Recurrent gram-negative bloodstream infection: a 10-year population-based cohort study

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Recurrent gram-negative bloodstream infections (BSI) lack population-based evaluation.
• Understanding recurrence patterns is crucial for patient management and public health strategies.

Purpose of the Study:

• To determine the incidence, recurrence, and mortality rates of gram-negative BSI in a population-based setting.
• To identify risk factors associated with recurrent gram-negative BSI.

Main Methods:

• Population-based retrospective cohort study in Olmsted County, Minnesota (1998-2007).
• Identified 944 gram-negative BSI episodes, including 98 recurrent cases.
• Kaplan-Meier and Cox proportional hazard regression analyses were employed.

Main Results:

• The incidence rate of gram-negative BSI was 84.5 per 100,000 person-years.
• Cumulative recurrence rates after 1, 5, and 10 years were 5.6%, 9.2%, and 14.6%, respectively.
• Klebsiella species BSI increased recurrence risk (HR: 2.33) compared to E. coli; 28-day mortality was ~10-11% for initial and recurrent episodes.

Conclusions:

• Recurrent gram-negative BSI is relatively uncommon but significant, affecting up to 15% of patients within a decade.
• Findings highlight the importance of monitoring and managing recurrent gram-negative BSI, even in the general population.