Persistent bacteremia and fungemia-risk factors and clinical significance

Choi, Won Suk; Seo, Yu Bin; Jo, Yu Mi; Kim, Jeong Yeon; Kee, Sae Yoon; Jeong, Hye Won; Park, Dae Won; Sohn, Jang Wook; Choeng, Hee Jin; Kim, Min Ja; Kim, Woo Joo

Abstract

BACKGROUDN: Persistent bloodstream infection is known to cause high mortality and a prolonged hospital stay. We performed a study examining risk factors and the clinical significance of persistent bacteremia and fungemia.
METHODS
This was a case-controlled study. Medical records of patients with bacteremia or fungemia in one university hospital in Korea from May 1999 to February 2005 were retrospectively reviewed. Patients with persistent positive blood cultures regardless of antibiotic treatment for more than three days were assigned to the persistent group. Patients with positive blood cultures only on the same calendar days with the persistent group but negative on follow-up were assigned to the short-term group.
RESULTS
A total of 64 patients were enrolled in the persistent group, and 146 patients in the short-term group among 1,737 patients with positive blood cultures. The persistent group was associated with previous antibiotic usage within 1 month (p=0.033), nosocomial infection (p=0.026), having an abscess (p=0.008), and infection by mixed organisms (p=0.001), independently. Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having a central venous catheter, or ICU care at the time of blood culture was higher in the persistent group as well. The persistent group had a prolonged number of hospital-days (p=0.010), but there was no difference in mortality between the two groups.
CONCLUSIONS
Patients with a persistent bloodstream infection should be assessed about previous antibiotic usage within 1 month, nosocomial infection, having an abscess, infection by mixed organisms, Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having central venous catheter, or ICU care at the time of blood culture.