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Josep A. Capdevila, MD; Bonito Almirante, MD; Albert Pahissa, MD; Anna Maria Planes, MD; Esteve Ribera, MD; José Manuel Martínez-Vázquez, MD

Arch Intern Med. 1994;154(4):411-415.

Abstract
Background
Bacteremia is a cause of high morbidity and mortality. Recurrent episodes of bacteremia, its risk factors and characteristics, have been poorly evaluated in the literature, although its occurrence has been established.

Patients and Methods
Analysis of 1426 patients who presented with 1579 episodes of bacteremia and who were prospectively evaluated in a university-affiliated hospital during a 48-month period. The risk factors for a patient to develop a recurrence of bacteremia was assessed comparing those with recurrent episodes with those who survived an episode of bacteremia with no recurrence during the follow-up period.

Results
A total of 105 patients presented with 248 episodes of bacteremia, of which 143 episodes were recurrent (recurrence rate, 9% of all bacteremic episodes). Two factors were independently predictive of recurrent bacteremia: (1) the presence of an underlying disease (especially a rapidly fatal one [odds ratio, 7.27]) or (2) any complication during the initial episode of bacteremia. Using these factors, the prediction model was significant, but misclassification was high, with a sensitivity of 61% and a specificity of 67% for a cutoff point that maximized both factors.

Conclusions
We identified risk factors for patients who presented with an initial episode of bacteremia to develop a recurrence rate. The recurrence risk factors may be used as a form of guidance for extreme preventive measures, but these factors could not predict recurrence with a high degree of accuracy.

(Arch Intern Med. 1994;154:411-415)

Author Affiliations
From the the Hospital General "Vall d'Hebrón" (Drs Capdevila, Almirante, Pahissa, Planes, Ribera, and Martínez-Vázquez), and the Servicio de Medicina Interna—Patologia Infecciosa (Drs Capdevila, Almirante, Pahissa, Ribera, and Martínez-Vázquez) and Servicio de Microbiologia (Dr Planes), Universidad Autónoma, Barcelona, Spain.

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