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.
