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Septicemia in granulocytopenic patients: a shift in bacterial etiology
P J Johansson1, E Sternby, B Ursing
1Department of Infectious Diseases, University Hospital, Lund, Sweden.
Abstract:
35 episodes of septicemia in 33 patients occurred among 269 consecutive patients with granulocytopenia (granulocyte cell count less than or equal to 0.5 x 10(9)/l) during the 7-year period 1982-1988. 59% of isolated bacteria were Gram-positive (Staphylococcus aureus, Staph. epidermidis, Streptococcus species and Pneumococcus) and 41% Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter, Acinetobacter and Citrobacter). Compared to the 7-year period 1975-1981, there was a decrease in the relative number of patients with Gram-negative septicemia. Thus, a shift from a predominating Gram-negative etiology in the 1975-1981 period to a predominating Gram-positive etiology in the 1982-1988 period was noted. In both periods the mortality rate was high in patients with Gram-negative septicemia, especially in patients with a Ps, aeruginosa infection.
Insights
Septicemia in patients with granulocytopenia shifted from Gram-negative to Gram-positive bacterial causes between 1975-1981 and 1982-1988. Gram-negative infections, particularly Pseudomonas aeruginosa, remained highly fatal.
Area of Science:
- Infectious Diseases
- Hematology
- Clinical Microbiology
Background:
- Granulocytopenia, a condition with low granulocyte counts (≤0.5 x 10^9/L), increases susceptibility to severe infections like septicemia.
- Understanding the evolving etiology of septicemia in immunocompromised patients is crucial for effective treatment strategies.
Purpose of the Study:
- To analyze trends in bacterial pathogens causing septicemia in patients with granulocytopenia.
- To compare the microbiological profile and outcomes of septicemia between two distinct 7-year periods.
Main Methods:
- Retrospective analysis of 269 patients with granulocytopenia over a 14-year period (1975-1988).
- Identification and categorization of bacterial isolates from septicemia episodes.
- Comparison of pathogen distribution and mortality rates between the periods 1975-1981 and 1982-1988.
Main Results:
- 35 episodes of septicemia occurred in 33 patients with granulocytopenia between 1982-1988.
- Gram-positive bacteria (59%) predominated over Gram-negative bacteria (41%) in the later period.
- A shift was observed from a Gram-negative to a Gram-positive etiology compared to the earlier period (1975-1981).
- Mortality remained high for Gram-negative septicemia, especially with Pseudomonas aeruginosa infections.
Conclusions:
- The causative agents of septicemia in granulocytopenic patients have shifted towards Gram-positive bacteria.
- Despite the shift, Gram-negative infections, particularly those caused by Pseudomonas aeruginosa, continue to be associated with high mortality rates.