Molecular epidemiology of gram-negative bacteremia

Abstract

We did pulsed field gel electrophoresis (PFGE) and antibiotic susceptibility testing on 202 gram-negative isolates obtained from blood cultures between 1 January 1989 and 31 December 1993. Seventy-eight patients had at least two gram-negative isolates of the same species recovered from blood drawn one or more days apart and met the other study criteria. Twenty patients had only 1 bloodstream infection, 48 patients had 1 recurrence of bacteremia, and 10 patients had > 1 recurrence of bacteremia. Of 80 recurrences of bacteremia, 52 (65%) were relapses and 28 (35%) were reinfections. Seventy-eight percent of the episodes of bacteremia occurring ≤300 days apart were relapses, and 100% occurring >300 days apart were reinfections (P < .001). Organisms causing recurrent bacteremia were not more resistant than those causing initial episodes. In conclusion, most episodes of recurrent gram-negative bacteremia were relapses. Relapses and reinfections could not be distinguished only by the length of time between episodes or by antimicrobial susceptibility patterns.