title: Recurrent gram-negative bloodstream infection: a 10-year population-based cohort study.
abstract: BACKGROUND
  Recurrent gram-negative bloodstream infection (BSI) has not been evaluated in a population-based setting; therefore, we performed a population-based retrospective cohort study to examine the incidence, recurrence, and mortality rates of gram-negative BSI.
  
  
  METHODS
  We identified 944 episodes of gram-negative BSI, including 98 recurrent episodes, among Olmsted County, Minnesota, residents from 1/1/1998 to 12/31/2007. Kaplan-Meier method was used to estimate the cumulative incidence rate of recurrence and 28-day all-cause mortality rate of gram-negative BSI. Cox proportional hazard regression was used to determine risk factors for recurrence.
  
  
  RESULTS
  The overall age- and gender-adjusted incidence rate of gram-negative BSI per 100,000 person-years was 84.5 (95% confidence interval [CI]: 79.1-90.0), including 75.7 (95% CI: 70.6-80.8) for first episodes and 8.8 (95% CI: 7.1-10.6) for recurrent episodes. Among 846 patients with first episodes of gram-negative BSI, the cumulative incidence rates of recurrence after 1, 5, and 10 years of the initial episode were 5.6%, 9.2%, and 14.6%, respectively, with death treated as a competing risk. Patients with Klebsiella species were more likely than those with Escherichia coli BSI to develop recurrent gram-negative BSI (hazard ratio: 2.33 [95% CI: 1.34-3.92], p=0.003). The 28-day all-cause mortality rates following the initial and second episodes of gram-negative BSI were 10.0% (95% CI: 8.0-12.0) and 11.3% (95% CI: 4.4-18.2), respectively.
  
  
  CONCLUSIONS
  Even though recurrent gram-negative BSI was relatively uncommon in the general population, up to 15% of patients with gram-negative BSI developed a recurrent episode within 10 years of the initial episode.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA. majdi.alhasan@uky.edu
authors.forename: Majdi N
authors.initials: MN
authors.lastname: Al-Hasan
authors.forename: Jeanette E
authors.initials: JE
authors.lastname: Eckel-Passow
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult