[Epidemiology of septicemias in a university hospital over 5 yeaars]

Bloodstream infections (are associated with high mortality. The incidence of bloodstream infections is increasing worldwide, with a shift towards multiresistant pathogens such as methicillin-resistant Staphylococcus aureus, enterococci and Candida spp. This study analysed retrospectively 1814 episodes of bacteraemia from 1993 to 1997 at a single tertiary care centre. True bloodstream infections was defined as clinical sepsis and positive blood culture without evidence for contamination of skin bacteria. Of the 1814 episodes, 380 (20.9%) were contaminated, resulting in 1434 true episodes of bloodstream infection. 42% were nosocomial bloodstream infections and one fourth were primary bloodstream infections. The incidence of bloodstream infections increased from 13.0/10,000 patient-days (1993) to 15.8/10,000 patient-days (1997). Mortality increased from 15.4% (1993) to 21% (1997) (p = 0.059). The five most frequently isolated microorganisms were Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci and streptococci. The distribution of bacteria did not change over time from 1993 to 1998. Multiresistant bacteria such as methicillin-resistant Staphylococcus aureus, enterococci, Pseudomonas spp. and yeasts were isolated in less than 5% of episodes. In addition, there is a trend towards decreasing resistance, in contrast to most other institutions in Southern Europe and the US. Further analyses and studies are necessary to answer questions raised by this retrospective study.