BLOOD-STREAM INFECTIONS AT A NORWEGIAN UNIVERSITY HOSPITAL, 1974-1979AND 1988-1989 - CHANGING ETIOLOGY, CLINICAL-FEATURES, AND OUTCOME

All episodes of bloodstream infection in patients admitted to a Norweg ian university hospital in 1974-1979 and in 1988-1989 were analyzed; a ltogether, there were 1,447 episodes involving 1,286 patients, and 54. 3% of all episodes were hospital-acquired. The incidence of bloodstrea m infection increased between the two periods studied from 4.26/1,000 admissions to 8.71/1,000. Crude mortality rates were 27.6% and 18.8% a nd attributable mortality rates were 12.3% and 6.9% in the first and s econd periods, respectively. Patients >60 years of age accounted for m ore than half of the bloodstream infections; mortality in this group w as significantly higher than that among younger patients (31.4% vs. 13 .9%). The frequency of isolation of Enterobacteriaceae decreased from 48% in the first period to 34% in the second, while the rate of isolat ion of coagulase-negative staphylococci increased from 6.5% to 16.9%. The shift in etiology may be explained in part by the occurrence of si gnificantly more bloodstream infections related to intravascular devic es, endocarditis, and skin and wound infections and of significantly f ewer episodes related to abdominal or genitourinary disease in the sec ond than in the first period. Almost all isolates of Enterobacteriacea e were susceptible to newer cephalosporins and aminoglycosides. In 197 4-1979, 96 (69.1%) of 139 patients with septic shock died; in 1988-198 9, the figure was 35 (52.2%) of 67 patients (P = .019). Clinical facto rs predictive of an adverse outcome were septic shock (odds ratio for first/second period, 12.7/4.6), intensive care treatment (not signific ant/ 10.6), malignant disease (4.6/2.6), any underlying disease (4.2/n ot significant), diabetes mellitus (3.6/not significant), age of >60 y ears (not significant/3.0), and pulmonary source of infection (not sig nificant/2.8).