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A total number of 836 episodes of bacteremia and fungemia were examined in 823 hospitalized patients in the University Hospital of Infectious Diseases "Dr Fran Mihaljević" Zagreb from the beginning of 1987 to the end of 1991. Twenty-five percent of them were nosocomial bacteremias and 5% were polymicrobial bacteremias. The most frequently isolated causative agents were Salmonella spp. (26%), Escherichia coli (17%), Streptococcus pneumoniae (11%) and Staphylococcus aureus (8%). There were 34% of gram-positive bacteremias. The increased frequency of nosocomial bacteremias caused by coagulase-negative staphylococci was recorded. The frequency of coagulase-negative staphylococci strains resistant to gentamicin and Klebsiella spp. strains resistant to cefotaxime was increased. Shock was present in 19% of episodes. Relation between septic shock occurrence and causative agent of bacteremia was not proved. Mortality in patients with bacteremia was 13%, and total mortality was 20%. The outcome of the disease was in direct relation with causative agent of bacteremia. The initial empiric antimicrobial therapy was prolonged in 91% of episodes of bacteremia after blood culture results were known.

Clinical and laboratory features were analyzed in 277 patients with 279 episodes of E. coli bacteremia, treated at the University Hospital of Infectious Diseases "Dr Fran Mihaljević"c, Zagreb between 1980 and 1989. Patients ranged in age from 4 days to 91 years. Thirty-two per cent of patients were male and 68% were female. The majority of patients had underlying disease which was considered not to be fatal within the next five years (57%) or they were completely healthy (34%). Four per cent of bacteremias were polymicrobic and 13% were considered nosocomial in origin. The clinical source of bacteremia was known in 84%. In community-acquired bacteremia, the urinary tract was the most frequent site of origin (78%) and in nosocomial-acquired bacteremia the source could not be identified (54%). Septic shock occurred in 24% of the patients and coagulation abnormalities were observed in 41% of the patients. Fatal outcome was registered in 10% of the patients. Mortality was higher among males (16%:7%) up to 2 months of age (29%) and above 60 years (15%), and in those with nosocomial-acquired bacteremia (49%), polymicrobial (50%) and recurrent bacteremia (50%), as well as in patients with severe underlying disease (29-75%). Mortality was lower in patients who were given an early appropriate antimicrobial therapy. The advantage of combinations of antimicrobial therapies over monotherapy could not be demonstrated among patients in each category of severity of underlying host disease.

The epidemiological, clinical and laboratory characteristic of group A beta-hemolytic streptococcal (GABHS) bacteremia in patients treated at the University Hospital of Infectious Diseases in Zagreb were analyzed. Of 51 cases of bacteremia due to GABHS seen over the past 15 years, 15 (29%) have been registered since 1987. The mean age of our patients was 25 years (range, 5 months to 87 years); and 29 (57%) were under 18. Ten (19%) patients died, 6 being less than 18 years of age. Forty-seven (92%) cases were community-acquired and 16 (32%) had underlying disease. Primary foci of infection, defined as a sites of inflammation that precedes bacteremia, included pharyngitis in 15 and erysipelas/cellulitis in 16 patients. Six patients had no focus of infection. Shock was recorded in 4 patients, all of whom died. Seven patients had a rash, in 5 the rash was typical of scarlet fever. Of the 6 children who died 4 were previously healthy and they all died within 24 hours following admission, and were sick at least 48 hours before admission to our hospital. Our experience suggests that serious GABHS infections may appear in children, that it requires prompt recognition and treatment and that a worldwide change in the virulence of GABHS may have occurred.