Etiology, diagnosis, and prognosis of positive blood cultures.

The case records of 516 patients with 613 organisms from positive blood cultures at Detroit General Hospital (1975) and Harper-Grace Hospitals (first half of 1979) were analyzed. Gram-negative bacilli predominated by 46 per cent at Detroit General Hospital and 39 per cent at Harper-Grace Hospital. The gram-negative bacteremias also had higher mortality rates (47 per cent at Detroit General Hospital and 39 per cent at Harper-Grace Hospital) than the other organisms (27 per cent at Detroit Hospital and 25 per cent at Harper-Grace Hospital). The lung was the most frequent source for positive blood cultures at Detroit General Hospital (42%), whereas the urinary tract was the major primary site at Harper-Grace Hospital (30%). If sepsis was not diagnosed and operated upon aggressively prior to the development of shock or organ failure, the mortality rate rose from 12 per cent to 64-88 per cent. Increased efforts must be made to diagnose sepsis early and drain any collections of pus, particularly in anergic patients who may show little or no evidence of sepsis even after the development of multiple organ failure or shock.