[Bacteriologic analysis of 150 episodes of septicemia in a hematology department according to the length of hospitalization].

One hundred and fifty episodes of septicaemia in patients in a haematology service were analysed as a function of the date of onset in relation to the date of hospitalisation. One hundred and three patients of the 122 patients were granulocytopenic and 97 patients (65%) had less than 500 polymorphonuclear neutrophils per microliter. The septicaemic episodes were classified according to three time periods: septicaemia starting before admission and during the first 24 hours in hospital, septicaemia occurring between day 1 and day 8 and septicaemia beginning on day 9 or later. For each period different factors have been studied, the number of septicaemic episodes, the frequency of multiple infection, the severity of the granulocytopenia, the antibiotics used compared to their sensitivity in vitro, the outcome of the septicaemia, the organisms isolated by blood culture and their sensitivity to different antibiotics. The patients with septicaemia arriving at the hospital with a fever, and those starting during the first week of hospitalisation are finally comparable, even though the level of mortality was distinctly different (33 and 17% respectively). The septicaemia starting after day 8 are more frequent and more severe (40% mortality). These late onset septicaemias are characterised by a higher frequency of Gram negative hospital infections, a high frequency of mixed infection with bacteria resistant to several beta-lactams and aminoglycosides. The observation of these differences between these septicaemias occurring in the first week and those starting after the eighth day should be taken into account in the choice of an empirical antibiotic regimen. An association of 2 or 3 antibiotics for these two situations respectively, involving beta-lactams and aminoglycosides, is proposed by the authors.