Bo Ursing

Septicemia in Granulocytopenic Patients: A Shift in Bacterial Etiology

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.

Infectious complications to granulocytopenia

A consecutive series of patients with granulocytopenia was analysed with consideration of rate and spectrum of infectious complications. The records of 98 patients from 1975-81 were studied retrospectively. Fever was the most common symptom of infection. 78 patients had one or more infectious manifestations, and Staphylococcus aureus was the most common pathogen isolated. Septicemia occurred in 22 patients of which 17 were caused by gram-negative bacteria. Pseudomonas aeruginosa caused septicemia in 8 patients. The risk of septicemia increased with a decreasing cell count and with the degree and duration of fever. The mortality rate for the whole group was 24% and for the septicemic patients 41%.