title: Impact of body mass index on clinical outcomes in patients with gram-negative bacteria bloodstream infections.
abstract: BACKGROUND
  Excess body mass index (BMI) is associated with a higher risk of death in many disease states, yet less is known about the impact of higher BMIs on clinical outcomes of serious bacterial infections. We sought to quantify the risk of all-cause mortality and/or organ failure following Gram negative bacteria bloodstream infections (GNBSI) according to BMI.
  
  
  METHODS
  We retrospectively reviewed the charts of patients with confirmed GNBSI who received ≥48 h of active antimicrobial therapy. Composite and component patient outcomes, including hospital mortality and organ failure, were assessed as a function of BMI. Organ failure was defined using modified consensus Surviving Sepsis Campaign definitions. Multi-variate methods were used to control for baseline confounders.
  
  
  RESULTS
  Seventy-six patients met our inclusion criteria, of whom 8 died (10.5%). The majority of GNBSI were Escherichia (41.6%) or Klebsiella species (23.3%). Patients with higher BMI more frequently developed cardiovascular failure (P = 0.032), respiratory failure (P < 0.001), renal failure (P = 0.003), and died (P = 0.009). Multivariate analyses demonstrated that higher BMIs were associated with a greater risk of death and/or organ failure (aOR 1.07, 95% CI 1.01-1.14), respiratory failure (aOR 1.10, 95% CI 1.03-1.17), and renal failure (aOR 1.08, 95% CI 1.01-1.14) after adjusting for relevant covariates.
  
  
  CONCLUSIONS
  Higher BMIs in patients with GNBSIs were associated with a greater risk of a composite of all-cause mortality and organ failure.
authors: Department of Pharmacy, Northwestern Medicine, USA.
authors: Bryan D
authors: BD
authors: Lizza
authors: Department of Pharmacy, Northwestern Medicine, USA; Department of Pharmacy Practice, Midwestern University, USA.
authors: Nathaniel J
authors: NJ
authors: Rhodes
authors: Department of Pharmacy, Northwestern Medicine, USA; Chicago State University College of Pharmacy, Department of Pharmacy Practice, USA.
authors: John S
authors: JS
authors: Esterly
authors: Chicago College of Pharmacy, Midwestern University, USA.
authors: Carolyn
authors: C
authors: Toy
authors: Chicago College of Pharmacy, Midwestern University, USA.
authors: Jenna
authors: J
authors: Lopez
authors: Department of Pharmacy, Northwestern Medicine, USA; Department of Pharmacy Practice, Midwestern University, USA. Electronic address: mschee@midwestern.edu.
authors: Marc H
authors: MH
authors: Scheetz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology / Q000401:mortality*; D050177:Overweight / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bloodstream infections; Death; Obesity; Organ failure; Sepsis