Gram-negative bacteremia of long duration

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Bacteremia caused by opportunistic gram-negative bacilli frequently is of short duration, varying in severity from transient, self-limiting illness to rapidly lethal disease. In 1924 bacteremia of long duration (BLD) was reported by Felty and Keefer1 as an uncommon complication of bloodstream infections caused by Escherichia coli. They stated that bacteremia rarely lasted more than 1 or 2 days. Since that time, reports of gram-negative bacillus BLD have been limited mostly to single cases,2–15 to studies of typhoid fever,16–17 or to investigations of unusual types of salmonellosis.18–20

To our knowledge, no systematic study has been undertaken to determine the incidence of BLD in a large number of patients with bloodstream infections caused by E. coli, Klebsiella, Enterobacter, Pseudomonas aeruginosa, Bacteroides, or other opportunistic gram-negative bacilli. Our investigation was undertaken to detect cases of BLD, to identify the organisms most often involved, and to determine possible pathogenic factors. We are reporting an analysis of our clinical and microbiologic observations and findings in the treatment of 29 patients during 30 episodes of BLD lasting from 4 to 46 days. In 25 of the 30 episodes, bacteremia persisted for 7 or more days.

Materials and methods

From September 15, 1967, to August 15, 1971, at the Cleveland Clinic Hospital, we examined repeatedly and treated 185 patients with gram-negative bacillus bacteremia; it was of long duration in 29. The criterion for diagnosis of BLD was continuing illness associated with one or more blood cultures positive for the same genus or species of gram-negative bacillus on . . .



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