Changes in Incidence and Etiology of Septicemia in an Infectious Unit

A prospective study on septicemia. II. Clinical manifestations and complications, results of antimicrobial treatment and report of a follow-up study

In a prospective study at a hospital for infectious diseases 151 patients, 110 with proved and 41 with probable septicemia, were analysed. Clinical, laboratory, therapeutic data and prognostic experiences, partly from a follow-up study, are described. Secondary manifestations, mostly from skin, mucous membranes, nervous system and lungs, were present in 72%. They were more often caused by gram-positive cocci than by gram-negative baccilli and in some cases not revealed until autopsy. Lesions in the nervous system were most often caused by strepto- or penumococci or Haemophilus influenzae. In 2 splenectomized patients with extensive hemorrhages, pneumococci were isolated. Subacute courses were rare even in alpha-streptococcal infection and its "classical signs" were never observed. Shock and thrombocytopenia suggesting disseminated intravascular coagulation occurred together in 11%, and in one-third in the lethal cases. Gram-positive bacteria were often involved. Leukocytosis was absent in 53 patients; 20 were alcohol or narcotic drug abusers, and 7 died. ECG changes were registered in 33%. Initial antibiotic treatment was applied according to a fixed schedule, with cure in 61% on this first treatment, and especially so in infections with gram-positive cocci. During the initial hospital stay 20% died from uncontrolled infection. All had underlying diseases or factors, often major causes of death. The infection was regarded as hospital-acquired in 40% among the lethal cases. During a one-year follow-up period 3 patients died from a new septicemia and 10 from their underlying disease.

Septicemia I. A prospective study on etiology, underlying factors and sources of infection

In a prospective study, 110 cases of proved and 41 of probable septicemia were analysed. Underlying diseases or factors were common, also in young patients, often narcotic drug or alcohol abusers. In one third, septicemia was probably hospital-acquired. Streptococci, staphylococci and gram-negative enteric rods were most common, followed by pneumococci and haemophilus species. Staphylococci and gram-negative enteric rods dominated in patients hospitalized at or before the onset of disease, and staphylococci in patients with vascular foreign bodies and in drug addicts. Enteric rods were common in elderly patients with urogenital disease, especially after instrumentation. Among streptococci, alpha-streptococci dominated; they did not emanate as often from dental foci as expected. In 2 of 3 asplenic patients with extensive hemorrhages pneumococci were found. Bacteria of low virulence and fungi occurring as opportunists were rare. Mixed infections, present in 4 cases, were severe. Portals of entry could often be proved or assumed. In half of all patients, the same organism was isolated from a primary focus as from blood. The importance of underlying illnesses and factors and of invasive procedures was evident. A tentative etiological diagnosis could often be made, based on case history, underlying factors and the probable portal of entry.

Bacteremia: the significance of outside versus inside hospital origin

168 patients with bacteremia seen in 1965-1969 were studied with regard to mortality rate, age and sex distribution, sources of infection, predisposing factors and infecting organisms. Special attention was drawn to outside hospital originating bacteremia vis-a-vis hospital-acquired bacteremia. In general, the results obtained were essentially in agreement with earlier experiences elsewhere. The most striking observations were, firstly, the grave prognosis associated with hospital-acquired bacteremia and, secondly, the dominant role played by gram-negative bacilli.