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PubMed2006

Comparison of risk factors for candidemia versus bacteremia in hospitalized patients.

BACKGROUND: Classic risk factors for candidemia include use of total parenteral nutrition (TPN), hospital location, use of central venous catheter, and others. Unfortunately, most of these variables are now also risk factors for antibiotic-resistant bacteria. Thus, use of these risk factors to identify patients at high risk for candidemia is difficult. The purpose of this study was to compare these classic risk factors for candidemia in patients with bloodstream infections to determine the relative strength of these predictors in differentiating patients with candidemia and bacteremia. METHODS: Clinical data were collected from the medical charts of patients who had been hospitalized between 2002 and 2004. Patients with their first episode of candidemia or bacteremia during their hospital stays were included. Risk factors were assessed using a multivariate logistic regression model and internally validated using a bootstrap analysis. A p-value < 0.05 was considered significant. RESULTS: A total of 164 patients (82 with candidemia) were evaluated. According to the logistic analysis, patients who had stayed in the intensive care unit (ICU) (OR = 6.24; 95% CI: 2.58-15.09) or had been using TPN (OR = 4.69; 95% CI: 1.76-12.48) were more likely to have candidemia than bacteremia. While patients with pulmonary (OR = 0.15; 95% CI: 0.055-0.39) or cardiac disease (OR = 0.21; 95% CI: 0.086-0.51) had a greater chance to have bacteremia than candidemia (p < 0.01 for all variables). These results were further validated using bootstrap analysis. CONCLUSION: Among classic risk factors for candidemia, the ICU location at the time of culture and TPN use were most predictive of candidemia while certain medical disorders predicted patients at the highest risk for bacteremia. These results can be used to help identify patients most likely to benefit from empiric antifungal therapy.

Adult↗
PubMed1991

A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices.

Reported incidences of bacteremia after endoscopy with esophageal variceal sclerotherapy are conflicting. A prospective controlled study was conducted to determine the frequency of bacteremia after emergency endoscopy with esophageal variceal sclerotherapy compared with frequency after elective esophageal variceal sclerotherapy and after emergency endoscopy in patients with upper gastrointestinal bleeding from nonvariceal sources. A total of 126 endoscopies were studied in 72 patients. Groups consisted of (a) emergency endoscopy without esophageal variceal sclerotherapy, 37 sessions with 36 patients; (b) elective esophageal variceal sclerotherapy, 33 sessions with 14 patients; and (c) emergency esophageal variceal sclerotherapy, 56 sessions with 36 patients. Blood cultures were obtained before and 5 and 30 minutes after endoscopy. There was a higher frequency of preendoscopic bacteremia in emergency esophageal variceal sclerotherapy (13%) than in emergency endoscopy alone (0%) (P = 0.02). Clinically significant bacteremia in emergency esophageal variceal sclerotherapy was observed in 7 of 56 (13%) sessions, compared with 0 of 33 in elective esophageal variceal sclerotherapy (P = 0.03) and 1 of 36 (3%) in emergency endoscopy alone (P = 0.45). Of these cases, 3 (5.4%) were potentially caused by emergency esophageal variceal sclerotherapy, but not clinically significant postendoscopic bacteremia was attributable to the procedure in the other groups.

Adult↗
PubMed1992

Group-C beta-hemolytic streptococcal bacteremia.

Group-C beta-hemolytic streptococci (GCBHS) is an uncommon cause of bacteremia. In a 5-year period, GCBHS accounted for 0.28% of positive blood cultures and 0.35% of bacteremias documented at our hospital. The incidence of GCBHS bacteremia was 0.05 episodes per 1000 admissions. We were able to analyze clinical data of 10 of the 13 patients with GCBHS bacteremias. All but one were adults with significant underlying diseases, and seven episodes were community acquired. The skin was the portal of entry in only one case. Clinical syndromes included primary bacteremia (four cases), pneumonia (two cases), endocarditis (two cases), and meningitis, intraabdominal infection, and metastatic suppurative pericarditis (one episode each). Of 13 isolates, 12 were identified to species level: six, Streptococcus equisimilis; three S. equi; two S. dysgalactiae; and one S. zooepidemicus. Resistance to penicillin was detected in one isolate and none of our isolates displayed penicillin tolerance, Four patients died (40%) despite appropriate antimicrobial therapy.

Adolescent↗
PubMed1991

Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients.

The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years). Thirty-four patients had one or more prosthetic heart valves. Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography. An additional late blood culture was obtained in 114 patients 1 h later. The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes. Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system. The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle. Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles. Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1). All were considered contaminants. Mean endoscopic time in these patients was not significantly different from that in the other patients. Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection. It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate.

Adult↗
PubMed2004

Prospective study of the impact of open and closed infusion systems on rates of central venous catheter-associated bacteremia.

OBJECTIVE: We sought to ascertain the effect of switching from an open infusion system to a closed system on rates and sequelae of central venous catheter (CVC)-associated bloodstream infection in the intensive care department (ICU) of 2 hospitals in Argentina. METHODS: A prospective, controlled, time-series, cohort trial was undertaken in adult patients admitted to 4 level-III adult ICUs in Buenos Aires, Argentina, who had a CVC in place for at least 24 hours. Rates of CVC-associated bloodstream infection during a period of active surveillance with an open system (baseline; externally vented, semirigid, noncollapsible, 1-port plastic bottles) were compared with rates after switching to a closed system (intervention; nonvented, collapsible, 2-port plastic bags). RESULTS: Between August 1999 and March 2002, 992 patients in the ICU with CVCs were enrolled. Patients during each study period (open system, 608; closed system, 384) were similar with respect to sex, severity-of-illness score, and prevalence of diabetes and cancer. Compliance with handwashing and CVC site care was also similar during the 2 study periods. The incidence of CVC-associated bacteremia during use of the closed system was significantly lower than during use of the open system (2.36 vs 6.52/1000 catheter-days, relative risk=0.36, 95% confidence interval=0.14-0.94, P=.02); bacteremias caused by gram-negative bacilli declined by 64%. In all, 17 patients with catheter-associated bacteremia died during the period when the open system was in use (2.8%), versus only 1 (0.2%) during use of the closed system (relative risk 0.09, P=.003). The calculated cost savings in the 20 hospital-month intervention period was $53,768 and 130.9 ICU days. CONCLUSION: Adoption of a closed infusion system resulted in major reductions in the incidence of catheter-associated bacteremia, related mortality, and cost. Because most Latin American hospitals still use externally vented fluid containers, switching to nonvented bags could substantially reduce rates of nosocomial bacteremia.

Aged↗
PubMed2006

Stenotrophomonas maltophilia bacteremia in burn patients.

Stenotrophomonas maltophilia has been increasingly reported as a nosocomial opportunistic pathogen in debilitated patients, including burn patients. There is, however, only one published report in English that discusses S. maltophilia bacteremia in burns. We performed a retrospective chart review and statistical analysis of the incidence, the duration of hospital stays before a diagnosis of bacteremia, antimicrobial susceptibility, prognosis, and mortality risk factors in burn patients. From January 1996 to December 2004, 14 episodes of S. maltophilia bacteremia in 13 of 666 patients admitted to the burn center at our hospital were identified. The patients, nine males and four females, ranged in age from 1 to 76 years (mean: 42.9+/-24.4 years). Eleven injuries were from flame burns and two were from scald burns. The mean total burned surface area (TBSA) was 47+/-30.2% and mean prognostic burn index (PBI) was 81.7+/-31.3. The average annual incidence was 2.3 episodes per 1000 admissions, and no outbreak cluster was noticed. The mean hospital stay before bacteremia was 19.8+/-11.9 days. Most isolates were susceptible to ticarcillin-clavulanate (87.5%) and moxalactam (85.7%). The overall mortality was 30.7% (4/13) and correlated significantly with TBSA (P<0.01) and PBI (P<0.05). The incidence of S. maltophilia bacteremia was higher in hospitalized burn patients than in hospitalized non-burn patients. Different antimicrobial susceptibility patterns may exist, especially in different geographic regions. Awareness of the possibility of infection by this opportunistic pathogen and commencement of adequate antibiotics treatment, especially after 3 weeks of intensive care, should be incorporated into the strategy of treatment in major burn patients.

Adolescent↗
PubMed2006

Community-onset Escherichia coli and Klebsiella pneumoniae bacteremia: influence of health care exposure on antimicrobial susceptibility.

Three hundred forty-one case patients with Escherichia coli bacteremia and 173 case patients with Klebsiella pneumoniae bacteremia were enrolled in this prospective observational study to compare the clinical manifestations of infections in the 2 organisms and to delineate the change in resistance of isolates after health care exposure. Liver abscess, primary bacteremia, and respiratory tract infection were more commonly seen in patients with K. pneumoniae bacteremia, whereas urinary tract infection was more common in those with E. coli bacteremia. The influence of prior hospitalization on resistance of E. coli to some antibiotics could be observed for as long as 6 months after discharge. Patients undergoing procedures in the outpatient setting and nursing home residents also had infections with more resistant E. coli strains than those without hospital exposure within the previous year. However, no difference in resistance was observed in K. pneumoniae isolates from patients in different clinical settings.

Adult↗
PubMed2006

Five years of nosocomial Gram-negative bacteremia in a general intensive care unit: epidemiology, antimicrobial susceptibility patterns, and outcomes.

OBJECTIVES: Nosocomial Gram-negative bacteremia in the critically ill is associated with significant morbidity and mortality. This study provides epidemiological and antimicrobial susceptibility data for nosocomial Gram-negative bacteremia in a general intensive care unit (ICU) over a five-year period. METHODS: Positive blood cultures from January 1, 1999 to December 31, 2003 were reviewed for microbial etiology and susceptibilities. Patient charts were reviewed to determine the source of infection and outcome. RESULTS: Forty-five nosocomial Gram-negative bacteremias occurred in 44 patients. Infection rates of 6.9/1000 admissions and 11.3/10,000 patient days remained stable. Admitting diagnoses included respiratory failure, solid organ transplant, post-surgery, and multi-trauma. Seven bacterial species were identified; Pseudomonas aeruginosa and Enterobacter spp were most common. Sources of bacteremia included pneumonia (48.9%), and central venous catheterization (22.2%). Antimicrobial susceptibilities were highest for imipenem, gentamicin, tobramycin, ceftazidime, and piperacillin-tazobactam. Ciprofloxacin susceptibility was inferior to imipenem, gentamicin, and tobramycin (p < 0.05). Mortality rates were 53.3% in the ICU, and 60% for overall hospitalization. Average length of ICU stay was 50.5 days compared to 6.13 days for all-comers. CONCLUSIONS: Nosocomial Gram-negative bacteremia is associated with marked morbidity and mortality in critically ill patients. Significant resistance to ciprofloxacin was demonstrated. Empiric treatment regimens should be based on unit-specific data.

Adolescent↗
PubMed2005

Bacteremia following pediatric adenoidectomy.

OBJECTIVE: Adenoidectomy is frequently performed in children. The goals of this work were to determine the incidence of bacteremia during the adenoidectomy, to identify the microorganisms implicated, and to analyze the possible association of bacteremia with postoperative complications. METHODS: One hundred pediatric patients operated of adenoidectomy without preoperative antibiotic prophylaxis were prospectively included in this study. They had no immunosuppressive and/or cardiovascular risk factors, no antimicrobial therapy for at least 15 days prior to operation, and no fever 1 week before surgery. Venous blood samples were obtained 30 s and 20 min after the curettage of adenoidal tissue. RESULTS: The 33 and 14% of the samples were positive at 30 s and 20 min. The organism more commonly isolated was the streptococcus viridans. Bacteremia was only related to postoperative acute otitis media (p=0.012). CONCLUSIONS: Bacteremia exists after pediatric adenoidectomy, although it seldom correlates with clinical signs or symptoms. Postoperative acute otitis media is the only complication related to postsurgical bacteremia.

Acute Disease↗
PubMed2004

Clinicians required very high sensitivity of a bacteremia prediction rule.

BACKGROUND AND OBJECTIVE: Efforts to improve blood culture practice have focused on developing clinical prediction rules to identify patients at risk for bacteremia. However, no such models have been accepted into general clinical use. The goal of this study was to determine physicians' criteria for acceptability of a bacteremia clinical prediction rule. METHOD: We conducted a survey of all medical and surgical house officers as well as all infectious diseases physicians at the University of Pennsylvania to identify physician requirements for the sensitivity of a bacteremia clinical prediction rule. RESULTS: Of 225 eligible physicians, 149 (66.2%) completed the survey, including 110 house officers and 39 infectious disease physicians. The median (95% confidence interval) sensitivity of a bacteremia prediction rule required by respondents was 95% (95% confidence interval, 95.9%). Furthermore, 29 (19.5%) respondents required the sensitivity of a prediction rule to be at least 99%. The median required sensitivity was significantly higher for infectious diseases physicians than for house officers (98% and 95%, respectively) (P=.04). CONCLUSION: Our survey of house staff and infectious diseases physicians demonstrates that the sensitivity of any bacteremia prediction rule must be extremely high (i.e., 99% to 100%) to be widely accepted by practicing clinicians. Elucidation of physician criteria for acceptability of clinical predictive models will be invaluable in future efforts to develop such prediction rules.

Attitude of Health Personnel↗
PubMed2005

Bacteremia and septic shock after solid-organ transplantation.

BACKGROUND: Bacteremia and septic shock remain important causes of morbidity and mortality after solid-organ transplantation. The aim of this study was to assess the characteristics and risk factors for mortality among patients with bloodstream infections and shock. METHODS: From January 1991 to December 2000, all episodes of bloodstream infection were prospectively examined, considering bacteremia or fungemia as significant according to the CDC criteria. Septic shock was diagnosed in a patient with systemic inflammatory response syndrome and persistent dysfunction of at least one organ caused by hypoperfusion despite hemodynamic support. RESULTS: There were 466 episodes of bacteremia in 382 patients, with 66 of them developing septic shock. Risk factors for developing shock were age >50 (P = .006), liver transplant (P = .029), nosocomial infection (P = .034), pulmonary focus (P = .0001), P. aeruginosa infection (P = .001), and polymicrobial etiology (P = .039). On multivariate analysis, only age, nosocomial infection, and pulmonary source were significant. Among 66 shock patients, bacteremia was due to gram-negative bacteria in 53%, gram-positive bacteria in 24%, fungal in 7.5%, and polymicrobial in 12% of patients. The most frequent source was the lung (26%). Empiric antimicrobial therapy was correctly chosen in 79%; however, 36 patients died (54%), including 27 despite correct therapy. Urinary tract infections had less mortality than other foci. CONCLUSIONS: Risk factors for developing septic shock in bacteremia were age more than 50 years, nosocomial acquisition, and pulmonary focus. Despite adequate empiric antibiotic therapy, the mortality remained high.

Bacteremia↗
PubMed1998

Granulocyte colony-stimulating factor use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients.

BACKGROUND: Neutropenia occurs in up to 17% of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival. METHODS: A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI). RESULTS: The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm3 versus 40 cells/ mm3, P=0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P=0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P=0.002). In a multivariate analysis, significant decreased risk for bacteremia was found with G-CSF use (odds ratio [OR]=0.15, P=0.02). Survival was longer in patients treated with G-CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP. CONCLUSIONS: We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed2001

Relapsing bacteremia in patients with ventricular assist device: an emergent complication of extended circulatory support.

BACKGROUND: Ventricular assist devices (VAD) are currently approved for use as a bridge for transplantation. Although reports have suggested acceptable rates of survival of patients with VAD, there is little information regarding the mechanism and etiology of bacteremia in these patients. METHODS: We prospectively followed patients who underwent VAD implantation and developed bacteremia during VAD support at the University of Pittsburgh Medical Center. Relapsing bacteremia was defined as at least two episodes of positive blood cultures with a genetically related organism on 2 different days. Species identification and susceptibility testing were performed on all isolates. Pulse field gel electrophoresis was performed on selected blood and VAD isolates. RESULTS: Between January 1998 and August 1999, 3 patients with VAD developed relapsing bacteremia, which was treated with full courses of antibiotic agents, 2 of whom also developed VAD endocarditis. All 3 patients had documented driveline or device pocket infections with these isolates. Consecutive blood and VAD isolates were found to be genetically related within each patient. CONCLUSIONS: These patients with bacteremia after VAD implantation had relapse due to the same strain, which may have originated from indolent driveline infection. Endovascular infection in this setting is difficult to eradicate with antibiotic agents and carries a high mortality. These patients should be considered to have priority for orthotopic heart transplantation.

Adult↗
PubMed2002

[Nosocomial bacteremia in the adult patient. Study of associated costs].

OBJECTIVE: Nosocomial infection causes a prolonged hospital stay and an increase in care costs. The objective of this study was to determine the length of stay excess and costs attributable to nosocomial bacteremia. PATIENTS AND METHODS: Retrospective study of clinical records of 148 patients with nosocomial bacteremia during 1996. A matched case-control study was performed. For matching, the following parameters were used: RDG, year of admission, age 10 years, main diagnosis and number of secondary diagnoses. Costs were determined by excess length of hospital stay and calculating alternative costs. RESULTS: Matching was obtained for 100 cases (67.5%) and cost estimation was performed. Compared with cases, non-matched cases showed differences regarding significant issues for cost, such as hospital stay ( p = 0.01), number of empirical (p = 0.001) or definitive antibiotics (p = 0.03). The median hospital stay for cases was longer than for controls (35 vs 15.5 days, respectively; p = 0.000). When only survivor case-control pairs were considered (n = 75), cases remained in hospital for a median of 36 vs 15 days for controls (p = 0.000). Hospital stay days attributable to nosocomial bacteremia were 19.5 for all matched and 21 for matched survivor cases. Only 76% of cases had stay days attributable to bacteremia. Significant differences between cases and controls included: the mean total costs of admission (p = 0.000), cost of stay (p = 0.001), pharmaceutical expenses (p = 0.000), and cost of microbiological studies (p = 0.000), laboratory work-up (p = 0.001) and radiological studies (p = 0.000). Hospital stay represented more than 60% of costs, followed by pharmaceutical expenses. Cost differences between bacteremic patients and controls, calculated in function of stay median, was 4.424 euros (p = 0.000) and 4.744 euros (p = 0.000) for alternative costs. Ten cases showed a difference that represented more than half of the total difference. CONCLUSIONS: Nosocomial bacteremia represent a stay prolongation and a significant economical burden. Hospital stay and pharmaceutical expenses accounted for the most part of the associated costs. The differences in costs obtained with both methods were small. Since not all selected cases were matched, there may be an error in the appreciation of the difference between cases and controls.

Aged↗
PubMedDate not supplied

Bacteremia following diagnostic and therapeutic ERCP.

The occurrence of bacteremia in association with diagnostic or therapeutic ERCP was studied in 180 patients undergoing a total of 194 examinations. Nineteen (15%) of 126 diagnostic procedures and 18 (27%) of 68 therapeutic procedures were associated with bacteremia (p less than 0.1). Nine patients had polymicrobial bacteremia and a total of 16 species were detected. Different streptococci, mainly alpha-hemolytic, were the most common bacteria which were identified in 38% of the bacteremic patients. There were no significant differences with regard to the occurrence of fever, pancreatitis, or septic complications between the diagnostic and therapeutic groups of patients. Neither did the complication rate in patients with bacteremia differ from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Complication rates did not differ between patients with and patients without pancreaticobiliary obstruction. However, the majority of patients with biliary stasis had drainage with relief of the obstruction at the time of the diagnostic ERCP. We conclude that general routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP. The question whether such prophylaxis should be given with certain diagnoses or treatments, or in patients with valvular heart disease, remains to be answered in controlled randomized studies.

Aged↗
PubMed1999

The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial.

BACKGROUND: Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics. METHODS: Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation. RESULTS: Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia (p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type. CONCLUSIONS: The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation.

Aged↗
PubMed1994

Clinical and molecular epidemiology of enterococcal bacteremia in a pediatric teaching hospital.

An apparent increase in the incidence of enterococcal bacteremias from 7 to 48/1000 bacteremias during 1986 to 1991 (p < 0.01) prompted this descriptive clinical and molecular epidemiologic study of 83 episodes occurring in 80 children between 1986 and 1992. Most community-acquired cases were in infants, in comparison with nosocomial episodes (24/26 and 34/57; p < 0.01); many of them were neonates (10/26 and 6/57; p < 0.01). Nosocomial cases were associated with underlying conditions including major surgery 56%, immunosuppression 49%, organ and tissue transplants 30%, and cardiac 32%, pulmonary 25%, renal 21%, and hepatic 21% disorders. Nosocomial episodes developed after a median of 32 days. There were 58 primary and 25 secondary bacteremias. Thirty-two episodes were polymicrobial and 44 organisms were involved. Twenty-six percent of the patients died. In 15%, death was preceded by septic shock, disseminated intravascular coagulation, and polymicrobial bacteremia (p < 0.01). Of 75 isolates, 82% were Enterococcus faecalis and 14% were Enterococcus faecium. Fourteen E. faecalis strains produced hemolysin; none produced beta-lactamase. Three had high-level resistance to gentamicin and 13 to streptomycin; two E. faecium and none of the E. faecalis strains were vancomycin resistant at a low level (p < 0.01) and one was ampicillin resistant. Pulsed-field gel electrophoresis of whole-cell DNA digested with restriction enzymes Sma I and Eag I showed five isolates with a homogeneous pattern, two with another homogeneous pattern, and 68 with distinct heterogeneous patterns. The increase in enterococcal bacteremias was not due to a clonal strain dissemination but to an increase in cases of heterogeneous enterococcal strains. We conclude that enterococcal septicemia is now an important cause of serious morbidity and death in critically ill children.

Anti-Bacterial Agents↗
PubMed1995

Bacteremia in children with sickle hemoglobin C disease and sickle beta(+)-thalassemia: is prophylactic penicillin necessary?

OBJECTIVE: To characterize the incidence of bacteremia and its potential for progression to septicemia in children with sickle hemoglobin C disease and sickle beta(+)-thalassemia to assess the need for penicillin prophylaxis. STUDY DESIGN: Retrospective chart review of the frequency and natural history of bloodstream infection in such patients not receiving prophylactic penicillin therapy and followed up in a single institution. RESULTS: During more than 842 patient-years of observation in 242 patients with sickle hemoglobin C disease, 15 episodes of bacteremia occurred in nine patients. Septicemia was fatal in one patient. The overall incidence of bacteremia, 1.8 events per 100 patient-years (95% confidence limits: 0.8, 2.8) in patients with sickle hemoglobin C disease, was similar to that in hematologically normal children. One episode of bacteremia occurred in a patient with sickle beta(+)-thalassemia. CONCLUSIONS: The incidence of bacteremia is not increased in young patients with sickle hemoglobin C disease and sickle beta(+)-thalassemia. Further, unlike its course in children with sickle cell anemia, it rarely evolves into life-threatening septicemia. This probably results from the maintenance of relatively intact splenic function during infancy and early childhood in patients with sickle hemoglobin C disease and sickle beta(+)-thalassemia. Prophylactic penicillin therapy may not be required in these patients.

Adolescent↗