BACTEREMIA AND SEVERE SEPSIS IN ADULTS - A MULTICENTER PROSPECTIVE SURVEY IN ICUS AND WARDS OF 24 HOSPITALS

To examine the relationships between bacteremia and severe sepsis and assess the influence of characteristics of infection on the risk of se vere sepsis and outcome of bacteremia, we analyzed all clinically sign ificant episodes of bacteremia occurring during a 2-mo prospective sur vey of 85,750 admissions to adult wards and intensive care units (ICUs ) of 24 hospitals in France. Incidence rates of bacteremia and of bact eremic severe sepsis were 9.8 (95% CI: 9.2 to 10.5) and 2.6 (95% CI: 2 .2 to 2.9), respectively, per 1,000 adult admissions; these rates were eight and 32 times higher in ICUs than in wards, respectively. Indepe ndent risk factors for severe sepsis during bacteremia included age (p < 0.001) and an intraabdominal (p < 0.001), pulmonary (p < 0.001), ne uromeningeal (p = 0.004), or multiple (p < 0.001) source of bacteremia , but not categories of organisms involved. The probability of death a t 28 d after bacteremia was 25% (95% CI: 23% to 29%), and was 54% (95% CI: 48% to 61%) in patients with bacteremic severe sepsis. The risk o f death after bacteremia increased with age (p < 0.001), a rapidly or ultimately fatal underlying disease (p < 0.001), and the presence of s evere sepsis (p < 0.001), shock (p = 0.03), and infection caused by gr am-positive organisms other than coagulase-negative staphylococci, rel ative to other organisms (p < 0.001). A primary urinary tract source o f infection was associated with a better prognosis (p = 0.03). We conc lude that whereas sources of infection influence both the risk of seve re sepsis and the outcome of bacteremia, the microbiologic characteris tics of infection influence only the outcome, with gram-negative organ isms and coagulase-negative staphylococci posing a lesser risk than ot her organisms.