ABSTRACT
PURPOSE: Appropriate antimicrobial therapy and surgical drainage, improve survival in patients with Gram negative bloodstream infections (BSI). Data about the yield of imaging studies in polymicrobial BSI is sparse. The aim of the study was to assess the need for imaging studies and surgical drainage among patients with polymicrobial compared to monomicrobial BSI. RESULTS: In a retrospective cohort study of adult patients with Gram negative BSI, 135 patients with monomicrobial BSI were compared to 82 with polymicrobial BSI. Imaging studies were performed in 56.3 % of patients with monomicrobial BSI and in 50 % of polymicrobial BSI (p=0.4), surgical drainage was performed in 20.1 % of patients with monomicrobial BSI and 27.2 % of polymicrobial BSI (p=0.25). Surgical drainage was performed in 26.2 % of patients who survived vs. 11.8 % of patients who died (p=0.035). CONCLUSIONS: There is no difference in the diagnostic approach to monomicrobial and polymicrobial Gram-negative BSI. Surgical drainage is associated with decreased mortality.
Subject(s)
Bacteremia , Coinfection , Gram-Negative Bacterial Infections , Humans , Retrospective Studies , Male , Female , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/mortality , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/drug therapy , Middle Aged , Bacteremia/microbiology , Bacteremia/drug therapy , Bacteremia/diagnosis , Bacteremia/mortality , Aged , Coinfection/microbiology , Coinfection/diagnosis , Adult , Drainage/methods , Aged, 80 and over , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/therapeutic useABSTRACT
BACKGROUND: Gram-negative bloodstream infections (GN-BSI) are life threatening. Appropriate antimicrobial therapy and source control when indicated improve survival. Dementia is an independent risk factor for death and is associated with increased risk for infections, especially in advanced stages. Data about the best diagnostic and therapeutic approaches for patients with dementia and GN-BSI are lacking. OBJECTIVES: To evaluate patients with dementia and GN-BSI and determine whether diagnostic imaging improves clinical outcomes. METHODS: We performed a retrospective cohort study of adult patients with GN-BSI, during 2019-2022. Patients with or without a diagnosis of dementia were compared. Outcomes were in-hospital mortality and recurrent bacteremia. Demographic, clinical, diagnostic, and therapeutic data were collected and analyzed. RESULTS: A total of 87 patients with dementia and 130 without were included. Patients with dementia received appropriate empirical antimicrobial therapy in 38% of cases compared to 62% of patients without dementia, P < 0.001. Imaging studies were performed in half of patients in both groups. In the dementia group, 17% had abnormal findings that required source control versus 30% in the control group (P = 0.049). Source control was performed in 15% of patients with dementia versus 28% of patients without dementia (P = 0.032). Mortality was 27.6% in the dementia group versus 22.3% in the control group (P = 0.42). CONCLUSIONS: In patients with dementia and GN-BSI, imaging studies have lower effect on clinical outcomes. Imaging studies should be performed in selected cases only and not conducted routinely.