Resumen

PAZOS ANON, R. et al. Pronostic factors of the bloodstream infections: prospective study. An. Med. Interna (Madrid) [online]. 2001, vol.18, n.8, pp.23-28. ISSN 0212-7199.

Background: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients.  Material and methods: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X² test and t Student, the survival was expresed with Kaplan Meyer graphics and the logistic regression model.  Results: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patiens. The calculated incidence of significant episodies of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%.  The mean age was 66.9 years (IC 95% 65-69), 59%episodes ocurred in men. The 78% episodes ocurred in patients hospitalized in medical services. 52% episodios were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatl diseases and 35% episodes ocurred in patients without underlying disease.  According to the univariant analysis, the variables which where significantly associated with greater risk death were: etilology (fungus), septic shock, the inadecuate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial theraphy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remanining independent predictors of mortality were: septic shock (p<0.0001, OR: 8), inadecuate antimicrobial therapy (p<0.005, OR: 6.7), existence of two or more extrinsic risk factors (p<0.04).  Conclusions: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropiate antimicrobian therapy and the asociation of various extrisinc risk factors. These variables could be modified partly, for this reason the agressive hemodinamic control and the early and appropiate antibotic therapy would be the support of the succesful bacteriemia management.

Palabras clave : Bacteriemia; Risk factors; Mortality.

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