BACTEREMIA AT A DANISH UNIVERSITY HOSPITAL DURING A 25-YEAR PERIOD (1968-1992)

In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. En terobacteriaceae dominated as causative agents (57%), following by Gra m-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia wa s found in 8% of the episodes. The incidence of Enterobacteriaceae bac teremia culminated in the middle (1978-82) of the period (4.7/1,000 ad missions) and decreased during the last decade. Gram-positive bacterem ia increased throughout the period (from 1.8 to 2.9; p < 0.001), due m ainly to increasing incidences of bacteremia caused by non-hemolytic s treptococci, Streptococcus pneumoniae and coagulase-negative staphyloc occi. Bacteroides fragilis accounted for a rising incidence of anaerob ic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were availabl e for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with i ndwelling catheters, mainly bladder catheters (28%) and i.v. lines (7% ). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently ma lignancies (20%) and diabetes mellitus (7%). The mortality rate relate d to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the fir st 2 days after the first positive blood culture was obtained. Logisti c regression analysis defined 7 variables that independently influence d the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antib iotic treatment. A local knowledge of the most common causative microo rganisms, the most common sources and the outcome of bacteremia, are o f the utmost importance in the selection of the initial empirical anti biotic regimens.