Significado de la Leucopenia en pacientes con bacteriemia

THE CLINICAL SIGNIFICANCE OF LEUKOPENIA IN PATIENTS WITH BACTEREMIA Objectives: To assess the clinical and bacteriological characteristics and morbimortality of bacteremia in patients with leukopenia ( 12.000 WBC/mm ). Material and Methods: Protocolized, descriptive and observational study in patients with 2 or more positive blood cultures hospitalized in an Internal Medicine Service from 1989 to 2007. Results: We identified 728 patients with bacteremia: 94 (12.91%) with leukopenia (Group A) and 407 (55.90%) with leukocytosis (Group B). The mean age was 55.57 years (SD±16.93) in A and 58.40 years (SD±17.34) in B. There were no differences in the mean hospital stay: 19.59 days (SD±18.67) in A vs 21.21 (SD±19.53) in B and in the male gender: 65.96 vs 57.25% (pNS). Nosocomial acquisition (57.44 vs 40.29%), unknown (25.53 vs 9.33%) and abdominal primary source (17.14 vs 9.21%) were more frequent in A (p<0.01). The presence of major comorbidity (82.98 vs 41.24%), neoplastic diseases (45.74 vs 12.84%) and immunosupression (31.91 vs 6.17%) were significative in A (p<0.01). Anemia (86.17 vs 62.40%) and thrombocytopenia (84.04 vs 25.06%) were common in A (p<0.01). Gram negative bacilli bacteremia occurred mainly in A (61.71 vs 37.83%)(p<0.01). Klebsiella (17.02 vs 9.82%) and Pseudomonas (10.64 vs 1.47%) in A (p<0.05) and S. aureus bacteremia in B (31.69 vs 11.70%) were the most common pathogens (p<0.01). In hospital mortality was 39.36% in A and 25.30% in B (p=0.006) and was associated in A to higher mortality in the first 24 hours (32.43 vs 16.50%), immunosupression (27.02 vs 7.76%), neumococcal bacteremia (52.94 vs 23.07%) and thrombocytopenia (75.67 vs 30.09%)(p<0.01).Conclusions: Bacteremia in leukopenic patients compared to those with leukocytosis were significantly associated to nosocomial acquisition, unknown and abdominal primary source, presence of a major comorbidity, oncologic diseases, Klebsiella and Pseudomonas bacteremia and to higher mortality.