• Cheol-In Kang, Jae-Hoon Song, Doo Ryeon Chung, Kyong Ran Peck, Kwan Soo Ko, Joon-Sup Yeom, Hyun Kyun Ki, Jun Seong Son, Seung Soon Lee, Yeon-Sook Kim, Sook-In Jung, Shin-Woo Kim, Hyun-Ha Chang, Seong Yeol Ryu, Ki Tae Kwon, Hyuck Lee, Chisook Moon, and Korean Network for Study of Infectious Diseases (KONSID).
• Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan Universiy School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, South Korea.
• J. Infect. 2011 Jan 1; 62 (1): 26-33.

BackgroundThe aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB).MethodsFrom the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis.ResultsOf 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35-4.74), after adjustment for other variables predicting poor prognosis.ConclusionsSevere sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB.Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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