Abstract
Bacteremia is a major clinical challenge requiring early treatment. Metabolic alterations occur during bacteremia, and accordingly plasma concentrations of lipoproteins LDL-C and HDL-C are substantially changed. We questioned whether bacteremia with Gram-negative versus Gram-positive bacteria causes contrasting changes of lipoprotein levels in order to differentiate between the 2-g stain types and if there is a relation with outcome parameters namely ICU-admission, 30-day mortality, duration of hospitalization. This is a retrospective dual-center cross-sectional study, including 258 patients with bacteremia. Plasma lipid levels were analyzed within 48 h to positive blood culture. Upon admission, HDL-C, LDL-C, and total cholesterol (p = 0.99) in plasma did not significantly differ between patients with Gram-negative and Gram-positive bacteremia, while significantly higher triglyceride concentrations were found in Gram-negative bacteremia (p < 0.05). 30-day mortality and ICU admission were associated with lower LDL-C and HDL-C concentrations as compared to survivors and non-ICU patients, and patients with HDL-C < 20 mg dl−1 and LDL-C < 55 mg dl−1 had a relative risk (RR) of 2.85 for ICU therapy requirement and RR = 2 of death within 30 days. Reduced HDL-C and LDL-C concentrations were associated with adverse patient’s outcome in bacteremia. Discrimination between Gram-negative and Gram-positive pathogens upon lipoprotein patterns is unlikely.
Highlights
Bacteremia occurs in 140–160 individuals per 100,000 per year in high-income countries and is associated with significant morbidity and mortality even years after the infection [1, 2]
We retrospectively identified 221 eligible patients with community-acquired bacteremia seen between January 2005 and December 2013 at the Department of Hygiene and Medical Microbiology of the Innsbruck University Hospital
This study focused on bacteremia in order to compensate the diagnostic uncertainty associated with sepsis, where Blood cultures (BC) might be negative [4]
Summary
Bacteremia occurs in 140–160 individuals per 100,000 per year in high-income countries and is associated with significant morbidity and mortality even years after the infection [1, 2]. The observed decrease in HDL-C plasma levels during the AP response remains incompletely understood, and a variety of different mechanisms have been suggested [8, 9]. It has been shown in vitro and in vivo that HDL-C can bind and neutralize lipopolysaccharide (LPS) from Gram-negative bacteria, yielding a clue to the importance of HDL-C during the AP [10, 11]. We aimed to evaluate the effect of manifest bacteremia on plasma cholesterol, HDL-C and lowdensity lipoprotein cholesterol (LDL-C) concentrations and to investigate to what extent alterations of the lipid profile at the time of a positive BC may indicate bacteremia with either Gram-positive or Gram-negative bacteria. A further goal was to analyze the correlation between lipoprotein concentrations and prognostic parameters, namely the length of hospital stay, 30-day mortality, and ICU admission
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