantly higher among those who died compared to survivors (33 vs. 26, p = 0.003). Obesity and smoking also remained independent risk factors for case fatality when their effect was studied together in a multivariate model adjusted with the effect of alcohol abuse, age (continuos variable), sex and causative organism.
  
  
  CONCLUSIONS
  Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, PL 2000, FIN-33521 Tampere, Finland. Reetta.Huttunen@uta.fi
authors.forename: Reetta
authors.initials: R
authors.lastname: Huttunen
authors.forename: Janne
authors.initials: J
authors.lastname: Laine
authors.forename: Jukka
authors.initials: J
authors.lastname: Lumio
authors.forename: Risto
authors.initials: R
authors.lastname: Vuento
authors.forename: Jaana
authors.initials: J
authors.lastname: Syrjänen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002423:Cause of Death; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents