Clinical significance of and outcomes for Bacteroides fragilis bacteremia.
OBJECTIVE
Bacteroides fragilis is a virulent anaerobic pathogen, resulting in considerable mortality. This study was conducted to investigate the clinical characteristics, significance of polymicrobial bacteremia, and treatment outcomes of B. fragilis bacteremia.


METHODS
This retrospective analysis enrolled 199 adult patients with B. fragilis bacteremia, who were admitted to hospital between January 2004 and May 2007. Chi-squared and Fisher's exact tests were used for comparison. A p value of <0.05 was considered statistically significant.


RESULTS
142 patients with B. fragilis bacteremia (71.4%) had at least 1 underlying disease. Malignancy was the commonest comorbidity (n = 62; 31.2%). Intra-abdominal infection accounted for 49.3% of the infection sources. Seventy seven patients (38.7%) had polymicrobial bacteremia and Escherichia coli was the most common concurrent isolate (n = 24). There was no significant difference in septic shock incidence and clinical outcome between the monomicrobial and polymicrobial groups. The overall 30-day crude mortality rate was 30.7%. Inappropriate early antimicrobial therapy did not affect outcome, but a higher mortality rate was noted for patients who never received appropriate antimicrobial therapy (55.2% vs 26.5%; p = 0.002). Independent risk factors for mortality were age 65 years and older (p = 0.010), malignancy (p = 0.001), shock (p < 0.001), thrombocytopenia (p = 0.026), and lack of surgical intervention (p = 0.035).


CONCLUSIONS
B. fragilis bacteremia causes a high mortality rate, especially for elderly people and patients with cancer. Clinicians should be alert to the infectious focus, and appropriate surgical intervention may be necessary to improve outcomes.
Cheng
Chun-Wen
CW
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Lin
Huang-Shen
HS
Ye
Jung-Jr
JJ
Yang
Chien-Chang
CC
Chiang
Ping-Cherng
PC
Wu
Ting-Shu
TS
Lee
Ming-Hsun
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D001442:Bacteroides Infections / Q000175:diagnosis / Q000382:microbiology*; D001441:Bacteroides fragilis / Q000302:isolation & purification*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult