@entity2259 in the chronic XXXX population: risk factors for mortality.

@entity1 @entity1688 @entity3256 @entity4988 @entity55 @entity5 @entity1066 @entity794 @entity281 @entity3147 @entity1566 @entity451 @entity204 @entity2259 @entity293
BACKGROUND: Individuals with @entity1566 ( @entity1566 ) have a lifelong increased risk of @entity281 , which may be associated with episodes of life-threatening @entity2259 . Information concerning specific organisms causing @entity2259 , the sites of @entity281 , and clinical predictors for mortality are necessary to provide optimal treatment. METHODS: A retrospective review of positive blood cultures collected over a 32-month period in chronic @entity1566 @entity1 treated at the Veterans Affairs Medical Center @entity1566 Unit. RESULTS: One hundred and twenty-three episodes of @entity2259 occurred in 63 @entity1 during 83 hospitalizations; 30 @entity1 had multiple episodes of @entity2259 . There were 1,644 admissions during this period, yielding an incidence of @entity2259 of 7.5% (5.8% after excluding positive cultures that were believed to be caused by contaminants). The @entity1 (31 with @entity451 and 32 with @entity1688 ) had a mean age of 59 +/- 2 years, and a mean duration of injury of 23 +/- 2 years. Bladder management technique consisted of indwelling bladder catheter (n = 53), ileal conduit (n = 6), intermittent catheterization (n = 2), and spontaneous voiding (n = 2). Episodes of @entity2259 were nosocomial in 89 out of 123 episodes. Multiple debilitating factors were present, including pressure @entity1066 in 36 out of 63 @entity1 , chronic ventilator dependency in 5 out of 63 @entity1 , recent surgical procedures in 17 out of 63 @entity1 , underlying @entity5 in 5 out of 63 @entity1 , and evidence of @entity3147 in 29 out of 63 patients (serum albumin concentration < 2.5 g/dL). Early mortality rate ( @entity204 within 30 days of @entity2259 ) occurred in 8 out of 63 @entity1 (13%) and late mortality (> 1 month following a bacteremic episode) occurred in 10 additional @entity1 , such that total mortality was 1 8 out of 63 (29%). The sources of @entity2259 were @entity293 (n = 39), presumed contaminant (n = 28), decubitus @entity1066 (n = 21), intravascular catheter (n = 19), @entity55 (n = 5), and other (n = 11). Gram-negative rods accounted for 26 out of 39 episodes of @entity2259 from a urinary source. @entity3256 -resistant @entity794 , @entity3256 -sensitive @entity794 , and coagulase-negative staphylococci were the predominant organisms when intravascular catheters or pressure @entity1066 were the source of @entity2259 . CONCLUSION: In this population, @entity2259 predominantly was caused by hospital-associated organisms, and occurred mainly in malnourished @entity1 who required hospitalization for major underlying debilitating conditions, particularly pressure @entity1066 . Chronic indwelling bladder catheters and chronic vascular catheter usage also were highly prevalent in @entity1 with bacteremic episodes. @entity4988 was the strongest independent predictor for mortality.
