[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. II. Clinical observations].

A study was made of 92 bacteremia episodes among patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) between June 1986 and September 1989. A single microorganism was isolated in 84 episodes (91.3%), the most common being: Staphylococcus aureus (21.7%), Escherichia coli (18.5%), Enterococcus (9.8%), Pseudomonas aeruginosa (6.5%), and Proteus mirabilis (5.4%). The episodes were of both hospital and community origin: 54.3% vs. 45.7%. Their main sources were: the urinary tract (16.3%), abdominal infections (14.2%), endocarditis (7.6%), and the respiratory tract (5.5%). No source could be identified in 26%. Brucellosis, salmonellosis and listeriosis together constituted 8.7% of the episodes. Abdominal infections were primarily responsible for the 8 cases (8.7%) of polymicrobial bacteremia. The overall mortality was 18.5% (6.5% community vs. 12% hospital episodes). Mortality directly due to bacteremia was 8.7%. Bacteremia was the direct or indirect cause of death in 22.6% of patients greater than or equal to 65, compared with 19% and 10% in those aged 35-64 and 15-44 respectively. The patient's clinical picture at the time of infection was a prognostic factor: mortality was much lower in subjects previously healthy or free from basic diseases (11.8%) than in those with non-rapidly-fatal diseases (21.7%) or rapidly-fatal diseases (54.5%). Bacteremia-linked mortality (direct and indirect) was higher in Gram-positive vs Gram-negative infections: 22.2% vs 15.8%. Mortality was 12.5% in the group of patients with polymicrobial infections.