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PubMed2005

Predictors of mortality in Acinetobacter baumannii bacteremia.

This study retrospectively investigated 149 episodes of Acinetobacter baumannii bacteremia which occurred during a 41-month period from September 1997 to January 2001. Bacteremia was nosocomial in 139 (93%) of the episodes and community-acquired in 10 (7%). Thirty three deaths (22.1%) were attributed to these episodes of A. baumannii bacteremia. The mean age of survivors was younger than that of patients who died of bacteremia (60.4 +/- 19.9 vs 67.1 +/- 17.4) but this result was not significant on univariate analysis (p=0.084). Previous intensive care unit stay was longer among survivors than among patients who died of bacteremia (9.5 vs 18 days, p=0.048). Factors associated with mortality included immunosuppression (p=0.019), shock (p=0.002), recent surgery (p=0.008), invasive procedures such as central venous catheterization (p=0.002), urinary catheterization (p=0.012), placement of a nasogastric tube (p<0.001), pulmonary catheterization (p=0.015), and mechanical ventilation (p=0.035). The number of underlying conditions (p=0.015) and invasive procedures (p<0.001) were positively correlated with mortality. Mortality was significantly associated with lower platelet count (p=0.001) and lower serum albumin concentration (p=0.005). Patients with catheter-related bacteremia had a high survival rate (96.2%), while survival rate was low in patients with infection originating from the respiratory tract (60.8%). Susceptibility testing by agar dilution test indicated that imipenem was the most effective antibiotic, followed by cefepime and ciprofloxacin. The mortality rate was lower in patients who received 1 or more antibiotics to which the isolates were susceptible, but this difference was not significant (p=0.197). On multivariate analysis, factors that independently correlated with mortality were increased age (p=0.003), immunosuppressive status (p=0.001), recent surgery (p=0.002), acute respiratory failure (p=0.004), acute renal failure (p=0.009) and septic shock (p<0.001). These findings highlight the importance of a treatment strategy based on risk stratification among patients with A. baumannii bacteremia.

Acinetobacter Infections↗
PubMed2006

Clinical characteristics and risk factors for attributable mortality in Enterobacter cloacae bacteremia.

BACKGROUND AND PURPOSE: Enterobacter spp. have emerged as an important cause of nosocomial bacteremia. The purpose of this study was to delineate the clinical, laboratory and microbiologic features that may influence prognosis of Enterobacter cloacae and enable a stratification of those patients at high risk of mortality. METHODS: This retrospective study reviewed 108 episodes of E. cloacae bacteremia occurring over a 2-year period (November 2001 to October 2003) at Taipei Veterans General Hospital. Univariate analysis were performed to demonstrate the relation of possible risk factors to death attributable to E. cloacae bacteremia. RESULTS: Ninety-three episodes (86.1%) were hospital-acquired. The most common portal of entry was the genitourinary tract (17.9%) followed by the gastrointestinal tract (15.1%). Underlying diseases associated with E. cloacae bacteremia were neoplastic diseases (42 episodes, 38.9%), diabetes mellitus (20 episodes, 18.5%) and chronic renal failure (18 episodes, 16.7%). The overall mortality rate was 42.6%, and E. cloacae bacteremia-attributable mortality occurred in 22 patients (20.9%). Factors significantly correlated with death attributable to bacteremia were older age, a higher medium number of underlying diseases, hemoglobin <10 g/dL, serum C-reactive protein >10 mg/dL, hypoalbuminemia, disseminated intravascular coagulation, septic shock, respiratory failure, renal failure (creatinine >2 mg/dL) and delayed clinical response after initiation of antibiotic therapy. CONCLUSIONS: Antibiotic-resistant isolates and appropriate empirical antibiotic use were not independent predictors of mortality in this study. The condition of patients at onset of symptoms and presence of underlying diseases appear to be important predictors mortality from E. cloacae bacteremia.

Adolescent↗
PubMed2006

Stenotrophomonas maltophilia bacteremia in pediatric patients-- a 10-year analysis.

BACKGROUND AND PURPOSE: Stenotrophomonas maltophilia bacteremia is an important cause of mortality among immunocompromised children. However, there has been little information concerning S. maltophilia bacteremia in the pediatric population. METHODS: We reviewed the drug susceptibility of bloodstream isolates of S. maltophilia and medical charts of S. maltophilia bacteremia patients less than 18 years old at the Department of Pediatrics, National Taiwan University Hospital from January 1993 to June 2003. The risk factors associated with mortality of the patients with S. maltophilia bacteremia were analyzed. RESULTS: In total, 32 episodes (31 patients) of S. maltophilia bacteremia were reviewed. The average rate of nosocomial bloodstream infection was 8.3 episodes per 100,000 patient-days, and an average of 6.4% of them were caused by S. maltophilia. Malignancy was the most common underlying disease (32%). Six episodes of S. maltophilia bacteremia had soft tissue involvement, and only 1 of them underwent surgical intervention and survived. These 32 isolates were most susceptible to trimethoprim-sulfamethoxazole (91%), and no obvious increase in multidrug resistance was noted in the previous 10 years. The crude mortality rate was 40.6%. Malignancy, failure to remove central venous catheter, and ineffective antibiotic treatment were significant risk factors for mortality. CONCLUSIONS: Early and effective antimicrobial therapy and removal of central venous catheter as soon as possible are vital for the successful management of S. maltophilia bacteremia.

Adolescent↗
PubMed2006

[Nosocomial bacteremia].

Nosocomial bacteremia according to different authors can be divided in to bacteremia persistent, polymicrobial bacteremia, alternate bacteremia, breakthrough bacteremia, different bacteremia. Developing techniques of microbiological and molecular diagnostics induce us to verify the definition and partition of term "bacteremia".

Aged↗
PubMed2006

Bacteremias in patients with severe burn trauma.

UNLABELLED: The aim of the study was to investigate the causative agents of bacteremia in burned patients during 1999-2003. MATERIAL AND METHODS: All case records of 82 burned patients with bacteremia treated at the Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital were analyzed during 1999-2003. RESULTS: Mean body surface area burned in bacteremic patients was 29%. Bacteremia was diagnosed, on an average, on the 15th day after hospitalization and the 16th day after the burn. The causative agent of bacteremia in 71% of cases was methicillin-resistant Staphylococcus aureus; 11% of bacteremias were caused by Pseudomonas aeruginosa, and in 78% of cases Pseudomonas was sensitive to gentamicin. In all years, methicillin-resistant Staphylococcus aureus was the most common agent of bacteremia. Altogether, 55 patients out of 82 recovered. The mean duration of inpatient treatment was 48 days. CONCLUSIONS: Bacteremia was diagnosed at the beginning of the third week of hospital stay. More than half of bacteremic patients (67%) survived. The most common causative agents of bacteriemia were methicillin-resistant Staphylococcus aureus and gentamicin-sensitive strains of Pseudomonas aeruginosa.

Adult↗
PubMed2006

Clinical characteristics and risk factors for mortality in Morganella morganii bacteremia.

BACKGROUND AND PURPOSE: To clarify the clinical characteristics and risk factors for mortality of patients with Morganella morganii bacteremia. METHODS: Retrospective analyses were undertaken of patients with M. morganii bacteremia treated at Chang Gung Memorial Hospital-Kaohsiung, between 2002 and 2003. RESULTS: Seventy three patients (39 male, 34 female; mean age, 64.43 +/- 16.58 years) were included for analyses. At least 1 underlying disease was found in 91.7% of patients. Solid tumors (34.2%) was most frequently encountered. The leading portals of entry of M. morganii bacteremia were the urinary tract (37%) and hepatobiliary tract (22%). Of all included cases, 69.9% were community-acquired and 45.2% were of polymicrobial bacteremia. Urinary tract (47.5%) and hepatobiliary tract (30.3%) were the major portals of entry among patients with monomicrobial and polymicrobial M. morganii bacteremia, respectively. The overall mortality rate was 38.3%. Susceptibility testing of M. morganii isolates showed universal resistance to cephalothin, and high resistance rates to cefuroxime (90.5%) and amoxicillin-clavulanate (95.9%). In contrast to 95.8% of the M. morganii isolates being ceftazidime-susceptible, 19.4% were imipenem-resistant. Univariate analyses showed that fatal cases had significantly higher rates of diabetes mellitus (50% vs 20%, p=0.010), polymicrobial bacteremia (64.2% vs 33.3%, p=0.015) and inappropriate antibiotic treatment (67.8% vs 26.6%, p=0.001). Multivariate analysis indicated that inappropriate antibiotic treatment (odds ratio, 4.8, p=0.002) was the only independent risk factor for mortality. CONCLUSIONS: M. morganii bacteremia frequently occurred secondary to urinary tract or hepatobiliary tract infection, and was associated with a high mortality rate, especially for those not receiving appropriate antibiotic therapy.

Adolescent↗
PubMed1991

Antibiotic therapy for gram-negative bacteremia.

Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, the amelioration of the underlying conditions, the correction of predisposing factors, the drainage of abscesses, the removal of infected foreign bodies, and adequate supportive care are also of paramount importance for curing the infection and should not be neglected. Beginning in the late 1960s, most of the clinical work on gram-negative infections has focused on the evaluation of new antibiotics. Numerous studies have shown that early, appropriate antibiotic treatment of gram-negative bacteremia significantly improved patients' outcomes and prevented the development of septic shock. Prescribing standard doses of antibiotics does not necessarily mean that therapeutic levels will be reached in all patients, and relapses of infections or breakthrough bacteremias can occur in patients with subinhibitory serum levels of antibiotics. The monitoring of serum concentrations of antibiotic is therefore recommended in critically ill septic patients. Whereas initial studies on the antibiotic treatment of gram-negative bacteremia were carried out in nonneutropenic patients, more recent clinical investigations have been performed almost exclusively in cancer patients with neutropenia. Studies conducted in the 1970s and 1980s among these patients have shown the following: (1) early empirical therapy reduced the mortality of gram-negative bacteremia; (2) therapy with a combination of two antibiotics, be it an extended spectrum penicillin plus an aminoglycoside or a third-generation cephalosporin, has significantly improved patients' outcomes; and (3) triple-drug combinations (i.e., a penicillin plus a cephalosporin plus an aminoglycoside) are not superior to combinations of beta-lactams and aminoglycosides. For the treatment of gram-negative bacteremia, clinicians today have a choice between well-established antibiotic combinations and broad-spectrum single-agent therapy with third-generation cephalosporins or carbapenem antibiotics. Although recent studies suggested that monotherapy could be as effective as combination therapy for the empirical treatment of fever in the neutropenic host, no definitive study has so far unquestionably demonstrated the equivalence of these treatments in patients with gram-negative bacteremias, especially those caused by P. aeruginosa, or in patients with adverse prognostic conditions, such as persistent and profound granulocytopenia. This literature should however be reviewed with great caution. Indeed, only a minority of studies have included a sufficient number of patients to confidently assess the impact of therapy on patients' outcomes. Obviously, small studies can have a significant risk of type II errors, that is, making false-negative conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)

Aminoglycosides↗
PubMed1995

Gentamycin reduces bacteremia and mortality rates associated with the treatment of experimental peritonitis with recombinant tissue plasminogen activator.

BACKGROUND: Recombinant tissue plasminogen activator (rtPA), administered intraperitoneally, reduces intra-abdominal abscess formation in rats with fecal peritonitis at the costs of increased mortality and early Escherichia coli bacteremia. It was determined whether or not mortality and bacteremia could be prevented by gentamycin in these rats. STUDY DESIGN: Fecal peritonitis was induced by intraperitoneal injection of sterile feces contaminated with 10(8) (experiment 1) or 10(4) (experiment 2) colony forming units (cfu) E. coli and 10(4) cfu Bacteroides fragilis. Male Wistar rats were randomly assigned to receive either methyl hydroxy propyl cellulose (MHPC) gel alone (M) or 0.5 mg/mL rtPA dissolved in MHPC gel (M-tPA). Three hours after inoculation, one-half of the rats in each of these groups received 6 mg/kg gentamycin sulfate (G) intramuscularly (group M-G and M-tPA-G). At one, three, six, 12, and 24 hours after inoculation, blood cultures were taken. At five days after inoculation, intra-abdominal abscess formation was assessed and abscesses were cultured (experiment 2). RESULTS: All rats in groups M and M-tPA in experiment 1 developed bacteremia and died within 24 hours. Bacteremia occurred significantly earlier in group M-tPA compared with group M (p < 0.05). Gentamycin significantly reduced the number of rats with bacteremia, the bacteria concentration in the blood, and mortality rates. Although in experiment 2 none of the rats developed bacteremia, gentamycin prevented mortality associated with the use of rtPA. The number of abscesses in groups M-tPA and M-tPA-G was significantly lower than in those in groups M and M-G (p < 0.01). Gentamycin did not influence the number of abscesses. CONCLUSIONS: Gentamycin reduces bacteremia and mortality rates in rats with fecal peritonitis treated with rtPA intraperitoneally to prevent intra-abdominal abscess formation.

Abdominal Abscess↗
PubMed1994

Enterococcal bacteremia in a medical center.

BACKGROUND: The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS: There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS: One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS: Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.

Adolescent↗
PubMedDate not supplied

[Clinico-laboratory parameters of bacteremia and sepsis caused by Escherichia coli].

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.

Adolescent↗
PubMed1993

[Nosocomial bacteremia caused by Enterobacter spp.: epidemiology and prognostic factors].

BACKGROUND: The aim of this study was to establish the clinical and epidemiologic features of nosocomial bacteremia by Enterobacter spp. and to analyse its prognostic factors. METHODS: A prospective study of the episodes of nosocomial bacteremia by Enterobacter spp. with clinical significance, detected in a third level university hospital from January 1984 to December 1990 was performed. RESULTS: During the study period, 226 episodes of bacteremia by Enterobacter spp., of which 184 (81%) were of nosocomial origin (8.1% of all the nosocomial bacteremias), while 14% were polymicrobial. An increasing trend was observed in the number of episodes (1984 vs 1990) from 0.9 vs 1.8 episodes per 1,000 admissions, respectively. The mean age was 57 years and the male/female relation was 2.4/1. The most frequent focus of origin was infection of the vascular catheter (43%), followed by intraabdominal catheter (21%), urinary tract (14%), and other foci (17%). Fifty-four percent of the patients had received antibiotics prior to the episode of bacteremia. Most of the cases were detected in the Intensive Care Units (ICU) (41%) and in the gastrointestinal surgery area (24%). Global mortality was 23%. Logistic regression analysis selected an entry site other than infection of the vascular catheter (odds ratio 6.1; CI [95%)] 2.0-18.4), shock (odds ratio, 6; CI [95%], 1.6-21.9) and immunosuppressive treatment (odds ratio, 5; CI [95%], 1.5-16.2) as independent variables of bad prognosis. CONCLUSIONS: Enterobacter spp. is an important nosocomial pathogen taking fourth place in the ranking of nosocomial bacteremia by gram negative bacilli. It predominantly affects a population of patients admitted in the ICU and surgery. The intravascular catheter is a frequent entry site for nosocomial bacteremia by Enterobacter spp.

Adult↗
PubMed1995

Bacteremia in hospitalized patients infected with the human immunodeficiency virus: a case-control study of risk factors and outcome.

We reviewed all episodes of nonmycobacterial bacteremias in human immunodeficiency virus (HIV)-infected patients from 1990 to 1991 to determine the incidence, risk factors, and outcome. Forty-five patients had a total of 63 episodes of bacteremia (9% of 689 HIV-related hospitalizations). In this cohort, the median CD4+ lymphocyte count was 17 cells/mm3, 71% had AIDS, and 78% were homosexual men. The most frequently isolated bacteria were Staphylococcus aureus (25%) and coagulase-negative staphylococci (22%). The most common site of infection was intravenous catheter-related, accounting for 35% of the bacteremias. Compared to HIV-infected, nonbacteremic controls, patients with bacteremia detected at admission were more likely to have an indwelling intravenous catheter (p = 0.003) and less likely to be likely zidovudine (p = 0.04). The overall in-hospital mortality rate was 24%. There was no significant difference in the in-hospital mortality rates in bacteremic patients with or without HIV infection. Seventeen patients had more than one episode of bacteremia (71% had recurrence with the same organism). We conclude that bacteremia is a significant problem in HIV-infected persons with low CD4+ lymphocyte counts, often related to the presence of an intravenous catheter; recurrence is common. In addition, HIV infection does not appear to increase the mortality rate for bacteremia.

Adult↗
PubMedDate not supplied

Bacteremia associated with extracorporeal shockwave lithotripsy of gallbladder stones.

BACKGROUND/AIMS: The possible induction of bacteremia by extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones was studied. MATERIALS AND METHODS: Seventy-six patients undergoing a total of 107 ESWL treatments were studied. RESULTS: Twenty-four (22%) of the 107 treatments were associated with bacteremia. Staphylococcus epidermidis was cultured during and/or after 23 (96%) of the treatments associated with bacteremia. The ESWL-induced tissue damage of the skin in the pass-way of the shock-waves was the most likely cause of bacteremia in these patients. There was no correlation between the occurrence of bacteremia and the age or body mass index of the patients. Neither was there any correlation of bacteremia related to the duration of the treatment, the number of shock waves, the energy delivered, the stone volume or the occurrence of calcified stones. No patient developed sepsis or endocarditis. Transient fever shortly after treatment was recorded in 5 patients (5%), one of whom had bacteremia. CONCLUSIONS: Routine antibiotic prophylaxis is not indicated in patients undergoing ESWL for gallbladder stones. The question whether such prophylaxis should be given to patients at special risk, for instance patients with artificial heart valves or known valvular heart disease, remains to be answered in larger controlled and randomized studies.

Antibiotic Prophylaxis↗
PubMed1998

E. Coli bacteremia-induced changes in the skeletal muscle microcirculation vary with anesthetics.

AIM: To test if anesthetic procedures change the hemodynamic pattern in animals with experimental septic shock. METHODS: The effect of two anesthetics on systemic hemodynamic and skeletal muscle microcirculatory responses in high cardiac output live E. coli bacteremia was studied in rats and compared to the effect of two other anesthetic procedures in previously published studies. RESULTS: Baseline blood pressures and cardiac outputs were similar in rats with decerebrate, ketamine/xylazine, pentobarbital or urethane/chloralose anesthesia. There was a relative baseline tachycardia in decerebrate rats. Ketamine/xylazine anesthetized rats had reduced blood pressure, cardiac output, and heart rate. In decerebrate, pentobarbital, and urethane/chloralose anesthesia, cardiac output increased initially during bacteremia but did not remain elevated in pentobarbital anesthesia. Blood pressure and heart rate remained constant in pentobarbital, decerebrate, and urethane/chloralose anesth esia. During bacteremia, cardiac output, blood pressure, and vascular resistance did not change with ketamine/xylazine, but the heart rate increased. Baseline diameters of cremaster muscle large (A1) arterioles were higher in decerebrate anesthesia. A1 arterioles constricted during high cardiac output bacteremia in decerebrate rats, and pentobarbital or urethane/chloralose-anesthetized rats. A4 arterioles in bacteremia dilated in decerebrate and pentobarbital anesthesia, but did not change under urethane/chloralose and ketamine/xylazine anesthesia. CONCLUSION: Anesthetics influence baseline systemic variables and the response of systemic hemodynamics of rats to E. coli bacteremia. During bacteremia, anesthetics primarily affect the reactivity of skeletal muscle small arterioles. Ketamine/xylazine anesthesia has the most pronounced effect on systemic and microcirculatory variables and seems to be an inappropriate choice in sepsis experiments in rats.

Anesthetics↗
PubMed1990

Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations.

Coagulase-negative staphylococci were the leading cause of nosocomial bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and Children's Hospital, Boston, Mass, in 1982. To determine the consequences of these nosocomial bacteremias, a cohort study was conducted in which two comparison subjects were matched with each of 38 bacteremic infants by hospital, birth weight within 100 g, and nearest date of discharge. To adjust for duration of stay in the hospital, it was also required that both comparison subjects have survived and remained in the hospital for as long as the time until bacteremia occurred in the bacteremic infant. The average day of onset of bacteremia was the 20th hospital day. Despite having similar birth weights and comparable severity of underlying illness, bacteremic infants remained in the hospital for an average of 19.8 days longer than the nonbacteremic comparison subjects (77.3 vs 57.5 days). The bacteremic patients received antibiotics for an average of 11.2 more days than the nonbacteremic infants. Vancomycin hydrochloride was given to 20 (52.6%) of the bacteremic patients but only 4 (5.3%) of the comparison patients. All of the comparison subjects and 37 of the 38 infants with bacteremia survived. Thus, nosocomial bacteremia with coagulase-negative staphylococci is a late complication of hospitalization that occurs in infants who are already relatively long-term survivors. This bacteremia appears to be associated with substantially longer hospital stay and antibiotic therapy but little, if any, excess mortality.

Cross Infection↗
PubMed1985

Enterococcal bacteremia in surgical patients.

In 73 surgical patients enterococcal bacteremia was preceded by antibiotic administration (n = 58), central venous catheters (n = 52), other-organism bacteremia (n = 44), and gastrointestinal tract operations (n = 41). Surgical wounds and urinary tract infections were the most frequent portal of entry. The overall mortality was 42%. The mortality risk was significantly greater in patients with preceding or concomitant gram-positive bacteremia and four or more days of cephalosporin administration prior to enterococcemia. In 21 patients who had been given cephalosporins and who had gram-positive bacteremia, specific antienterococcal therapy resulted in survival in five of nine patients, compared with three of 12 who survived without therapy. Enterococcal bacteremia in surgical patients follows antibiotic administration, central venous catheter use, other-organism bacteremia, and intra-abdominal operations. Preceding or concomitant gram-positive bacteremia defines a subgroup of patients with high mortality who seem to respond to antienterococcal therapy.

Adult↗
PubMed1999

Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case-controlled study.

The aim of this study was to assess whether multiresistant gram-negative bacteremias (MRGNB) were associated with specific risk factors for higher mortality than sensitive gram-negative bacteremias. Two groups of subjects: (51 cases and 102 controls) were matched for sex, age, underlying disease, and neutropenia. There were no significant differences in the incidence of cytotoxic chemotherapy administered, vascular catheter insertion, catheter as source of bacteremia, and etiology of bacteremia. The proportion of Klebsiella-Enterobacter, Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia was similar in the two groups. Prior surgery (21.6% vs 7.9%, P < 0.05) was significantly associated with sensitive gram-negative bacteremia. Previous prophylaxis with ofloxacin (45.1% vs 24.5%; P < 0.05) and prior therapy with broad-spectrum antibiotics (41.2% vs 27.5%; P < 0.05), such as first and second generation cephalosporins (19.6% vs 7.8%; P < 0.05), third generation cephalosporins (41.2% vs 13.7%; P < 0.01), aminoglycosides (39.2% vs 9.8%; P < 0.01), ofloxacin (11.8% vs 2.0%; P < 0.005), and imipenem (19.6% vs 2.0%; P < 0.001) were significantly more frequently observed among cases than controls. Cases (patients with bacteremia due to multiresistant gram-negative bacteremias) were also significantly more frequently infected with bacteria resistant to ceftazidime (68.6% vs 17.6%; P < 0.001), amikacin (52.9% vs 7.8%; P < 0.001), imipenem (50.1% vs 23.5%; P < 0.05), ciprofloxacin (32.1% vs 5.9%; P < 0.001), and piperacillin (41.2% vs 7.8%; P < 0.01). With regard to outcome, attributable mortality was similar (15.7% vs 13.8%; not significant) in the two groups; however, cure rates were lower among cases (patients infected with MRGNB) because crude mortality was higher in cases (35.3% vs 13.8%; P < 0.01) than in controls.

Journal Article↗
PubMed1989

Community-acquired bacteremia in patients with acquired immunodeficiency syndrome: clinical presentation, bacteriology, and outcome.

PURPOSE: Community-acquired bacteremia is an easily treatable infection occurring in patients with acquired immunodeficiency syndrome (AIDS). Although other studies have reported bacterial infections in AIDS patients, none have clearly described the clinical presentation of these patients. In this survey, we sought to define how frequently AIDS patients presented to our institution with community-acquired bacteremia; which organisms and sources of bacteremia were involved; the frequency that these patients presented with abnormal vital signs and white blood cell counts; and the in-hospital outcome of these patients. PATIENTS AND METHODS: We retrospectively identified patients with AIDS hospitalized at San Francisco General Hospital in the 16 months between August 1986 and December 1987 in whom a positive blood culture was drawn within 24 hours of admission. Each of the patient's charts was reviewed for demographic data, relevant past medical history, clinical admission information, laboratory data, and discharge status. RESULTS: We identified 44 episodes of community-acquired bacteremia in 38 patients with AIDS. These episodes represented approximately 5% of the admissions of patients with AIDS. The patients were young (mean age, 38 +/- 7 years), homosexual (43 of 44), and in some cases intravenous drug users (nine of 44). On admission, only 57% of the patients were febrile (temperature greater than 38.3 degrees C) and 23% of the patients presented with normal vital signs. Twenty-seven percent were neutropenic (less than 1,000 neutrophils/mm3). The most common sources of the bacteremia were pneumonia (10), an indwelling central venous line (eight), and cellulitis (seven). A total of 14 patients had no apparent source. Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli were the most common organisms. Only four of the 44 patients died during their hospitalization. CONCLUSION: We conclude that patients with AIDS and community-acquired bacteremia can present to the hospital without abnormal vital signs or white blood cell counts. Clinicians cannot depend on these data to assist them in excluding the possibility of bacteremia in patients with AIDS. In addition, due to the variety of organisms found in our survey, we recommend that broad-spectrum antibiotics should be the empiric therapy in patients with a suspected bacterial infection.

Acquired Immunodeficiency Syndrome↗