TY - JOUR
T1 - Recurrent gram-negative bloodstream infection
T2 - A 10-year population-based cohort study
AU - Al-Hasan, Majdi N.
AU - Eckel-Passow, Jeanette E.
AU - Baddour, Larry M.
N1 - Funding Information:
Funding. The study received funding from the Small Grants Program and the Baddour Family Fund at the Mayo Clinic, Rochester, MN. The funding source had no role in study design.
Funding Information:
This work was made possible by research grant R01-AR30582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (National Institutes of Health, U.S. Public Health Service).
PY - 2010/7
Y1 - 2010/7
N2 - Background: Recurrent gram-negative bloodstream infection (BSI) has not been evaluated in a population-based setting; therefore, we performed a population-based retrospective cohort study to examine the incidence, recurrence, and mortality rates of gram-negative BSI. Methods: We identified 944 episodes of gram-negative BSI, including 98 recurrent episodes, among Olmsted County, Minnesota, residents from 1/1/1998 to 12/31/2007. Kaplan-Meier method was used to estimate the cumulative incidence rate of recurrence and 28-day all-cause mortality rate of gram-negative BSI. Cox proportional hazard regression was used to determine risk factors for recurrence. Results: The overall age- and gender-adjusted incidence rate of gram-negative BSI per 100,000 person-years was 84.5 (95% confidence interval [CI]: 79.1-90.0), including 75.7 (95% CI: 70.6-80.8) for first episodes and 8.8 (95% CI: 7.1-10.6) for recurrent episodes. Among 846 patients with first episodes of gram-negative BSI, the cumulative incidence rates of recurrence after 1, 5, and 10 years of the initial episode were 5.6%, 9.2%, and 14.6%, respectively, with death treated as a competing risk. Patients with Klebsiella species were more likely than those with Escherichia coli BSI to develop recurrent gram-negative BSI (hazard ratio: 2.33 [95% CI: 1.34-3.92], p = 0.003). The 28-day all-cause mortality rates following the initial and second episodes of gram-negative BSI were 10.0% (95% CI: 8.0-12.0) and 11.3% (95% CI: 4.4-18.2), respectively. Conclusions: Even though recurrent gram-negative BSI was relatively uncommon in the general population, up to 15% of patients with gram-negative BSI developed a recurrent episode within 10 years of the initial episode.
AB - Background: Recurrent gram-negative bloodstream infection (BSI) has not been evaluated in a population-based setting; therefore, we performed a population-based retrospective cohort study to examine the incidence, recurrence, and mortality rates of gram-negative BSI. Methods: We identified 944 episodes of gram-negative BSI, including 98 recurrent episodes, among Olmsted County, Minnesota, residents from 1/1/1998 to 12/31/2007. Kaplan-Meier method was used to estimate the cumulative incidence rate of recurrence and 28-day all-cause mortality rate of gram-negative BSI. Cox proportional hazard regression was used to determine risk factors for recurrence. Results: The overall age- and gender-adjusted incidence rate of gram-negative BSI per 100,000 person-years was 84.5 (95% confidence interval [CI]: 79.1-90.0), including 75.7 (95% CI: 70.6-80.8) for first episodes and 8.8 (95% CI: 7.1-10.6) for recurrent episodes. Among 846 patients with first episodes of gram-negative BSI, the cumulative incidence rates of recurrence after 1, 5, and 10 years of the initial episode were 5.6%, 9.2%, and 14.6%, respectively, with death treated as a competing risk. Patients with Klebsiella species were more likely than those with Escherichia coli BSI to develop recurrent gram-negative BSI (hazard ratio: 2.33 [95% CI: 1.34-3.92], p = 0.003). The 28-day all-cause mortality rates following the initial and second episodes of gram-negative BSI were 10.0% (95% CI: 8.0-12.0) and 11.3% (95% CI: 4.4-18.2), respectively. Conclusions: Even though recurrent gram-negative BSI was relatively uncommon in the general population, up to 15% of patients with gram-negative BSI developed a recurrent episode within 10 years of the initial episode.
KW - Bacteremia
KW - Epidemiology
KW - Gram-negative
KW - Incidence
KW - Mortality
KW - Recurrent
KW - Risk factors
KW - Rochester Epidemiology Project
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U2 - 10.1016/j.jinf.2010.03.028
DO - 10.1016/j.jinf.2010.03.028
M3 - Article
C2 - 20378069
AN - SCOPUS:77953810436
SN - 0163-4453
VL - 61
SP - 28
EP - 33
JO - Journal of Infection
JF - Journal of Infection
IS - 1
ER -