Gram-negative bacteremia: variable clinical course and useful prognostic factors

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In recent years, bacteremia caused by gram-negative bacilli has become a common cause of death. It is estimated that from 18,000 to 100,000 deaths are now caused by gram-negative bacteremia in the United States each year.1, 2 Coexistent diseases3–9 and shock10 appear to be major determinants of outcome. However, in most published studies of gram-negative bacteremia, deaths caused by infections have not been differentiated from those unrelated to infection,1 the effect of duration of bacteremia on outcome has not been assessed11–13 and, to our knowledge, no attempt to grade the illness produced by infection has been reported. Furthermore, opinions vary concerning the possible relationship of the apparent portal of entry of the causal organism to outcome. Some investigators8, 14, 15 found a significantly higher mortality from gram-negative bacteremia when it arose from the abdomen or lung than when it developed from the urinary tract or pelvic cavity. However, other investigators4–6 found that the source of bacteremia did not significantly influence mortality when the grade of underlying disease was taken into consideration.

The investigation we report here was undertaken in order to study the course of gram-negative bacteremia and to assess the possible influence of the following five factors on the outcome of the infection: (1) duration of the episode of bacteremia, (2) grade of systemic illness attributed to the infection, (3) apparent portal of entry of the causal organism, (4) grade of the underlying disease, and (5) antimicrobial chemotherapy. Each patient included in this study had one. . .



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