Recurrent gram-negative bloodstream infection: A 10-year population-based cohort study

Majdi N. Al-Hasan, Jeanette E. Eckel-Passow, Larry M. Baddour

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Recurrent gram-negative bloodstream infection (BSI) has not been evaluated in a population-based setting; therefore, we performed a population-based retrospective cohort study to examine the incidence, recurrence, and mortality rates of gram-negative BSI. Methods: We identified 944 episodes of gram-negative BSI, including 98 recurrent episodes, among Olmsted County, Minnesota, residents from 1/1/1998 to 12/31/2007. Kaplan-Meier method was used to estimate the cumulative incidence rate of recurrence and 28-day all-cause mortality rate of gram-negative BSI. Cox proportional hazard regression was used to determine risk factors for recurrence. Results: The overall age- and gender-adjusted incidence rate of gram-negative BSI per 100,000 person-years was 84.5 (95% confidence interval [CI]: 79.1-90.0), including 75.7 (95% CI: 70.6-80.8) for first episodes and 8.8 (95% CI: 7.1-10.6) for recurrent episodes. Among 846 patients with first episodes of gram-negative BSI, the cumulative incidence rates of recurrence after 1, 5, and 10 years of the initial episode were 5.6%, 9.2%, and 14.6%, respectively, with death treated as a competing risk. Patients with Klebsiella species were more likely than those with Escherichia coli BSI to develop recurrent gram-negative BSI (hazard ratio: 2.33 [95% CI: 1.34-3.92], p = 0.003). The 28-day all-cause mortality rates following the initial and second episodes of gram-negative BSI were 10.0% (95% CI: 8.0-12.0) and 11.3% (95% CI: 4.4-18.2), respectively. Conclusions: Even though recurrent gram-negative BSI was relatively uncommon in the general population, up to 15% of patients with gram-negative BSI developed a recurrent episode within 10 years of the initial episode.

Original languageEnglish (US)
Pages (from-to)28-33
Number of pages6
JournalJournal of Infection
Issue number1
StatePublished - Jul 2010


  • Bacteremia
  • Epidemiology
  • Gram-negative
  • Incidence
  • Mortality
  • Recurrent
  • Risk factors
  • Rochester Epidemiology Project

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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