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Pneumonia caused by gram-negative bacilli.

A Karnad, S Alvarez, S L Berk

    The American Journal of Medicine
    |July 15, 1985
    PubMed
    Summary
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    Gram-negative pneumonia is a serious threat to vulnerable patients. Bacteremic pneumonia, especially with Pseudomonas aeruginosa, has a poor prognosis despite treatment.

    Area of Science:

    • Infectious Diseases
    • Pulmonology
    • Critical Care Medicine

    Background:

    • Gram-negative bacillary pneumonia is a growing concern in immunocompromised, elderly, and hospitalized individuals.
    • Understanding the differences between bacteremic and non-bacteremic forms is crucial for effective management.

    Purpose of the Study:

    • To compare clinical features, pathogens, and outcomes of bacteremic versus non-bacteremic gram-negative pneumonia.
    • To identify key differences in etiologic agents and patient populations.

    Main Methods:

    • Retrospective comparison of patients with documented gram-negative pneumonia.
    • Categorization into bacteremic and non-bacteremic groups based on blood cultures and transtracheal aspiration.
    • Analysis of clinical presentation, causative organisms, and treatment responses.

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    Main Results:

    • Clinical signs of gram-negative pneumonia were often subtle in both groups.
    • Common pathogens differed: Pseudomonas aeruginosa and Serratia marcescens in bacteremic cases, Escherichia coli and Klebsiella in non-bacteremic cases.
    • Pneumonias documented by transtracheal aspiration frequently involved multiple bacterial species.

    Conclusions:

    • Gram-negative pneumonia, particularly the bacteremic form, carries a high mortality rate.
    • Treatment with two-drug regimens was often insufficient, especially in bacteremic patients.
    • Prompt identification of pathogens and appropriate therapy are critical for improving outcomes.