AN ANALYSIS OF NINETY ADULT PATIENTS WITH GRAM-NEGATIVE ROD BACTEREMIA

Abstract

The clinical courses have been analyzed on 90 adult patients with gram-negative rod bacteremia. The yearly frequency rate of the disease has tended to increase. The highest rate was seen in 1972 at 4. 1 episodes per 1, 000 admissions to Chiba University Hospital.
Mortality of the overall patients was 49%. Shock was seen in 38% of them. The mortality was analyzed from severity of underlying disease and accompanying of shock. Mortality of the patients having nonfatal underlying disease without shock was least, 17%, whereas that of the patients accompanying ultimately fatal underlying disease with shock was 78%. None of the patients of rapidly fatal underlying disease survived.
The most common organisms isolated from the bacteremia was E. coli, followed by Klebsiella, Pseudomonas, and Proteus, in order. E. coli was isolated more frequently from the patients with nonfatal underlying disease, whereas Pseudomonas was detected more frequently in the cases with fatal underlying disease, and associated with the highest mortality. Polymicrobial bacteremia was seen in 10% of the patients. The most common source of the bacteremia was urinary tract, and followed by biliary tract. The species of the isolated organisms was different in character following the portal of entry, hospital service, category of underlying disease.
All but four patients had high fever. Leukocytosis was not seen in 32% of the patients without hematologic disease and they were mostly elderly persons. Instrumentation of urinary tract, immunosuppressive agents, hematologic disease, biliary and hepatic disease, diabetes mellitus, and neoplastic disease appeared to be chief predisposing factors of the bacteremia. More than a half of the patients acquired the bacteremia in the hospital. All isolated gram-negative rods, except Bacteroides, were susceptible to gentamicin in vitro.