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PubMed1991

Bacteremia with otitis media.

To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures greater than or equal to 39 degrees C, and were diagnosed with isolated clinical otitis media. A total of 2982 patients were identified. Blood cultures were obtained from 1666 (56%). Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia. These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus. The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures less than or equal to 40 degrees C and 5.0% at temperatures greater than 40 degrees C. Younger children were more likely to have bacteremia; 3.7% less than or equal to 12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant). Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient. It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well. The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort.

Child, Preschool↗
PubMed1990

[Nosocomial bacteremia caused by Acinetobacter].

Forty episodes of nosocomial Acinetobacter calcoaceticus bacteremia produced by the Anitratus type over a period of 4 years were analyzed and compared with a control group of 28 patients with bacteremia produced by gram negative bacilli. Although most of acinetobacter bacteremia were endemic an outbreak involving 12 cases were observed in an intensive care unit during the study period. Thirteen patients presented a transient bacteremia. When the site of origin of the infection could be established the respiratory system was the most commonly involved (5 cases). Polymicrobial bacteremia was present in 11 patients (27.5%). Gram-positive cocci were the most commonly associated microorganisms. Most of isolated Acinetobacter strains were resistant to cotrimoxazole, beta-lactams, and aminoglycosides but were uniformly sensitive to ciprofloxacin and imipenem. The overall mortality was 22.5%. As compared with the control group, Acinetobacter bacteremia occurred more frequently during the first week of hospitalization and involved patients with less severe underlying diseases in whom three or more potential risk factors were detected. The entering site of infection was commonly unknown and the antibiotic treatment was inappropriate in most of the cases of Acinetobacter bacteremia.

Acinetobacter Infections↗
PubMed1979

A review of Providencia bacteremia in a general hospital, with a comment on patterns of antimicrobial sensitivity and use.

Six cases of Providencia bacteremia occurring between 1969 and 1978 were reviewed. These cases represented 3% of the gram-negative bacteremias occurring at one hospital. All six cases of Providencia bacteremia were secondary to urinary tract infection with P. stuartii, and in most the infection developed only shortly before the onset of bacteremia; in three cases the bacteremia developed immediately following manipulation of the urinary tract. Patients with long-standing Providencia infections did not acquire bacteremia. The signs and symptoms of Providencia bacteremia were typical of those of septicemia except that vascular collapse was not a prominent feature, occurring in only one patient. The mortality was 33%. All the Providencia strains cultured from the bloodstream were susceptible to gentamicin, although the frequency of gentamicin resistance increased from roughly 10% to 50% during the period studied; the increase in gentamicin use over this period was more gradual. Also noted was a decrease in resistance to ampicillin that paralleled a decrease in ampicillin use. All the Providencia strains were susceptible to amikacin.

Aged↗
PubMed1984

Staphylococcus aureus bacteremia and endocarditis: comparison of nosocomial and community-acquired infection.

Staphylococcus aureus bacteremia continues to be a frequent clinical problem even in communities where intravenous drug abuse is relatively rare. One-hundred-three evaluable cases of S. aureus bacteremia that occurred in a large tertiary care facility over a four year period (1979-1982) are reviewed. A comparison of nosocomial and community-acquired S. aureus bacteremia reveals several fundamental differences. Community-acquired S. aureus bacteremia frequently develops in the absence of a primary focus of infection and is more likely to result in endocarditis and secondary metastatic foci of clinical infection. In contrast, nosocomial S. aureus bacteremia tends to be diagnosed earlier, a primary site of portal entry is usually identified and endocarditis is less frequent as are secondary foci of infection. Irrespective of the epidemiological origin of S. aureus bacteremia, the mortality remains high particularly in nosocomial infection where the presence of severe underlying disease contributes to the high mortality. Methicillin resistant S. aureus adds a new dimension to the challenge of successful treatment of staphylococcal bacteremia.

Adolescent↗
PubMed1978

Streptococcus bovis bacteremia and underlying gastrointestinal disease.

Twenty-six adults with Streptococcus bovis endocarditis and ten with bacteremia alone were studied to determine possible portals of entry. Of 36 patients (17 with endocarditis, eight with bacteremia alone), 25 had gastrointestinal lesions or manipulation. In 22, the gastrointestinal tract appeared to be the source of S bovis bacteremia. Four patients had either carcinoma of the colon (two) or potentially malignant villous adenomas (two) when first seen because of S bovis bacteremia. None of these, nor two other patients with benign colonic polyps, had bowel-related symptoms or signs prior to admission. Since S bovis is a normal intestinal tract inhabitant, bacteremia may frequently be associated with bowel lesions. Streptococcus bovis bacteremia may provide an early clue to the presence of serious and clinically unexpected gastrointestinal disease. Gastrointestinal tract evaluation should be part of S bovis bacteremia patient management, with or without endocarditis.

Adult↗
PubMed1976

Bacteremia in children: an outpatient clinical review.

In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia. Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b. Ninety-three percent of children with H. influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit. Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea. In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion. Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially. Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease. A temperature larger than or equal to 40.5 C showed more specificity for bacteremia than lesser fevers. A white blood cell count greater than 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures. Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid. Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement. This therapy may not be without soft tissue involvement. This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated.

Adolescent↗
PubMed1995

Streptococcal group C bacteremia. Survey in Israel and analytic review.

BACKGROUND: Data concerning group C streptococcal bacteremia come mainly from case reports; thus, population-based studies from different geographic areas are needed to validate these findings. METHODS: Eight years of data on group C streptococcal infection in Israel and cases of bacteremia in five hospitals were reviewed. We compared data from our survey as well as from other population-based studies with multiple cases published as case reports. RESULTS: The organisms were isolated in 78 cases (excluding pharyngitis); 16 had bacteremia. Ten cases of bacteremia were reviewed in five hospitals; none of the patients reported exposure to animals, and nine had severe underlying diseases. The clinical syndromes included four cases of primary bacteremia, four cutaneous infections, and one case each of meningitis and pneumonia. There were two deaths, one patient underwent amputation of a toe, one had a stroke, and one had a relapse. We compared 80 cases published as case reports with 59 cases reported in five population-based studies from different countries. We found higher rates of underlying diseases, alcohol abuse, liver diseases, and cutaneous infections, and lower rates of exposure to animals or raw products, endovascular infections, and central nervous system infections in population-based studies. Morbidity and mortality were 20% to 30% each in both types of studies. CONCLUSIONS: Group C streptococcal bacteremia affects patients with underlying diseases; exposure to animals is variable and less frequent than previously reported. Morbidity and mortality are high and probably reflect the patients' underlying state as well as the severity of the infection.

Adolescent↗
PubMed2001

Recurrent pneumococcal bacteremia: risk factors and outcomes.

BACKGROUND: Recurrent pneumococcal bacteremia receives infrequent mention in the literature, usually in association with patients who are immunocompromised. OBJECTIVE: To examine recurrent cases of pneumococcal bacteremia to determine risk factors and outcomes (mortality rates and emergence of resistance) associated with recurrences. METHODS: We retrospectively reviewed all cases of pneumococcal bacteremia identified by our microbiology laboratory from January 1, 1992, through December 31, 1996. Demographic, clinical, and laboratory data were abstracted. RESULTS: There were 462 bacteremic episodes in 432 patients; 23 of these patients had 30 recurrent episodes. The 5.3% recurrence rate (23/432) is greater than that previously described. The median time to recurrence was 200 days. The mean age of patients with recurrences was 34 years, 70% were women, all were black or Hispanic (in near equal numbers), and 87% were infected with the human immunodeficiency virus (HIV). Human immunodeficiency virus infection, coexistent cancer, and female sex were independent predictors of recurrence. Only patients who were HIV-infected had multiple recurrences. Isolates from recurrent bacteremias were more likely to be penicillin-resistant than were initial bacteremic isolates (relative risk, 2.0; P =.16). Patients with recurrences had a higher (although not statistically significant) mortality rate than those without recurrences (22% vs 16%; P =.33). There was an inverse relationship between severity of illness and likelihood of recurrence. CONCLUSIONS: Rates of recurrent pneumococcal bacteremia may be higher than previously reported. In patients with recurrent pneumococcal bacteremia, the presence of an underlying immunodeficiency should be investigated.

AIDS-Related Opportunistic Infections↗
PubMed1996

Recurrent pneumococcal bacteremia. A warning of immunodeficiency.

BACKGROUND: Recurrent pneumococcal infections are known to occur occasionally in patients with profound immune defects. We performed a case-control analysis of recurrent pneumococcal bacteremias). PATIENTS AND METHODS: The 547 episodes of Streptococcus pneumoniae bacteremia detected from January 1, 1985, to December 31, 1994, were reviewed. We selected all cases with more than 1 episode separated by 30 days or more ("cases") and compared each of them with 2 controls (patients with single episodes of pneumococcal bacteremia). RESULTS: Fifteen patients (2.8%) had 31 episodes of pneumococcal bacteremia. Except for multiple myeloma (P < .02), the underlying disease was remarkably similar among patients with single and recurrent episodes of pneumococcal bacteremia. However, among patients positive for human immunodeficiency virus infection, those who had recurrences were at a more advanced stage of their disease than those who did not. The presence of an ultimately fatal underlying condition was more frequent in case patients (P < .001). Overall, 47% of the patients with recurrences died during their second episode of pneumococcal bacteremia. CONCLUSIONS: Our data suggest that recurrence is more than anecdotal in patients with bacteremic infections caused by S pneumoniae (2.8%). We believe that recurrence is a warning sign of immunodeficiency. Patients with multiple myeloma, human immunodeficiency virus infection, solid organ tumors, and chronic liver disease with bacteremic pneumococcal infections should be offered antipneumococcal vaccine and other potentially preventive measures, despite doubts about their efficacy. This is justified by the high mortality rate associated with recurrent episodes (47%).

AIDS-Related Opportunistic Infections↗
PubMed2003

Risk of bacteremia in young children with pneumonia treated as outpatients.

BACKGROUND: Blood cultures are often obtained as part of the evaluation of children with pneumonia. There are few data regarding the risk of bacteremia with pneumonia in children since introduction of the Haemophilus influenzae type b vaccine. OBJECTIVE: To evaluate the risk of bacteremia in young children with pneumonia who were treated as outpatients. METHODS: A retrospective cohort study of 580 children aged 2 to 24 months who were evaluated by blood culture in a tertiary care children's hospital emergency department between February 1, 1993, and May 31, 1996, and discharged with the diagnosis of pneumonia. RESULTS: The mean patient age was 14.1 months; 339 patients (58.4%) were boys. Thirty-eight patients (6.6%) reported the use of oral antibiotics before initial emergency department evaluation. The prevalence of bacteremia was 1.6% (95% confidence interval, 0.7%-2.9%). Streptococcus pneumoniae was the causative organism in all 9 cases. The serotype was available for 8 of 9 cases. Six (75%) of 8 cases of S pneumoniae bacteremia were caused by serotypes included in the current heptavalent pneumococcal conjugate vaccine, which was not available at the time of this study. The contamination rate was 1.9% (95% confidence interval, 1.0%-3.4%). The mean +/- SD time to blood culture positive for organisms in a continuously monitored system was significantly shorter for pathogens (13.9 +/- 1.3 hours) than for contaminants (21.2 +/- 6.1 hours; P =.01). CONCLUSIONS: Children aged 2 to 24 months with pneumonia who are treated as outpatients are at low risk of bacteremia. Widespread use of the pneumococcal conjugate vaccine may further decrease the incidence of bacteremia in this population.

Bacteremia↗
PubMed1996

Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group.

OBJECTIVE: To determine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the serotypes and antimicrobial susceptibilities of the pneumococcal isolates. DESIGN: Prospective case ascertainment and procurement of S pneumoniae isolates between January 1991 and April 1994. SETTING: Ten adult care hospitals in Franklin County, Ohio. PATIENTS: Patients (N = 590) in whom S pneumoniae was isolated from blood cultures. MEASUREMENTS: Demographic data from patients with pneumococcal bacteremia were obtained by chart review. Pneumococcal serotyping and antimicrobial susceptibility testing were performed on 499 bacteremic isolates. RESULTS: Among residents of Franklin County, the annual incidence of pneumococcal bacteremia was higher in patients at least 65 years old (83.0 per 100,000 population) compared with younger adults (9.6 per 100,000 population) (odds ratio [OR], 8.74; 95% confidence interval [CI], 7.19 to 10.62) and more common among African Americans than whites (OR, 1.36; 95% CI, 1.06 to 1.75). The relative risk of pneumococcal bacteremia among persons infected with the human immunodeficiency virus was 41.8 times (CI, 19.0 to 92.0) that of county residents 18 to 64 years of age. The overall mortality rate was 19% and was age-dependent, reaching 38% in patients at least 85 years old. The distribution of pneumococcal serotypes causing bacteremia was remarkably consistent over time. The incidence of drug-resistant strains increased during the study period; by 1994 14% were resistant to penicillin, 12% to ceftazidime, and 24% to trimethoprim-sulfamethoxazole. The resistant strains included several serotypes of S pneumoniae. Most serotypes (89.8%) of S pneumoniae causing bacteremia are contained in the pneumococcal vaccine. CONCLUSIONS: Increased use of pneumococcal vaccine and recognition of antimicrobial resistance patterns may assist physicians in treating patients with S pneumoniae bacteremia. Educational programs to discourage unnecessary antimicrobial drug use should be developed for patients and physicians.

Adult↗
PubMed1995

Bacteremia associated with percutaneous transluminal coronary angioplasty.

Bacteremia after diagnostic cardiac catheterization is uncommon, but bacteremia after percutaneous transluminal coronary angioplasty (PTCA) has not been studied prospectively. Unlike diagnostic cardiac catheterization, PTCA involves the use of an indwelling arterial sheath after completion of the procedure, which is connected to a pressurized heparin solution, both of which increase the risk of local infection and/or bacteremia. During a 16-week period, we prospectively evaluated patients undergoing 164 PTCA procedures in order to determine the frequency of bacteremia and the significance of fever in this patient population. Blood cultures were obtained from the femoral catheter at the conclusion of the procedure and again 30 min later from the indwelling arterial sheath. Temperature was recorded every 30 min for 2 h following PTCA, then every 4 h over the subsequent 36-hr period. Bacterial isolates were recovered from 23/286 blood cultures (8.0%), with Staphylococcus epidermidis the most common organism present (74%). Only one isolate of Staphylococcus aureus was considered to represent true bacteremia and corresponded with the only documented infectious complication. Fever, defined as > or = 101 degrees F developed in four (2.4%) patients but was procedure related in only one case. The use of the ipsilateral femoral artery for repeat procedures was not associated with either positive blood cultures or difference in maximum temperature elevation. We conclude the overall risk of bacteremia after PTCA is low; therefore, antimicrobial prophylaxis is not warranted.

Adult↗
PubMed1996

Bacteremia in a pediatric hemodialysis unit secondary to Enterococcus fecalis.

UNLABELLED: Bacteremia is often a serious and recurring problem in children with hemodialysis catheters. We report an outbreak of Enterococcus bacteremia in a pediatric hemodialysis unit occurring from June 1992 to June 1993. During this period, 18 episodes of bacteremia occurred in eight children; 11 infections were polymicrobial. Enterococcus fecalis was associated with 13 infections in five patients (8 polymicrobial). Other pathogens included Enterobacter cloacae (5 infections), Staphylococcus (3), Staphylococcus epidermidis (2), and Klebsiella pneumoniae (2). All Enterococcus infections occurred in patients with dual-lumen subclavian venous catheters. Skin and catheter sites were culture negative, except in one patient. Rectal swabs were positive for Enterococcus in five patients. Enterococcus was not isolated from any source within the unit. Serotypes of all Enterococcus isolates were different, except for 2 isolates in the same patient. Starting in June 1993, catheters were flushed after dialysis with vancomycin or ampicillin. Since initiating this procedure, further episodes of Enterococcus bacteremia have not occurred. A questionnaire sent to other pediatric hemodialysis units failed to identify Enterococcus among 26 cases of bacteremia. IN CONCLUSION: (1) Enterococcus is an unusual pathogen for hemodialysis-related bacteremia in children; (2) patients with dialysis catheters were predisposed to this infection; (3) a common source for Enterococcus could not be identified by either culture or by serotyping; (4) flushing catheters with antibiotics after dialysis was effective prevention.

Bacteremia↗
PubMed1996

Prospective study of Streptococcus milleri bacteremia.

In a prospective study of bacteremia caused by organisms of the Streptococcus milleri group a total of 32 adult patients were observed over a seven-year period. These patients accounted for 1.6% of all patients diagnosed as having significant bacteremia and 17% of all cases of streptococcal (nonpneumococcal) bacteremia diagnosed during the study period. Only five patients had polymicrobic bacteremia. In 31 cases, a presumed origin of infection was identified, generally oral or gastrointestinal disease. There were only six cases of nosocomial acquisition. The most common presenting symptom was prolonged fever. The following forms of presentation were documented: bacteremia with local suppurative infection (56%), bacteremia without local suppurative infection (25%), and endocarditis (19%). An associated focus of infection was found in the abdominal cavity in 20 cases (62%). The mortality rate was 12.5%. All isolates were susceptible to penicillin. Caution is necessary in interpreting a blood culture positive for Streptococcus milleri group organisms, since, unlike other viridans streptococci, they are rarely contaminants. For this reason patients with suppurative processes and/or digestive tract disease must be carefully investigated.

Adult↗
PubMed1994

Risk factors for nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus.

In a prospective surveillance study (February 1990-December 1991) performed at a 1000-bed teaching hospital to identify risk factors for nosocomial methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, 309 patients were found to be colonized (n = 103; 33%) or infected (n = 206; 67%) by MRSA. Sixty-three of them developed bacteremia. Compared with 114 patients who had nosocomial bacteremia caused by methicillin-sensitive Staphylococcus aureus during the same period of time, MRSA bacteremic patients had more severe underlying diseases (p < 0.01), were more often in intensive care units (p < 0.01) and had received prior antibiotic therapy more frequently (p < 0.01). To further identify risk factors for MRSA bacteremia, univariate and multivariate analyses of this series of 309 patients were performed using the occurrence of MRSA bacteremia as the dependent variable. Among 14 variables analyzed, intravascular catheterization, defined as one or more intravascular catheters in place for more than 48 h, was the only variable selected by a logistic regression model as an independent risk factor (OR = 2.7, CI = 1.1-6.6). The results of this study reinforce the concept that recent antibiotic therapy may predispose patients to MRSA infection and suggest that among patients colonized or infected by MRSA, those with intravascular catheters are at high risk of developing MRSA bacteremia.

Adult↗
PubMed2001

Predisposing factors and outcome of Staphylococcus aureus bacteremia in neutropenic patients with cancer.

Staphylococcus aureus caused 30 of 438 (7%) cases of bacteremia in neutropenic patients with cancer during a 10-year study period. Acute leukemia as an underlying disease and severe oral mucositis were more frequent among patients with Staphylococcus aureus bacteremia (57% vs. 33%, P = 0.01, and 32% vs. 12%, P = 0.006, respectively) than among the 151 patients who had gram-negative bacteremia during the same study period. The most frequent source of Staphylococcus aureus bacteremia was the venous catheter (35% vs. 1%; P = 0.00001). Septic metastases were more frequent in patients with Staphylococcus aureus bacteremia (14% vs. 4%, P = 0.03). Attributable mortality was 10% and overall mortality 23%. Staphylococcus aureus bacteremia remains a significant cause of morbidity and mortality in neutropenic patients with cancer.

Adolescent↗
PubMedDate not supplied

Dental bacteremia in children.

Bacteremia resulting from dental extraction is regarded as an important cause of bacterial endocarditis, and it is therefore recommended that patients undergoing tooth extraction be given prophylactic antibiotics. As dental procedures other than extractions may also cause bacteremias, we studied a variety of dental procedures routinely used in pediatric dentistry. Blood samples for cultures were obtained 30 s after each of 13 dental operative procedures in 735 anesthetized children aged 2-16 years. Four procedures used for conservative dentistry caused bacteremias significantly more often than the baseline value of 9.4%: polishing teeth 24.5%, intraligamental injection 96.6%, rubber dam placement 29.4%, and matrix band with wedge placement 32.1%. In comparison, toothbrushing alone caused a bacteremia on 38.5% of occasions. The organisms isolated were typical of odontogenic bacteremias in that 50% of the isolates were identified as varieties of viridans streptococci. These data show that a wider variety of dental procedures than was previously documented cause bacteremia.

Adolescent↗
PubMed2003

Febrile neutropenia and Fusobacterium bacteremia: clinical experience with 13 cases.

OBJECTIVES: To assess the disease spectrum of Fusobacterium bacteremia in our neutropenic patients and review the literature. METHODS: This was a 6.5-year retrospective study in which all the records of neutropenic patients with Fusobacterium bacteremia were analyzed. RESULTS: Fusobacterium bacteremia was found in 13 neutropenic patients, 10 with hematological malignancies and 3 with solid tumors. The standard clinical presentation was that of primary bacteremia with benign evolution under antibiotics with anaerobic coverage. Most patients presented with oral mucositis as the probable portal of entry. Coinfection with other germs was documented in four patients. No patient had a localized infection documented. Most patients were receiving ciprofloxacin chemoprophylaxis. None of the patients had catheter-related infection. All tested strains were susceptible to all standard anaerobic agents. Fusobacterium spp. were responsible for 5% of bacteremias in neutropenic patients in our hospital during the last 6.5 years. CONCLUSION: Fusobacterium bacteremia is a possible cause of febrile neutropenia, especially in the setting of quinolone prophylaxis and oral mucositis after intense chemotherapeutic regimens. We think that its benign outcome if there is no localized infection detected does not justify the use of antianaerobic prophylaxis. Combination of beta-lactams and beta-lactamase inhibitors is a safe and reasonable treatment.

Adult↗