Risk factors associated with a poor prognosis:
(1) complex bacteremia, especially extensive soft tissue infection (see previous algorithm)
(2) shock
(3) bacteremia with one of the following:
(3a) Pseudomonas species
(3b) Clostridium species
(3c) bacteria resistant to initial antibiotic therapy
(3d) alpha-hemolytic streptococcus not treated with vancomycin initially
(4) failure of the neutrophil count to recover (persistent or worsening neutropenia)
(5) serum albumin < 3.5 g/dL
where:
• Shock was the most important risk factor.
• Recovery of the neutrophil count was a good prognostic factor, so failure to do indicates a worse prognosis.
Risk factors for prolonged antibiotic therapy:
(1) monotherapy for a Gram-negative bacteremia
(2) delay in starting vancomycin for a Gram-positive bacteremia
where:
