GRAM-NEGATIVE BACTEREMIA IN NON-NEUTROPENIC PATIENTS - A 3-YEAR REVIEW

The causative organisms, clinical manifestations, factors influencing prognosis, and other epidemiological characteristics of 81 episodes of bacteremia due to gram-negative organisms, in non-neutropenic patient s, were studied retrospectively during a 3-year period (1992-1994) at the Department of Internal Medicine of the University Hospital of Hera klion, Crete, Greece. The gram-negative bacteremia incidence was 2% an d the overall mortality 12%, All 81 patients had fever; Escherichia co li was the most frequent organism isolated (from 47 patients -58%) and was associated,vith shock (9/47), disseminated intravascular coagulat ion (DIC) (8/47), anuria (5/47), adult respiratory distress syndrome ( ARDS) (3/47), and pneumonia (1/47), Other less frequent gram-negative microorganisms were Klebsiella spp, (ten patients; 12%), Pseudomonas s pp, (7; 7%), Salmonella spp. (5; 6%), Enterobacter spp, (5; 6%), Prote us spp, (3; 3.4%), Stenotrophomonas spp, (3; 3.4%), and Acinetobacter spp, (1; 1.2%). ARDS, shock, DIG, anuria, presence of central venous c atheter, urinary catheter, unknown origin of infection and inappropria te treatment were significantly associated with a higher death rate. E arly initiation of appropriate therapy was the most important interven tion that favorably affected the outcome of gram-negative bacteremias in this patient population.