Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia.
BACKGROUND
The aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB).


METHODS
From the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis.


RESULTS
Of 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35-4.74), after adjustment for other variables predicting poor prognosis.


CONCLUSIONS
Severe sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan Universiy School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, South Korea.
Cheol-In
CI
Kang
Jae-Hoon
JH
Song
Doo Ryeon
DR
Chung
Kyong Ran
KR
Peck
Kwan Soo
KS
Ko
Joon-Sup
JS
Yeom
Hyun Kyun
HK
Ki
Jun Seong
JS
Son
Seung Soon
SS
Lee
Yeon-Sook
YS
Kim
Sook-In
SI
Jung
Shin-Woo
SW
Kim
Hyun-Ha
HH
Chang
Seong Yeol
SY
Ryu
Ki Tae
KT
Kwon
Hyuck
H
Lee
Chisook
C
Moon
D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D012772:Shock, Septic / Q000453:epidemiology*; D018746:Systemic Inflammatory Response Syndrome; D016896:Treatment Outcome