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Risk Factors For Mortality In Patients With Anaerobic Bacteremia

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Abstract

Risk factors for mortality in anaerobic bacteremia have been incompletely defined. The aims of the present study were to determine clinical significance by pathogen for a broad range of obligate anaerobic organisms isolated from blood, and to define the factors independently associated with mortality among those with clinically significant bacteremia. All patients who had anaerobic bacteria isolated from blood over a 19-month period (from 1 September 1998 to 1 April 2000) at two urban teaching hospitals were included in this study. Each case was analyzed for clinical significance by means of a retrospective medical record review using predetermined definitions. Information was collected on a broad range of clinical and microbiological factors, which were evaluated for their association with mortality using a Cox proportional hazards model. Among 166 patients with obligate anaerobic bacteria isolated from blood, 73 (44%) were deemed to have clinically significant bacteremia. Clinical significance ranged from 0% (0/53) for Propionibacterium spp. to 96% (43/45) for Bacteroides spp. The crude mortality rate in patients with clinically significant anaerobic bacteremia was 25% (18/73). Mortality was significantly associated with age, polymicrobial infection, and underlying heart, kidney or liver disease in univariate analysis. Only the presence of liver disease (relative risk, 5.3; 95% confidence interval, 1.7–16.0; P=0.003) and patient age (relative risk, 1.06/y; 95% confidence interval, 1.0–1.1; P=0.005) remained significant in multivariate analysis. Among patients with anaerobic bacteremia, clinical significance varies markedly by pathogen and mortality is independently associated with age and underlying liver disease.

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References

  1. Goldstein EJ (1996) Anaerobic bacteremia. Clin Infect Dis 23 (Suppl 1):97–101

    PubMed  Google Scholar 

  2. Vazquez F, Mendez FJ, Perez F, Mendoza MC (1987) Anaerobic bacteremia in a general hospital: retrospective five-year analysis. Rev Infect Dis 9:1038–1043

    PubMed  Google Scholar 

  3. Bouza E, Reig M, Garcia de la Torre M, Rodriguez-Creixems M, Romero J, Cercenado E, Baquero F (1985) Retrospective analysis of two hundred and twelve cases of bacteremia due to anaerobic microorganisms. Eur J Clin Microbiol 4:262–267

    PubMed  Google Scholar 

  4. Gomez J, Banos V, Ruiz J, Herrero F, Perez M, Pretel L, Canteras M, Valdes M (1993) Clinical significance of anaerobic bacteremias in a general hospital. A prospective study from 1988 to 1992. Clin Investig 71:595–599

    PubMed  Google Scholar 

  5. Kornowski R, Schwartz D, Averbuch M, Levo Y, Berger S, Giladi M (1993) Anaerobic bacteremia: a retrospective four-year analysis in general medicine and cancer patients. Infection 21:241–244

    PubMed  Google Scholar 

  6. Brook I (1989) Anaerobic bacterial bacteremia: 12-year experience in two military hospitals. J Infect Dis 160:1071–1075

    Google Scholar 

  7. Peraino VA, Cross SA, Goldstein EJ (1993) Incidence and clinical significance of anaerobic bacteremia in a community hospital. Clin Infect Dis 16 (Suppl 4):288–291

    PubMed  Google Scholar 

  8. Lombardi DP, Engleberg NC (1992) Anaerobic bacteremia: incidence, patient characteristics, and clinical significance. Am J Med 92:53–59

    CAS  PubMed  Google Scholar 

  9. Salonen JH, Eerola E, Meurman O (1998) Clinical significance and outcome of anaerobic bacteremia. Clin Infect Dis 26:1413–1417

    CAS  PubMed  Google Scholar 

  10. Wilson WR, Martin WJ, Wilkowske CJ, Washington JA (1972) Anaerobic bacteremia. Mayo Clin Proc 47:639–646

    CAS  PubMed  Google Scholar 

  11. Dorsher CW, Rosenblatt JE, Wilson WR, Ilstrup DM (1991) Anaerobic bacteremia: decreasing rate over a 15-year period. Rev Infect Dis 13:633–636

    CAS  PubMed  Google Scholar 

  12. Riley TV, Aravena MA (1995) Anaerobic bacteraemia in an Australian teaching hospital. Eur J Clin Microbiol Infect Dis 14:73–75

    CAS  PubMed  Google Scholar 

  13. Nguyen MH, Yu VL, Morris AJ, McDermott L, Wagener MW, Harrell L, Snydman DR (2000) Antimicrobial resistance and clinical outcome of Bacteroides bacteremia: findings of a multicenter prospective observational trial. Clin Infect Dis 30:870–876

    Article  CAS  PubMed  Google Scholar 

  14. Chen YM, Lee HC, Chang CM, Chuang YC, Ko WC (2001) Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients. J Microbiol Immunol Infect 34:113–118

    CAS  PubMed  Google Scholar 

  15. Haddy RI, Nadkarni DD, Mann BL, Little DR, Domers TD, Clover RD, Silvers MJ (2000) Clostridial bacteremia in the community hospital. Scand J Infect Dis 32:27–30

    Article  CAS  PubMed  Google Scholar 

  16. Koransky JR, Stargel MD, Dowell VR Jr (1979) Clostridium septicum bacteremia. Its clinical significance. Am J Med 66:63–66

    CAS  PubMed  Google Scholar 

  17. Pietrafitta JJ, Deckers PJ (1982) Significance of clostridial bacteremia. Am J Surg 143:519–522

    CAS  PubMed  Google Scholar 

  18. Rechner PM, Agger WA, Mruz K, Cogbill TH (2001) Clinical features of clostridial bacteremia: a review from a rural area. Clin Infect Dis 33:349–353

    Article  CAS  PubMed  Google Scholar 

  19. Myers G, Ngoi SS, Cennerazzo W, Harris L, DeCosse JJ (1992) Clostridial septicemia in an urban hospital. Surg Gynecol Obstet 174:291–296

    CAS  PubMed  Google Scholar 

  20. Marcoux JA, Zabransky J, Washington JA II, Wellman WE, Martin WJ (1970) Bacteroides bacteremia. Minn Med 53:1169–1176

    CAS  PubMed  Google Scholar 

  21. McHencry MC, Wellman WE, Martin WJ (1961) Bacteremia due to Bacteroides: review of 11 cases. Arch Intern Med 107:572–577

    PubMed  Google Scholar 

  22. Bourgault AM, Lamothe F, Dolce P, Saint-Jean L, Saint-Antoine P (1997) Fusobacterium bacteremia: clinical experience with 40 cases. Clin Infect Dis 25 (Suppl 2):181–183

    Google Scholar 

  23. Bryan CS, Reynolds KL, Kirkhart B, Brown JJ (1984) Bacteroides bacteremia. Analysis of 142 episodes from one metropolitan area. Arch Surg 119:894–897

    CAS  PubMed  Google Scholar 

  24. Chow AW, Guze LB (1974) Bacteroidaceae bacteremia: clinical experience with 112 patients. Medicine (Baltimore) 53:93–126

    Google Scholar 

  25. Henry S, DeMaria A Jr, McCabe WR (1983) Bacteremia due to Fusobacterium species. Am J Med 75:225–231

    CAS  PubMed  Google Scholar 

  26. Bodner SJ, Koenig MG, Goodman JS (1970) Bacteremic Bacteroides infections. Annals Intern Med 73:537–544

    CAS  Google Scholar 

  27. Rathbun HK (1968) Clostridial bacteremia without hemolysis. Arch Intern Med 122:496–501

    Article  CAS  PubMed  Google Scholar 

  28. Olsen H (1976) Bacteroides bacteraemia. A clinical and bacteriological analysis of 51 patients. Scand J Infect Dis 8:107–111

    CAS  PubMed  Google Scholar 

  29. Lawrence PF, Tietjen GW, Gingrich S, King TC (1977) Bacteroides bacteremia. Ann Surg 186:559–563

    CAS  PubMed  Google Scholar 

  30. Felner JM, Dowell VR Jr (1971) “Bacteroides” bacteremia. Am J Med 50:787–796

    CAS  PubMed  Google Scholar 

  31. Fry DE, Garrison RN, Polk HC Jr (1979) Clinical implications in Bacteroides bacteremia. Surg Gynecol Obstet 149:189–192

    CAS  Google Scholar 

  32. Topiel MS, Simon GL (1986) Peptococcaceae bacteremia. Diagn Microbiol Infect Dis 4:109–117

    Article  CAS  PubMed  Google Scholar 

  33. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB (1997) The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 24:584–602

    CAS  PubMed  Google Scholar 

  34. Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 5:35–53

    CAS  PubMed  Google Scholar 

  35. McCabe WR, Jackson GG (1962) Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 110:847–855

    Google Scholar 

  36. Ortiz E, Sande MA (2000) Routine use of anaerobic blood cultures: are they still indicated? Am J Med 108:445–447

    Article  CAS  PubMed  Google Scholar 

  37. Sharp SE, McLaughlin JC, Goodman JM, Moore J, Spanos SM, Keller DW III, Poppiti RJ Jr (1993) Clinical assessment of anaerobic isolates from blood cultures. Diagn Microbiol Infect Dis 17:19–22

    Article  CAS  PubMed  Google Scholar 

  38. Cockerill FR III, Hughes JG, Vetter EA, Mueller RA, Weaver AL, Ilstrup DM, Rosenblatt JE, Wilson WR (1997) Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis 24:403–418

    PubMed  Google Scholar 

  39. Arzese A, Trevisan R, Menozzi MG (1995) Anaerobe-induced bacteremia in Italy: a nationwide survey. Clin Infect Dis 20 (Suppl 2):230–232

    Google Scholar 

  40. Gaynes RP, Horan TC (1999) Surveillance of nosocomial infections. In: Hospital epidemiology and infection control. Lippincott Williams & Wilkins, Philidelphia, pp 1285–1317

  41. Wilson WR, Rosenblatt JE, Washington JA II (1975) Anaerobic bacteremia. Conn Med 39:597–600

    CAS  PubMed  Google Scholar 

  42. Gransden WR, Eykyn SJ, Phillips I (1991) Anaerobic bacteremia: declining rate over a 15-year period. Rev Infect Dis 13:1255–1256

    CAS  PubMed  Google Scholar 

  43. Gray JW, Pedler SJ (1992) Low frequency of anaerobic bacteremia. Am J Med 93:706–707

    CAS  PubMed  Google Scholar 

  44. Siboni A, Graversen K, Olsen H (1993) Significant decrease of gram-negative anaerobic bacteremia in a major hospital from 1967–73 to 1981–89: an effect of the introduction of metronidazole? Scand J Infect Dis 25:347–351

    CAS  PubMed  Google Scholar 

  45. Jousimies-Somer H, Summanen P (2002) Recent taxonomic changes and terminology update of clinically significant anaerobic gram-negative bacteria (excluding spirochetes). Clin Infect Dis 35 (Suppl 1):17–21

    Article  Google Scholar 

  46. Shah HN, Collins MD (1988) Proposal for reclassification of Bacteroides asaccharolyticus, Bacteroides gingivalis, and Bacteroides endodontalis in a new genus, Porphyromonas. Int J Syst Bacteriol 38:12831

    Google Scholar 

  47. Shah HN, Collins MD (1989) Proposal to restrict the genus Bacteroides (Castellani and Chalmers) to Bacteroides fragilis and closely related species. Int J Syst Bacteriol 39:857

    Google Scholar 

  48. Shah HN, Collins MD (1990) Prevotella, a new genus to include Bacteroides melaninogenicus and related species formerly classified in the genus Bacteroides. Int J Syst Bacteriol 40:2058

    Google Scholar 

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Acknowledgements

The authors thank Dr. A. Dewanji of the Indian Statistical Institute (Calcutta; India), and Dr. S. Moolgavkar of the Fred Hutchinson Cancer Research Center (Seattle, Washington, USA) for their generous help with statistical analysis, Dr. S. Pottumarthy of the University of Washington (Seattle, Washington, USA) for her critical review of the manuscript and E. Stefansson of the University of Washington (Seattle, Washington, USA) for his assistance with data collection. This study was reviewed and accepted by our institution’s Independent Review Board, and complies with all applicable United States laws governing research.

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  1. Departments of Laboratory Medicine and Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357110, Seattle, WA 98195-7110, USA

    J. R. Wilson & A. P. Limaye

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  1. J. R. Wilson
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Correspondence to A. P. Limaye.

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Wilson, J.R., Limaye, A.P. Risk Factors For Mortality In Patients With Anaerobic Bacteremia. Eur J Clin Microbiol Infect Dis 23, 310–316 (2004). https://doi.org/10.1007/s10096-004-1111-y

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