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Recurrent gram-negative bacteremia: incidence and clinical patterns
C Wendt1, S A Messer, R J Hollis
1Department of Internal Medicine, The University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242-1081, USA.
Summary
Recurrent gram-negative bacteremia, often from IV catheters, includes relapses and reinfections. Shorter antibiotic courses correlate with relapses, suggesting longer treatment could reduce recurrence.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Microbiology
Background:
- Recurrent gram-negative bacteremia poses a significant clinical challenge.
- Understanding the epidemiology of recurrent bacteremia is crucial for effective management.
Purpose of the Study:
- To define the epidemiology of recurrent gram-negative bacteremia.
- To differentiate between relapses and reinfections.
- To identify factors associated with recurrence.
Main Methods:
- Retrospective evaluation of 58 patients with at least two episodes of gram-negative bacteremia.
- Analysis of probable sources, timing of recurrence, and duration of antibiotic therapy.
- Comparison of characteristics between relapses and reinfections.
Main Results:
- 55% experienced single relapses, 28% single reinfections, and 17% multiple recurrences.
- Intravenous catheters were the most common source.
- Relapses occurred significantly earlier than reinfections (58 vs. 292 days).
- Shorter initial antibiotic duration was associated with relapses (13.9 vs. 17.5 days).
- No unusual antimicrobial resistance was observed in recurrent pathogens.
Conclusions:
- Recurrent gram-negative bacteremia comprises distinct relapse and reinfection patterns.
- Relapses may be reduced by optimizing antibiotic duration and eradicating infection sources.
- Preventing reinfections is challenging due to underlying illness severity.