ACUTE RENAL-FAILURE IN COMMUNITY-ACQUIRED BACTEREMIA

Over a 1-year period, 239 patients with community-acquired bacteraemia in positive blood culture were prospectively evaluated to establish the prevalence and outcome of acute renal failure (ARF). Fifty-eight patients (24%) were identified as having ARF defined by a doubling or more in serum creatinine. The overall mortality in this group was 53% compared with 22% for patients with bacteraemia but without ARF (p < 0.001). Within the ARF group there were two identifiable subgroups. Thirty patients had resolution of renal failure with treatment of the bacteraemia, and only 6 (20%) of these died. Of the remaining 28 where ARF persisted, 25 (89%) died (p < 0.000001). Nine patients were dialysed, and only 2 survived. The majority of the remaining 24 patients died of overwhelming bacteraemia before dialysis was indicated. ARF is a common finding in community-acquired bacteraemia, and this has a poor prognosis particularly in those without early resolution of renal failure.