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PubMed1998

[Analysis of critically ill patients with bacteremia].

OBJECTIVE: To study the epidemiology of bacteremia of critically ill patients and the mortality associated with bacteremia and risk factors for death in an intensive care unit. METHOD: 75 patients with 116 episodes of bacteremia were retrospectively studied. RESULTS: The mortality rate of the patients was 43%. Staphylococci (29%), Enterococci (12%), Class I inducible beta-lactamase-producing Enterobacter (12%), extensive spectrum beta-lactamase-producing Enterobacter (10%) were the most common pathogens, among which gram-positive organisms constitute a major part. The most commonly affected organs were respiratory (77%), hepatic (53%), circulatory (53%), gastrointestinal (50%), renal (47%), central nervous (36%), and hemopoietic systems (27%). Multiple organ failure accounted for 76%. Univariate analysis revealed that the severity of underlying illness, multiple organ failure (MOF), septic shock, hepatic failure, renal failure and infection focus were the risk factors for in-hospital death (P < 0.05). Cox proportional hazard model analysis suggested central nervous system failure, septic shock, hemopoietic failure, hepatic failure and respiratory manipulation significantly affected the survival time of patients with bacteremia (P < 0.05). CONCLUSION: Gram-positive organisms are major pathogens of bacteremia in critically ill patients. Antibiotic therapy can not prevent the occurence of bacteremia, nor can it improve the prognosis.

Adult↗
PubMed2001

Klebsiella pneumoniae bacteremia: community-acquired vs. nosocomial infections.

BACKGROUND: This study attempted to determine the clinical manifestations and influential factors affecting the prognosis of patients with community-acquired and nosocomial bacteremia of Klebsiella pneumoniae (K. pneumoniae). METHODS: We retrospectively reviewed the medical records of 211 patients who had a clinically significant episode of K. pneumoniae bacteremia from January 1997 until December 1999. RESULTS: Most reports describe K. pneumoniae bacteremia as typically nosocomial, but in our study approximately 3 of 4 episodes were community-acquired. Without including "unknown origin", the most common infectious site for both community-acquired and nosocomial bacteremia was the hepatobiliary tract. The overall mortality for all 211 patients with K. pneumoniae bacteremia was 25.1%. Significantly higher mortality rates occurred in patients who were elderly (> 65 years), had a nosocomial infection, for whom the respiratory tract was the portal of entry, and ultimately fatal conditions or acute complications were due to shock or renal insufficiency. CONCLUSIONS: Patients with community-acquired and nosocomial bacteremia had different types of underlying diseases. Isolates from nosocomial infections were significantly more frequently resistant to aminoglycosides, antipseudomonal penicillin, and all three generations of cephalosporins. In this regard, an aggressive empirical therapeutic approach to infections of K. pneumoniae is suggested.

Adult↗
PubMed2002

[Pseudomonas aeruginosa bacteremia: clinical and epidemiological patterns and treatment].

Pseudomonas aeruginosa bacteremia has the highest mortality among Gram-negative infections. We studied its clinical and epidemiological patterns in order to achieve an early and accurate diagnosis and treatment. We prospectively studied 211 cases of P. aeruginosa bacteremia admitted to our hospital from 1991 to 1998. All patients had at least one positive blood culture for P. aeruginosa and clinical symptoms of bacteremia. The prognosis of the underlying disease, past illnesses, foci location, initial clinical status, type of bacteremia, complications, and the type of antibiotic treatment were analyzed. Clinical and microbiological controls were carried out at baseline, at the end of the treatment period, and 1 month later. Of the 211 cases, 73% were men with a mean age of 56.5 years. Overall, 45.5% were hospitalized in the ICU, 28% in the surgical ward, and 26% in the medical service, with a mean length of stay of 40.4 days. As risk factors we identified a length of stay more than 14 days (76.7%), previous manipulations (87.6%), and surgery (44.5%). A total of 43.1% had had an infection in the last 6 weeks, and 46.4% were treated with antibiotics, usually broad-spectrum antibiotics without activity against P. aeruginosa. The most frequent underlying diseases were neoplasia (25.5%), postsurgical cardiopathy (24.1%), nephrosis (22.7%), chronic obstructive pulmonary disease (17.5%) and diabetes (13.2%). The most frequent foci were pulmonary (29.3%), urinary (21.8%), and undetermined (38.3%). The mortality rate was 27.9% and was considered related to P. aeruginosa bacteremia in 76.2% of the cases. The antibiotic treatment was considered adequate in 89% of the cases. It was concluded that knowledge of the clinical and epidemiological factors of patients with P. aeruginosa bacteremia may help to optimize its management and to reduce its morbidity and mortality.

Bacteremia↗
PubMed2003

Enterobacter bacteremia.

OBJECTIVES: To study the incidence, antimicrobial susceptibility pattern, age and sex distribution, mortality and prognostic factors in cases of Enterobacter bacteremia. METHODS: A total of 18,745 indoor patients with suspected bacteremia were included in study. Enterobacter spp were identified and speciated using standard protocols. Antimicrobial susceptibility testing was done using Stoke's disc diffusion method and minimum inhibitory concentration (MIC) was determined by agar dilution method as recommended by NCCLS. RESULTS: Enterobacter spp ranking sixth was responsible for 4.6% of total group of significant bacteremias. The species most commonly causing bacteremia was E. cloacae (61.8%). The bacteremia was unimicrobial in 85.1% and part of a polymicrobial bacteremia in 14.8%. Portal of entry in decreasing order of frequency were unknown, respiratory tract, urinary tract and surgical wound. The most common clinical finding was fever (97.2%). Of Enterobacter isolates 72.9% were multiresistant to three or more antimicrobial agents. Overall mortality was 51.1%. CONCLUSION: Enterobacter spp are becoming increasingly important nosocomial pathogens. To prevent further emergence of multidrug resistance it may beprudent to avoid third generation cephalosporins and instead combination therapy may be used.

Adolescent↗
PubMed2004

Neonatal bacteremia in a neonatal intensive care unit: analysis of causative organisms and antimicrobial susceptibility.

BACKGROUND: Infections cause significant mortality and morbidity in neonates, especially the premature ones. Although there are various antibiotics can be used to combat neonatal infection, resistant strains have subsequently emerged. In an epidemiological survey, we analyzed bacterial isolates and their antibiotic susceptibilities for cases of bacteremia in a neonatal intensive care unit (NICU) of a teaching hospital. METHODS: From November 1999 to October 2001, 623 neonates admitted to the NICU were enrolled. The incidence and incidence density of bacteremia, morbidity and mortality of sepsis, as well as antibiotic susceptibility, were investigated. RESULTS: Totally, 754 blood cultures were done on 623 patients. Fifty-eight patients experienced 85 episodes of bacteremia, with 87 isolates cultured. The incidence of bacteremia in our NICU was 9.31% (58/623) with an incidence density of 10.98/1000 patient-days. The overall mortality rate was 7.22%. The case fatality rate of bacteremia was 20.7% (12/58). The bacterial pathogens encountered, in order of frequency, were coagulase-negative Staphylococcus (29%), Staphylococcus aureus (22%), and Enterobacter cloacae (17%). All of the gram-positive bacteria were susceptible to vancomycin, while the gram-negative bacteria were susceptible to imipenem, amikacin and ciprofloxacin. Oxacillin-resistant S. epidermidis, oxacillin-resistant S. aureus, and multi-drug resistant enterobacteriae were the leading microorganisms causing bacteremia in our NICU. CONCLUSIONS: It is an endless struggle to combat neonatal infection. Periodic evaluation of bacterial antibiotic susceptibility is necessary. More judicious selection of antibiotics and rotating antibiotic regimens should be kept in mind to reduce the resurgence of multidrug resistant strains.

Anti-Bacterial Agents↗
PubMed2005

Alcaligenes xylosoxidans bacteremia: clinical features and microbiological characteristics of isolates.

Bacteremia caused by Alcaligenes xylosoxidans is rare. Between 1999 and 2002, 12 cases of bacteremia caused by A. xylosoxidans were diagnosed at a tertiary referral center in central Taiwan. The clinical features of these patients and the antimicrobial susceptibilities and pulsed-field gel electrophoresis (PFGE) pattern of their blood isolates were studied. All infections were acquired nosocomially. All of the adult patients had underlying diseases, and 10 (83%) had undergone an invasive procedure. The clinical syndrome included primary bacteremia in 7 patients (58%), and catheter-associated bacteremia, surgical wound infection, pneumonia, urinary tract infection, and empyema in 1 each. Polymicrobial bacteremia was found in 1 patient. The case-fatality rate was 17% (2/12). All isolates were susceptible to piperacillin and ceftazidime and resistant to aminoglycoside, ciprofloxacin and cefepime. Susceptibility to imipenem (67%), ampicillin-sulbactam (75%) and trimethoprim-sulfamethoxazole (92%) was variable. Genetic fingerprints obtained by PFGE showed identical pattern in the isolates from 2 neonates, indicating the epidemiologic relatedness of these infections. We conclude that A. xylosoxidans isolates are multi-resistant and A. xylosoxidans bacteremia should be considered as a possible etiology of infection after invasive procedures in patients with underlying diseases. Strict infection control is needed to prevent this infection.

Adult↗
PubMedDate not supplied

A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices.

A comparison of the incidence of transient bacteremia and infectious sequelae in patients undergoing sclerotherapy and those undergoing variceal ligation has not yet been reported. Fifty patients admitted with acute esophageal variceal bleeding were treated with sclerotherapy between July 1990 and July 1991. Fifty-five patients were treated with banding ligation between July 1991 and July 1992. Blood cultures were taken before and 5 minutes, 30 minutes, and 24 hours after treatment to compare the incidence of transient bacteremia in each group. The incidence of infectious sequelae during hospitalization was also compared. Transient bacteremia occurred in 17.2% of the sclerotherapy group and in 3.3% of the ligation group (p < 0.03). Infectious sequelae occurred in 18% of the sclerotherapy group and 1.8% of the ligation group (p < 0.01). Apart from bacteremia, the most frequently encountered infectious sequela was spontaneous bacterial peritonitis. Both transient bacteremia and infectious sequelae are more likely to develop when liver disease is severe. Two patients in the sclerotherapy group but none in the ligation group died of infectious sequelae. The incidence of transient bacteremia and infectious complications after sclerotherapy for acute variceal bleeding is about 5 to 10 times greater than that after variceal ligation. Inasmuch as it is equally effective and entails fewer infectious complications, variceal ligation is preferable to sclerotherapy for patients with acute variceal bleeding. Further randomized trials are needed.

Acute Disease↗
PubMed1994

Childhood bacteremia in Israel: causes, age relation, predisposing factors and source.

To delineate the spectrum of childhood bacteremia in a tertiary medical center in Israel and to define the historical, clinical and environmental variables that affect it, 339 bacteremic episodes were studied. Ten of the episodes (3%) were polymicrobial and 148 (44%) were hospital acquired. Staphylococcus epidermidis (17%), Staph. aureus (10%), gram-negative bacilli and Haemophilus influenzae (7%) were the most frequent etiologic pathogens. Some organisms (e.g., H. influenzae, Streptococcus pneumoniae) caused mainly community-acquired bacteremia, while Klebsiella sp., Enterococcus faecalis, and Acinetobacter sp. caused mainly nosocomial bacteremia. Underlying conditions were noted in 72% of the bacteremic children. A source of the bacteremia was identified in 60% of the episodes; the most common was i.v.-line infection. Age, underlying condition, source and location in the hospital markedly affected the profile of microorganisms causing childhood bacteremia. Each of these variables defined 3-5 organisms that were most prominent. In each episode of suspected bacteremia, these variables should be considered, thus defining the most likely causative pathogen(s), which should be covered by appropriate empiric antimicrobial treatment.

Adolescent↗
PubMed1994

[Bacteremia caused by Campylobacter jeikeium in 2 AIDS patients without neutropenia].

BACKGROUND: Bacteremia by Corynebacterium jeikeium is generally described in patients with a bone marrow transplantation and/or neutropenia. In 1991, the first case of bacteremia by C. jeikeium was described in a patient with AIDS and neutropenia. The aim of this study was to describe 2 cases of bacteremia by C. jeikeium in patients with AIDS without neutropenia. To the authors' knowledge, this presentation has not been described previously. METHODS: The bacteremia episode was related with a central venous catheter in both patients. The first patient was diagnosed of tuberculous lymphadenitis and cerebral toxoplasmosis and the second patient of disseminated tuberculosis. Both receive specific treatment for these diseases. Zidovudine was not administered. The bacteremia resolved in both cases after withdrawal of the catheter and antibiotic treatment with vancomycin. CONCLUSIONS: Bacteremia by Corynebacterium jeikeium should be considered in the differential diagnosis of febrile patients with AIDS and vascular catheters, even if granulocytopenia is not present. The isolation of C. jeikeium from blood in AIDS patients, particularly neutropenic patients, should be carefully evaluated by microbiologists and clinicians prior to discard it as a "contaminant".

AIDS-Related Opportunistic Infections↗
PubMed1993

[Bacteremia due to Mycobacterium tuberculosis in patients coinfected with the human immunodeficiency virus].

BACKGROUND: Since the appearance of AIDS, bacteremia by Mycobacterium tuberculosis is an event described with ever greater frequency. The isolation of M. tuberculosis in blood cultures in patients coinfected by the human immunodeficiency virus and M. tuberculosis may vary the initial clinical diagnosis and confirm the picture as disseminated tuberculosis. METHODS: The clinical records of patients admitted to the General Penitentiary Hospital of Madrid with significant bacteremia during the study period (March 1, 1991-September 1992) were retrospectively and prospectively reviewed. Special attention was given to the bacteremias by M. tuberculosis with the most significant clinical evolutive data being collected. The blood cultures were performed according to the routine technique using a non radiometric system with 10-day incubation and posterior processing of the sample for visualization and culture for mycobacteria. RESULTS: In an 18 moth period and out of a total of 284 positive blood cultures (154 significant isolations) 14 episodes of bacteremia by M. tuberculosis were studied in 12 prison patients coinfected by the human immunodeficiency virus with associated severe immunosuppression (mean of CD4 = 0.068 x 10(9)/l). All the patients were intravenous drug addicts. Likewise, 37 other significant bacteremias were reviewed. The positivity of the blood culture as the sole sample or associated to respiratory isolations, changed the initial diagnosis and classified the picture as disseminated tuberculosis on 6 occasions (43%). All the patients presented pictures of disseminated tuberculosis although only four had been previously diagnosed of AIDS. CONCLUSIONS: Bacteremia by M. tuberculosis is frequent in patients infected by the human immunodeficiency virus. M. tuberculosis (27.4%) was the most frequently isolated microorganism in blood cultures in this study. The processing of blood cultures for mycobacteria may be useful in patients positive for the human immunodeficiency virus with tuberculosis in order to confirm the diagnosis of disseminated tuberculosis. The isolation of M. tuberculosis in the blood may vary the initial diagnosis and could modify the prevalence of AIDS cases in Spain.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Bacteremia in children with acute lymphoblastic leukemia.

Bacteremia is one of the important complications of the treatment of hematological malignancy. In this report, we analyze bacteremias in 72 children with acute lymphoblastic leukemia who were admitted to our hospital from July 1, 1988 to October 31, 1991. Positive blood cultures were found in 26% (19/72) of the patients. There were 24 episodes of bacteremia; Gram-negative, Gram-positive and mixed bacteremia comprised 62.5% (15/24), 33.3% (8/24) and 4.2% (1/24), respectively. E. coli, klebsiella pneumoniae and Pseudomonas aeruginosa were the three most common pathogens. Eighty-three percent of the bacteremic episodes occurred during neutropenia (absolute neutrophil count below 500/mm3). Our data suggest that a Pseudomonas etiology, associated pneumonia, and shock accounted for a poor outcome. The over-all mortality for bacteremic events was 26.3% (5/19). Intensive supportive treatment and effective antibiotics are the most important factors in improving the outcome of bacteremia. The success in recent ALL treatment can be attributed in part to the improved outcome of bacteremia.

Adolescent↗
PubMed1997

Use of a clinical sepsis score for predicting bacteremia in neonatal dairy calves on a calf rearing farm.

In human, equine, and bovine neonates, early diagnosis of bacteremia remains a challenge for the internist. The objective of this study was to develop a predictive model for risk of bacteremia, based on a clinical evaluation system called the clinical sepsis score. Blood from 90 ill calves, 1- to 14-days-old from a calf-raising farm in the San Joaquin Valley of California was cultured. The calves were also scored according to a clinical score for hydration status, fecal appearance, general attitude, appearance of scleral vessels, and umbilical abnormality. Age, rectal temperature, heart rate, respiratory rate, and presence or absence of a focal site of infection were recorded. Prevalence of bacteremia was 31% (28/90). A logistic regression model indicated that high clinical score, presence of a focal infection, and increased age were associated with an increased risk of bacteremia in ill calves (P < 0.06). Calves for which the model predicted bacteremia with a probability > or = 40.8% were considered bacteremic, yielding acceptable sensitivity (75%) and specificity (71%) estimates. The predictive model was validated through a 2nd sampling of 100 calves (79 ill calves and 21 controls), of which 17 calves were bacteremic. The classification was 75% correct using the model, with an estimated sensitivity of 76% and specificity of 75%. Overall, results indicated that the model could be a useful tool for predicting bacteremia in ill calves in a clinical setting.

Aging↗
PubMed1997

Low risk of bacteremia during catheter replacement in patients with long-term urinary catheters.

BACKGROUND: Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It is conceivable that catheter replacement causes bacteremia and contributes to this morbidity and mortality. The purpose of our study was to determine the incidence and clinical relevance of bacteremia induced by urinary catheter replacements. METHODS: We analyzed clinical signs and symptoms and laboratory measures (leukocyte count, C-reactive protein, urine sediment, urine culture) during 120 routine catheter replacements in geriatric patients. In addition, blood cultures were drawn before and at 5, 15, and 30 minutes after catheter replacement. RESULTS: The urine cultures showed growth of 1 to 5 different microorganisms before replacement. Of 480 blood cultures, 27 (5.6%) were positive. However, the same species grew from blood and urine in only 5 catheter replacements. None of the patients met criteria for systemic inflammatory response syndrome. There were no significant differences in clinical and laboratory findings between patients with and without bacteremia. Coagulase-negative staphylococci grew in 12 blood cultures. Their distribution over time suggested that they mainly represented catheter replacement-related bacteremia rather than contaminants. Consequently, 64 intraurethral catheter segments were additionally cultured. Coagulase-negative staphylococci grew in 10 catheter cultures, but in only 2 simultaneously cultured urine samples. CONCLUSION: Bacteremia induced by routine replacement of long-term urinary catheters occurred in 4.2% (5/120) of replacements in geriatric patients. Such bacteremia did not have a detectable clinical relevance in our study.

Aged↗
PubMed1997

[Bacteremia in patients undergoing chronic hemodialysis in a 16-year period].

OBJECTIVE: To determine the incidence of bacteremia among patients on hemodialysis, the responsible microorganisms and to describe the predisposing and prognostic factors. METHODS: A retrospective analysis was conducted of 85 episodes of bacteremia occurred from 1979-1994; the episodes involved 71 patients (male/female ratio: 27/44) with a mean age of 58 years (29-80). RESULTS: Eighty-seven microorganisms were recovered, which included 61 grampositive cocci (67% Staphylococcus aureus), 25 gramnegative bacilli (52% Escherichia coli) and 1 anaerobe. The mean incidence was 3.1/100 patients on hemodialysis/year (range: 1.1-8.3), higher in patients with interstitial and cystic renal disease. In 52% of cases an intravascular source was detected, associated with vein access for hemodialysis (in 91% there were inflammatory signs at the fistula). In 16 cases (19%) no portal of entry was detected and in the remaining patients the portal of entry had an extravascular origin. Eighty patients received antibiotic therapy and 35 patients required the substitution of the vein access. Thirteen patients died (15%) as a result of bacteremia. The mortality rate was higher among patients developing shock (50%), endocarditis (75%) and in those who had remained for longer than 1,000 days on hemodialysis (45%). Bacteremia accounted for the third known cause of death on dialysis, and was responsible for 11% of deaths occurred during the time of the study. CONCLUSIONS: Bacteremia among hemodialysed patients was mainly associated with Staphylococcus aureus infections at the vascular access. Bacteremia was the direct responsible for 11% of deaths occurred on dialysis.

Adult↗
PubMed1998

Bacteremia in nursing home patients. Prevalence among patients presenting to an emergency department.

OBJECTIVE: To measure the prevalence of bacteremia and any correlation between signs and symptoms, risk factors, and laboratory data in elderly patients. DESIGN: Prospective analysis. All patients were contacted by the study nurse at 48 hours and 7 days after study entry. SETTING: Adult tertiary care hospital with an emergency department managing 48,000 visits yearly in a metropolitan area of 250,000. PARTICIPANTS: Members of the study population referred to the emergency department for medical or surgical problems. Of 113 nursing home patients, blood culture results were available for 111. MAIN OUTCOME MEASURES: Blood cultures were obtained by standard protocol. Demographic and medical information was collected from the medical record. Three groups of patients were compared with respect to symptoms, risk factors, laboratory data, and outcome. RESULTS: Group 1 (n = 86) had two sets of negative blood cultures. Group 2 (n = 10) had true-positive cultures. Group 3 (n = 15) had false-positive cultures of Staphylococcus epidermidis. The prevalence of bacteremia was 9.8% in the study population. No risk factors were predictive of bacteremia. Great variation in signs and symptoms were noted in all three groups, none correlating with bacteremia. Although seven of the 10 patients with positive cultures were febrile, this association did not reach statistical significance. All groups had high admission (> 50%) and mortality (20% to 37%) rates. CONCLUSIONS: The prevalence of bacteremia in the nursing home population presenting to the emergency department was 9.8%. The symptoms and signs of bacteremia in this population were variable and nonspecific. The high rate of false-positive cultures in this setting is of concern.

Adult↗
PubMed1997

[Pseudomonas aeruginosa bacteremia as a complication after endoscopic retrograde cholangiopancreatography].

BACKGROUND: The present was performed to describe the characteristics of bacteremias by Pseudomonas aeruginosa following cholangiopancreatography and the methods of prevention and treatment of the same. METHODS: Twelve different episodes of bacteremia by Pseudomonas aeruginosa were retrospectively studied in patients submitted to endoscopic cholangiopancreatography (ERCP) from 1993-1997. RESULTS: Three point six percent of the patients undergoing ERCP presented episodes of bacteremias by the microorganism in the 48 hours following the procedure. Except for one case, the patients presented obstructive disease in the form of calculi or neoplasms at the level of the biliary tree. In three cases, sphincterotomy had been carried out which was followed by clinical manifestations of hemorrhage in one case. Three patients (25%) died as a consequence of bacteremia and a hepatic abscess was developed in one case. The bacteremia appeared in successive outbreaks from 1993-1997. CONCLUSIONS: Bacteremia by Pseudomonas aeruginosa following ERCP is more frequent in patients with obstructive disease of the biliary tract and has an important additional morbimortality. It is associated with incorrect endoscopic disinfection. The use of drugs with an antipseudomonal spectrum should be considered as preendoscopic prophylaxis.

Adult↗
PubMed1998

Can hospital discharge diagnosis be used for surveillance of bacteremia? A data quality study of a Danish hospital discharge registry.

OBJECTIVE: To assess the data quality of septicemia and sepsis registration in a hospital discharge registry in the County of Northern Jutland, Denmark. DESIGN: Comparison of data from the discharge registry of an 880-bed, public, urban hospital in the County of Northern Jutland with data from a computerized bacteremia database at the regional department of clinical microbiology. SETTING: Urban hospital with approximately 45,000 admissions per year. PATIENTS: The study included 406 episodes of bacteremia in the bacteremia database and 83 discharges with the diagnosis of septicemia registered in the hospital discharge registry between January 1, 1994, and December 31, 1994. INTERVENTIONS: None. RESULTS: Eighteen episodes were registered in both the hospital discharge registry and the bacteremia database. Using the bacteremia database as reference standard, the sensitivity for the diagnosis of septicemia in the hospital discharge registry was 4.4% (18/406; 95% confidence intervals [CI95, 2.4%-6.4%]). By review of hospital records, we estimated the positive predictive value of septicemia registration in the hospital discharge registry as 21.7% (18/83; CI95, 12.8%-30.5%). No blood culture had been obtained in 44.4% (36/81; CI95, 33.6%-55.3%) of the cases with a discharge diagnosis of septicemia. In 33.3% (27/81; CI95, 23.1%-43.6%), the discharge diagnosis of septicemia was given, although blood cultures were negative. CONCLUSIONS: The hospital discharge registry revealed numerous misclassifications, and the system was found not suited for surveillance of, or research in, bacteremia at present.

Bacteremia↗
PubMed1998

Bacteremia in patients with hematologic malignancies.

The decision regarding the appropriate empirical antibiotic therapy for bacteremia in patients with hematologic malignancies must be individualized in each institution, by taking into account variations in the patterns of microbial isolates and their resistance profiles. Microbial isolates and antibiotic resistance patterns must be taken into account at each hospital. A shift from bacteremia due to infections caused by predominantly gram-negative organisms to predominantly gram-positive organisms in patients with hematologic malignancies has been noted in reports from other countries. We investigated bacterial isolates and their antibiotic sensitivities in patients with hematologic malignancies in the Veterans General Hospital-Taipei. A total of 185 episodes of bacteremia in 140 patients with hematologic malignancies were recorded during the period from 1995 to 1996. Unlike foreign reports, our investigation shows that gram-negative organisms still predominate, accounting for 72.7% of isolates, followed by gram-positive organisms, accounting for 26.3% of isolates, and anaerobes, accounting for 1% of isolates. Escherichia coli was the most commonly isolated organism, accounting for 23.9% of isolates, followed by Klebsiella pneumoniae (18.5%), Pseudomonas aeruginosa (12.2%), Enterobacter cloacae (7.3%), and methicillin-resistant Staphylococcus aureus (7.3%). A high mortality rate was observed in gram-negative bacteremia: 31% for E. coli, 26% for K. pneumoniae, 24% for P. aeruginosa, and 33% for E. cloacae. If methicillin-resistant S. aureus bacteremia occurred, mortality was high (47%). The antibiotic sensitivity profiles of the four most common gram-negative isolates (E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae) indicated that, in our hospital, amikacin with either cefoperazone, ceftazidime, ciprofloxacin, or imipenem, would be an ideal combination for empirical therapy for bacteremia in patients with hematologic malignancies.

Adolescent↗