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L Leibovici

Publications and source records attributed to L Leibovici.

At least 55 records · Page 3Linked to original sources
PubMed1999

Empirical treatment of bacteraemic urinary tract infection. Evaluation of a decision support system.

INTRODUCTION: In a Danish county with a low prevalence of antibiotic resistance to most antibiotics, we have constructed and evaluated a decision support system (DSS) for guidance of empirical antibiotic therapy in patients with bacteraemia originating from the urinary tract. METHODOLOGY: The DSS was based upon a causal probabilistic network, and a decision theoretic approach was used to balance the costs of antibiotic therapy against the therapeutic benefit. The costs included direct cost of purchasing antibiotics, side effects, and the risk of development of antibiotic resistance. The therapeutic benefit was defined as the increase in life-expectancy caused by antibiotic therapy. Life-years were chosen as the common currency unit. Four hundred and ninety-one bacteraemias seen during 1992-1994 were used to construct the DSS (derivation set), and 426 bacteraemias during 1995-1996 were used for evaluation (validation set). The cases were identified in a regional register of bacteraemias. The study was non-interventional. RESULTS: The DSS suggested antibiotics which would provide coverage in 377 of the 426 episodes (88.5%) compared to 259 episodes (60.8%) for which empirical therapy actually provided coverage (p < 0.01, McNemar-test). The regimens suggested by the DSS included mecillinam as monotherapy in 240 episodes (56.3%), gentamicin as monotherapy in 81 (19.0%), and a combination of gentamicin and ampicillin in 80 (18.8%). CONCLUSION: A decision theoretic approach shows promise of improving empirical antibiotic treatment, and may be a measure to support an antibiotic policy.

Aged↗
PubMed1998

The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection.

OBJECTIVES: To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement. DESIGN: Observational, prospective cohort study. SETTING: University hospital in Israel. SUBJECTS: All patients with bloodstream infections detected during 1988-94. INTERVENTIONS: None. MAIN OUTCOME MEASURES: In-hospital fatality rate and length of hospitalization. RESULTS: Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons. In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr. A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4-2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3-2.4). Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0-2.7). The highest benefit associated with appropriate treatment was observed in paediatric patients (OR = 5.1, 95% CI = 2.4-10.7); intra-abdominal infections (OR = 3.8, 95% CI = 2.0-7.1); infections of the skin and soft tissues (OR = 3.1, 95% CI = 1.8-5.6); and infections caused by Klebsiella pneumoniae (OR = 3.0, 95% CI = 1.7-5.1) and S. pneumoniae (OR = 2.6, 95% C = 1.1-5.9). On a multivariable logistic regression analysis, the contribution of inappropriate empirical treatment to fatality was independent of other risk factors (multivariable adjusted OR = 1.6, 95% CI = 1.3-1.9). CONCLUSION: Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection.

Adolescent↗
PubMed1997

The development and progression of diabetic retinopathy in type I diabetic patients: a cohort study.

To describe the course and risk factors for development and progression of retinopathy, we studied a cohort of 333 Israeli Jewish patients with Type 1 (insulin-dependent) diabetes mellitus. The median age at diagnosis was 9.5 (range 0.04-26.2) years and the median duration of follow-up was 14 (range 1.6-30) years. Evaluation of both retinae was performed yearly since referral and HbA1 values were tested every 3 months since 1978. During a follow-up of 4070 patient-years, 162 patients developed non-proliferative retinopathy. The median retinopathy-free interval was 14.9 years and after 30 years all patients were affected. Pre-pubertal duration of diabetes was relevant. Independent and significant risk factors for early onset of non-proliferative retinopathy were: poor cumulative glycaemic control (median retinopathy-free interval in the 1st vs 4th quartiles of mean HbA1 values over all years: 18.0 vs 12.5 years, p = 0.0001); onset of diabetes during or after puberty (median retinopathy-free interval in patients with onset of diabetes before, during or after pubescence: 16.3, 13.2 and 14.0 years, respectively, p = 0.0001); and non-Ashkenazi Jewish origin (median retinopathy-free interval 15.8 years in Ashkenazi vs 14.0 in non-Ashkenazi patients, p = 0.0004). Of 162 patients with non-proliferative retinopathy, progression to proliferative retinopathy occurred in 37, during 707 patient-years. The first event of proliferative retinopathy was diagnosed within the 1st year after non-proliferative retinopathy evolved, and at 6.3 years since onset of non-proliferative retinopathy 75% of the patients were still free of proliferative changes. Risk factors significantly and independently associated with an early progression to the proliferative stage were: poor glycaemic control in the last 3 years prior to the development of proliferative retinopathy and non-Ashkenazi Jewish origin. All patients in the 4th quartile of HbA1 values were affected by proliferative retinopathy within 11.6 years after onset of non-proliferative retinopathy.

Adolescent↗
PubMed1997

Five-year prospective study of bacteraemic urinary tract infection in a single institution.

In order to determine the epidemiology, microbiology, and outcome of bacteraemia originating in the urinary tract in hospitalised patients, a prospective study was conducted in a large general hospital in Israel. Data from all patients with bacteraemia were collected prospectively, and a subgroup of patients with bacteraemia secondary to urinary tract infection was analysed. There were 702 episodes of bacteraemia secondary to urinary tract infection during a five-year period (33.9% of all episodes of bacteraemia). The mean age of the patients was 76 years, and the male:female ratio was 0.9:1.0. The most common pathogens were Escherichia coli (52%), Klebsiella spp. (14%), and Proteus spp. (9%). Pseudomonas spp. were isolated from 8% of all patients, from 19% of those who had received antibiotics, and from 15% of males. Enterococcus spp. were isolated from 4% of males but from no females. Five percent of the episodes were polymicrobial, and 16% of the infections were hospital acquired. On logistic multivariate regression analysis, predictors of mortality were: hospitalisation in a medical department, hospital-acquired infection, inappropriate empiric antibiotic treatment, presence of decubitus ulcer(s), respiratory or renal failure, and elevated urea and decreased albumin levels.

Adolescent↗
PubMed1997

Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system.

OBJECTIVES: Develop a problem-orientated and data-based decision support system (DSS) to improve empirical antibiotic treatment, and compare the performance of the system to that of the physician. DESIGN: The DSS was tested in a prospective, noninterventional, comparative cohort study. SETTING: University hospital in Israel. SUBJECTS: Consecutive patients (n = 496) in four departments of internal medicine suspected of harboring a moderate to severe bacterial infection. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The percentage of appropriate empirical antibiotic treatments. RESULTS: Out of 496 patients included in the study, 219 had positive cultures or serological tests. The physicians prescribed inappropriate empirical antibiotic treatment in 91 of 219 patients (42%); whilst the recommendations of the system were inappropriate in 50 patients (23%) (P < 0.05). Superfluous treatment was prescribed in 15% of patients by the physician, and in 11% by the system. Out of the 91 patients given inappropriate treatment by the physician, the DSS advised treatment to which the pathogens were susceptible in 61 patients. The advantage of the DSS over the physician was most evident in multiresistant gram-negative isolates, enterococci and Staphylococcus aureus. Out of the 277 patients with negative cultures, the DSS advised narrower-spectrum antibiotic treatment than prescribed by the physicians in 27% of patients, and broader-spectrum in 13%. CONCLUSION: A problem-orientated, data-based DSS outperformed physicians in the choice of appropriate empirical antibiotic treatment, and recommended less broad-spectrum antibiotics.

Acinetobacter↗
PubMed1997

Monotherapy versus beta-lactam-aminoglycoside combination treatment for gram-negative bacteremia: a prospective, observational study.

The aim of the present study was to test whether the combination of a beta-lactam drug plus an aminoglycoside has advantage over monotherapy for severe gram-negative infections. Of 2,124 patients with gram-negative bacteremia surveyed prospectively, 670 were given inappropriate empirical antibiotic treatment and the mortality rate in this group was 34%, whereas the mortality rate was 18% for 1,454 patients given appropriate empirical antibiotic treatment (P = 0.0001). The mortality rates for patients given appropriate empirical antibiotic treatment were 17% for 789 patients given a single beta-lactam drug, 19% for 327 patients given combination treatment, 24% for 249 patients given a single aminoglycoside, and 29% for 89 patients given other antibiotics (P = 0.0001). When patients were stratified according to risk factors for mortality other than antibiotic treatment, combination therapy showed no advantage over treatment with a single beta-lactam drug except for neutropenic patients (odds ratio [OR] for mortality, 0.5; 95% confidence interval [95% CI], 0.2 to 1.3) and patients with Pseudomonas aeruginosa bacteremia (OR, 0.7; 95% CI, 0.3 to 1.8). On multivariable logistic regression analysis including all risk factors for mortality, combination therapy had no advantage over therapy with a single beta-lactam drug. The mortality rate for patients treated with a single appropriate aminoglycoside was higher than that for patients given a beta-lactam drug in all strata except for patients with urinary tract infections. When the results of blood cultures were known, 1,878 patients were available for follow-up. Of these, 816 patients were given a single beta-lactam drug, 442 were given combination treatment, and 193 were given a single aminoglycoside. The mortality rates were 13, 15, and 23%, respectively (P = 0.0001). Both on stratified and on multivariable logistic regression analyses, combination treatment showed a benefit over treatment with a single beta-lactam drug only for neutropenic patients (OR, 0.2; 95% CI, 0.05 to 0.7). In summary, combination treatment showed no advantage over treatment with an appropriate beta-lactam drug in nonneutropenic patients with gram-negative bacteremia.

Adolescent↗
PubMed1997

Septic shock in bacteremic patients: risk factors, features and prognosis.

Of 4,289 episodes of bacteremia detected in 3,631 patients, septic shock was diagnosed in 453 episodes (10.5%). In 56% of shock episodes, septic shock developed more than 24 h after the first positive blood culture was taken. In a logistic regression analysis, variables predictive of septic shock were: advanced age [odds ratio (OR) of 1.015 for an increment of 1 year]; renal failure as an underlying disorder (OR = 1.47); neutropenia (OR of 2.26); curtailed functional capacity (OR of 1.54 for an increment of 1 category); unknown source of infection (OR = 1.66); anaerobic (OR = 2.86), polymicrobial bacteremia (OR = 1.54), or pathogens other than Streptococcus viridans (OR = 0.08 for Streptococcus viridans). The in-hospital mortality associated with septic shock was 80% vs 21% in episodes of bacteremia without shock, and shock episodes accounted for 31% of all deaths. The fatality rate in shock patients given appropriate empiric antibiotic treatment was 74.9% vs 84.7% in patients given inappropriate treatment (p = 0.01). Judging by the present results, host factors are more important determinants for development of septic shock in bacteremic patients than the type of pathogen. Even in patients with shock, appropriate empiric antibiotic treatment was associated with an improved chance of survival.

Adult↗
PubMed1996

Influence of diabetes mellitus and glycaemic control on the characteristics and outcome of common infections.

The aim of the present study was to elucidate the effect of diabetes and metabolic control on the presentation, sources, pathogens and outcome of common infections. Of 515 patients admitted to three departments of internal medicine because of a suspected acute infection, 132 (26%) had diabetes mellitus. Osteomyelitis was diagnosed in 3% of the diabetic patients and in 1% of patients without diabetes, and infection of the extremities in 7% and 0%, respectively (p = 0.003). Klebsiella sp. caused 24% of urinary tract infections in diabetic patients, versus 13% in patients without diabetes (p = 0.1). The percentage of Staphylococcus aureus infections in diabetic patients was 10% versus 5% in non-diabetic patients (p = 0.06). The gross mortality rate in the diabetic patients was 10%, and in patients without diabetes, 12%. In patients without fatal underlying disorders, mortality in the diabetic patients was 10% (2% in patients with glycosylated haemoglobin (GHb) lower than median, and 17% in patients with GHb higher than median) and in the non-diabetic patients 4% (p = 0.04). Five factors were independently and significantly related to mortality in diabetic patients: acute respiratory distress (very large odds-ratio [OR]), coma (OR 3.8, 95% confidence interval [CI] 1.0-14.3), GHb above the median (OR 3.3, 95% CI 1.8-6.2), the interaction between GHb and absence of a severe underlying disorder (OR 12.0, 95% CI 2.9-50.7) and duration of diabetes (OR of 1.072 for 1-year increment, and 1.42 for a 5-year increment). Choice of empiric antibiotic treatment in diabetic patients with suspected bacterial infection should take into account the preponderance of Klebsiella sp. and Staphylococcus aureus infections. The present results favour an association between poor glycaemic control and a fatal outcome of infectious diseases in diabetic patients.

Aged↗
PubMed1996

Factors associated with increased risk in inappropriate empiric antibiotic treatment of childhood bacteraemia.

UNLABELLED: To identify bacteraemic children who are at increased risk of inappropriate empiric antibiotic therapy, we performed univariate and multivariate analyses of prospectively-studied bacteraemic episodes. Appropriateness of therapy was defined according to the in vitro susceptibility of the isolate. Inappropriate empiric therapy was found in 38% of 516 bacteraemic episodes and was associated with higher mortality. The rate of inappropriate treatment was lower in neonates and infants (28% and 33%, respectively) but higher in children 1- to 5-years old (51%, P = 0.0029). The rate was dependent on the source of bacteraemia (range, 18%-70%, P = 0.0092), underlying conditions (range, 26%-53%, P = 0.0001), the specific paediatric section in which the child was hospitalized (range, 24%-70%, P = 0.0002), and the causative micro-organism (range, 15%-75%, P < 0.0001). Four clinical variables that independently and significantly affected the rate of inappropriate antibiotic treatment were identified by multivariate stepwise logistic regression analysis (odds ratios in parentheses): hospital-acquired bacteraemia (2.3), age of 1- to 5-years (2.1), cytotoxic therapy (1.8) and presence of central i.v. line (1.6). CONCLUSION: We defined bacteraemic children who are at risk of inappropriate empiric antibiotic therapy. Special efforts are needed to improve their treatment and consequently their outcome.

Adolescent↗
PubMed1996

Two rules for early prediction of bacteremia: testing in a university and a community hospital.

BACKGROUND: Two rules (model 1 and model 2) were previously derived and prospectively validated at the same institution to predict the likelihood of bacteremia. The objective of the present study was to test and compare the performance of the rules in patients admitted to two sites of inpatient care: a university hospital and a community hospital. METHODS: Clinical and laboratory data (including the variables contained in the two models) were collected within 24 hours in all patients admitted to the Department of Medicine of the Beilinson Medical Center, a university hospital in central Israel, and Emek Hospital, a community hospital in northern Israel, because of an acute infectious disease. The scores of the models were compared with the results of blood cultures. RESULTS: The percentage of bacteremia was 15% in the university and 18.5% in the community hospital. The area under the receiver-operating characteristic curve was 0.56 + or - 0.04 SE for model 1, and 0.67 + or - 0.04 SE for model 2 in the university hospital; and 0.59 + or - 0.05 SE versus 0.63 + or - 0.04 SE, respectively, in the community hospital. At the best calibration, model 1 defined low-risk groups of 205 patients in the university hospital, and 66 patients in the community hospital, with prevalences of bacteremia of 13% and 15%. The high-risk groups defined by model 1 had prevalences of 30% and 32%. Model 2 defined low-risk groups with prevalences of bacteremia of 7% (8 of 114) and 8% (6 of 76); and high-risk groups with percentages of 29% and 38%. CONCLUSIONS: The overall accuracy of the two models deteriorated significantly. Both models defined groups at high risk of bacteremia, but the percentages of bacteremia and of death in the low-risk groups do not encourage withholding blood cultures in these patients. The failure of the two models points toward the need for external validation, and for monitoring performance of prediction models over time.

Adolescent↗
PubMed1996

A prospective study of Gram-negative bacteremia in children.

BACKGROUND: Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in > 50% of pediatric patients with bacteremia. OBJECTIVES: To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center. METHODS: A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel. RESULTS: Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin. CONCLUSIONS: Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.

Adolescent↗
PubMed1996

Incidence and severity of group A streptococcal bacteremia in a medical center in Israel, 1981-1994.

To determine recent trends in the incidence and severity, group A streptococcal (GAS) bacteremia was studied over the last 14 years (1981-1994). There were 116 events of GAS bacteremia, representing 1.7% of all bacteremic episodes, without an increase in recent years. A total of 108 patients were available for study. Underlying conditions were found in 95 patients (88%), including mainly malignant diseases, chronic obstructive pulmonary disease, congestive heart failure and diabetes mellitus. A source of the bacteremia was noted in 71 patients (66%), with skin and soft tissue infection being the major portal of entry. All isolates were susceptible to penicillin. Overall mortality was 21%. Mortality had not increased in recent years, but depended significantly on several clinical factors: increased age; admission temperature; source of bacteremia (highest for GAS bacteremia without an identified source); and underlying conditions (highest for diabetes mellitus and chronic pulmonary disease, absent for patients with no underlying disease). This study shows that neither the incidence nor the severity of GAS bacteremia has increased in recent years. Severity is significantly affected by the source of bacteremia and the presence of underlying conditions.

Adolescent↗
PubMed1995

Long-term survival following bacteremia or fungemia.

OBJECTIVE: To delineate long-term survival after an episode of bacteremia or fungemia and risk factors for mortality. DESIGN: Cohort study. SETTING: A 900-bed university hospital in Israel. PATIENTS: Study group 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 diseases, matched for age, sex, department, date of admission, and underlying 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 years. 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 was 16.2 months. In the control group, the mortality rate was 7% at 1 month, 27% at 1 year, and 42% at 4 years, and the median survival was greater than 75 months (P < .001). Factors significantly and independently associated with mortality in bacteremic patients were functional class (median survival, 0.5 month in bedridden patients), septic shock (median survival, 0.2 month), serum albumin (median survival, 1.1 months in the lowest quartile), serum creatinine (median survival, 2.9 months in the highest quartile), age (median survival, 2.9 months in the highest quartile [age > 80 years]), inappropriate empirical antibiotic treatment (median survival, 4.9 months), nosocomial infection (median survival, 9.6 months), and malignancy (median survival, 2.4 months). CONCLUSIONS: 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 creatinine, nosocomial infections, malignancy, inappropriate antimicrobial treatment, and septic shock and in elderly patients.

Adult↗
PubMed1995

Bacteraemia in a community and a university hospital.

Four hundred and forty-one and 1048 episodes of bacteraemia were prospectively surveyed over a period of 18 months in two hospitals, a 450 bed community hospital and a 900 bed tertiary care urban university hospital. Incidence of bacteraemia was 2.18 per 1000 hospitalization days (10.1 per 1000 admissions) in the community hospital and 2.64 per 1000 hospitalization days (12.0 per 1000 admissions (P < 0.004)) in the university hospital. Sixty six and 62% of episodes of bacteraemia were community acquired. The majority of bacteraemic episodes originated on the internal medicine wards of both hospital--46.7% and 58.7% respectively; the incidence of bacteraemia in the medical divisions of both hospitals was 23.1 and 17.5 per 1000 admissions respectively (P < 0.01). Overall mortality rates were 22% and 26.7% respectively. 39.9% and 44% of all isolates were Gram-positive pathogens. Escherichia coli was the commonest Gram-negative pathogen in both hospitals, particularly the community hospital--47.5% vs 32.8% (P < 0.005) of all Gram-negative pathogens, while Pseudomonas spp. were significantly more common in the university hospital--18.5% vs 11.8% (P < 0.02). Non-enterococcal streptococci were more common in the community hospital while enterococci were far more common at the university hospital--15.1% vs 1% of all Gram-positive pathogens (P < 0.05). Staphylococcus epidermidis was more common among the community hospital Gram-positive bacteraemias--31.1% vs 18.6% (P < 0.005). For almost all genera and species, antibiotic resistance was higher at the university hospital. Twenty nine point four per cent of Staphylococcus aureus isolates from the university hospital were methicillin resistant compared to 2.4% at the community hospital (P < 0.005). 29.4% of all Streptococcus pneumoniae isolates at the university hospital were penicillin resistant while no resistance was found at the community hospital. A high resistance rate to ofloxacin was found at the university hospital among S. aureus and Pseudomonas sp. Sources of bacteraemia did not differ significantly between the two hospitals. In conclusion, although outcome did not differ significantly for the two hospitals, there were significant differences between blood culture isolates in these two different settings. These differences may influence clinical decision-making about antibiotic therapy for patients in these hospitals.

Adult↗
PubMed1995

Bacteraemia in the very old. Features and treatment.

Bacteraemia is a common disorder in the elderly, and its prevalence and incidence increase with age. It carries a mortality rate of 20 to 40%. The signs and symptoms of bacteraemia are often blunted or nonspecific in the elderly, and the index of suspicion should therefore be high. Comparing underlying disorders of bacteraemia between older and younger patients, the percentage of past cerebrovascular accidents, dementia and decubitus ulcer increases sharply with age, while the percentage of neutropenia is lower. Elderly patients have a predilection for anaerobic bloodstream infections, and for multiresistant bacteria, although age is not an independent risk factor for resistance. Bacterial endocarditis in the old is caused mainly by gut bacteria. Appropriate empirical antibiotic treatment reduces mortality, regardless of age. To target antibiotic treatment, the physician should consider the patient's salient features, and the overall susceptibility of the micro-organisms in the local ecosystem. The most important supportive measure for treatment of sepsis or septic shock is fluid repletion. No non-antibiotic drug has been shown to be effective in sepsis.

Aged↗
PubMed1995

Prognostic significance of the neutrophil count in immunocompetent patients with bacteraemia.

To examine the prevalence of neutropaenia in immunocompetent, bacteraemic patients, and whether it carries an independent risk for mortality, we surveyed 2096 bacteraemic patients without malignant diseases, and who were not receiving cytotoxic drugs. The granulocyte count on the day of the first positive blood culture was < 1 x 10(9) cells/l in 33 patients (1.7%, group 1); 1.0-4.0 x 10(9) cells/l in 154 patients (7.9%, group 2); 4.0-8.0 x 10(9) cells/l in 564 patients (29%, group 3); 8.0-20.0 x 10(9) cells/l in 1034 patients (53%, group 4); and > 20.0 x 10(9) cells/l in 163 patients (8.4%, group 5). The mortality rates in the five groups were 39.4%, 18.8%, 18.1%, 25.7% and 25.8%, respectively (p = 0.0001). The main pathogens in group 1 were Staphylococcus aureus in 25% of patients and Pseudomonas sp. in 23%. Mortality in group 1 patients was higher than in the other patients (odds ratio 1.4, 95% CI 1.1-1.9]. Mortality was also significantly higher in group 2 patients with high blood urea nitrogen. The percentage of neutropaenia, septic patients without known risk factors for neutropaenia is small, but their mortality is high. Overall mortality in patients with relative neutropaenia (1.0-4.0 x 10(9) cells/l) is low, but a subgroup of patients with high blood urea nitrogen is at considerable risk for a fatal outcome. High leucocyte counts are also a marker of increased risk for mortality, but this association is not an independent prognostic factor.

Adolescent↗