LONG-TERM SURVIVAL FOLLOWING BACTEREMIA OR FUNGEMIA

Objective.-To delineate long-term survival after an episode of bactere mia or fungemia and risk factors for mortality. Design.-Cohort study. Setting.-A 900-bed university hospital in Israel. Patients.-Study grou p comprising 1991 patients 18 years of age or older in whom bacteremia or fungemia were detected between March 1988 and October 1992, and a control group comprising 1991 inpatients without any infectious diseas es, matched for age, sex, department, date of admission, and underlyin g disorders.Interventions.-None. Measurements.-Interval from the date of the first positive blood culture (study group) or from date of the identical hospital day (in the matched control patient) to the date of death as recorded in the Israeli National Population registry or, if alive, to June 1, 1994. Results.-The median age of patients was 72 yea rs. in the study group, the mortality rate was 26% at 1 month, 43% at 6 months, 48% at 1 year, and 63% at 4 years, and the median survival w as 16.2 months. In the control group, the mortality rate was 7% at 1 m onth, 27% at 1 year, and 42% at 4 years, and the median survival was g reater than 75 months (P<.001). Factors significantly and independentl y associated with mortality in bacteremic patients were functional cla ss (median survival, 0.5 month in bedridden patients), septic shock (m edian survival, 0.2 month), serum albumin (median survival, 1.1 months in the lowest quartile), serum creatinine (median survival, 2.9 month s in the highest quartile), age (median survival, 2.9 months in the hi ghest quartile [age >80 years]), inappropriate empirical antibiotic tr eatment (median survival, 4.9 months), nosocomial infection (median su rvival, 9.6 months), and malignancy (median survival, 2.4 months). Con clusions.-Bacteremia is associated with high short-term mortality, but also a sign of severely curtailed long-term prognosis, especially in patients with low functional capacity, low serum albumin, high serum c reatinine, nosocomial infections, malignancy, inappropriate antimicrob ial treatment, and septic shock and in elderly patients.