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Overview :
Bonomo et al identified factors affecting survival in
patients with bacteremia caused by an Enterobacter species in a tertiary medical
center. This can help identify a patient at a high risk for mortality who may
benefit from more aggressive interventions. The authors are from University
Hospitals of Cleveland and the Cleveland Veterans Affairs Medical Center.
Definition of bacteremia in the adult - all of the
following:
(1) at least one set of positive blood cultures
(2) fever > 37.7°C, or hypothermia
(3) WBC count >= 11,000 or <= 2,000 per µL
(4) hypotension with systolic blood pressure < 90 mm
Hg
Factors associated with increased mortality in logistic
regression:
(1) age > 65 years (odds ratio 2.35)
(2) intra-abdominal source for the bacteremia (odds ration
3.72)
(3) need for vasopressor support (septic shock)
(4) steroid use (odds ratio 3.11)
(5) instrumentation at the time of bacteremia (odds ratio
3.00)
Factors associated with increased survival (resulting in
removal of source):
(1) removal of indwelling catheters (either urinary or
intravascular)
(2) surgical intervention with drainage of abscess (odds
ratio for mortality 0.12)
Resistance of the bacteria to third generation cephalosporins
and broad-spectrum penicillins was constant at 7% during the study period.
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