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PubMed1998

Pneumococcal bacteremia in childhood: a 6-year experience in a community hospital.

OBJECTIVE: To review the clinical and laboratory findings in children with pneumococcal bacteremia during a 6-year period between 1989 and 1995. DESIGN: Retrospective review of medical records identified from computer-generated blood culture records. SETTING: Hurley Medical Center in Flint, Mich, a community teaching hospital affiliated with Michigan State University. MEASUREMENTS: Data concerning age, gender, race, clinical findings, laboratory features, nature of antibiotic therapy, source of bacteremia, and outcome were obtained from patient medical records. RESULTS: Most (68%) of the children with pneumococcal bacteremia were <2 years of age. About 50% of the cases of invasive pneumococcal disease in childhood occurred between February and May. Focal source of bacteremia was as follows: 11.5% had meningitis, 37% had pneumonia, 30% had otitis media, and 33% had no focal source. Overall, 60% of children were African-Americans, although in children with meningitis, whites were predominant (p<0.04). Leukocytosis was present in 81% and bandemia >1,500/microL was present in 53% of children. The overall mortality was 1.6% with a case fatality rate for meningitis of 14%. Penicillin resistance was found in 6.5% of pneumococcal isolates, although during 1 study year (1993), 17% of all pneumococcal isolates from all sources in the same hospital were found to be penicillin resistant. CONCLUSIONS: Clinical and laboratory findings seen in children with pneumococcal bacteremia at a community hospital are presented with a review of literature. Pneumococci isolated from sterile body sites were found to be less resistant to antibiotics compared with those isolated from nonsterile body sites.

Bacteremia↗
PubMed2002

A study of bacteremia in febrile neutropenic patients at a tertiary-care hospital with special reference to anaerobes.

Patients with hematological malignancies who are receiving chemotherapy suffer prolonged periods of neutropenia, which leads to a greater risk of infection and mortality. A prospective study was conduced to determine the incidence of bacteremia in patients of hematological malignancies over a 2-yr period. A total of 119 episodes of febrile neutropenia occurred among 96 consecutive patients, of which 35 episodes were associated with bacteremia. Forty-four percent of the isolated bacteria were Gram-positive aerobes and 46% were Gram-negative aerobes. Staphylococcus aureus, Enterococcus spp., and Escherichia coli were the most common isolates. Gram-negative bacteremia was associated with a higher mortality. Anaerobes accounted for 4.4% of all isolates. The episodes of anaerobic bacteremia were polymicrobial and had a fatal outcome. A high incidence of antimicrobial resistance among aerobic and anaerobic bacteria was also recorded. Compared to previous years, a shift from a predominating Gram-negative to a Gram-positive etiology was noted. The initial empiric antibiotic regimens should be based on a local knowledge of the most common causative microorganisms, their sensitivity pattern, and the outcome of bacteremia.

Adolescent↗
PubMedDate not supplied

Actinobacillus sp. bacteremia in foals: clinical signs and prognosis.

Medical records of 101 blood culture-confirmed bacteremic foals were reviewed to determine whether foals with Actinobacillus sp. bacteremia are affected at an earlier age, have more severe signs of disease, and have a worse prognosis than do foals with bacteremia of other causes. Thirty percent (30/101) of bacteremic foals had Actinobacillus sp. cultured, and these were 2 times more likely to die (crude odds ratio [OR(CR)] 0.8, 4; P = .14), with a survival rate of 43% (13/30) compared to the overall survival rate of 55% (56/101). When compared to other bacteremic foals, foals with actinobacillosis were 7 times more likely to have been sick from birth (adjusted odds ratio [OR(ADJ)] 2, 26; P = .003) and 6 times more likely to have diarrhea (OR(ADJ) 1, 22; P = .009). By bivariate analysis. foals with Actinobacillus sp. bacteremia were 5 times more likely to have a sepsis score >11 (OR(CR) 1, 18; P = .007), 6 times more likely to be obtunded (OR(CR) 2, 20; P = .005), and 3 times more likely to have pneumonia (OR(CR) 1, 7; P = .03). Furthermore, Actinobacillus sp. bacteremic foals were 27 times more likely to have a segmented neutrophil count <3.3 X 10(9) cells/L (OR(ADJ) 4, 166: P < .0001) and were 4.5 times more likely to have a band neutrophil count >0.46 x 10(9) cells/L (OR(ADJ) 1, 17; P = .02) when compared to foals that had bacteremia caused by either gram-negative enteric or gram-positive organisms. Sepsis score was < or = 11 in 49% (29/59) of bacteremia foals aged <13 days for which a discernible sepsis score was calculable. Results of this study should improve the diagnostic sensitivity of clinical examinations of neonatal foals, thereby facilitating treatment decisions.

Actinobacillosis↗
PubMed2005

Transient Haemophilus influenzae type b bacteremia in a healthy child.

Occult bacteremia with Streptococcus pneumoniae (S. pneumoniae) is sometimes experienced in general clinics, while that with Haemophilus influenzae type b (Hib) is less common and mostly develops to serious central nervous infection. Recently we encountered a patient with bacteremia due to Hib, in whom bacteremia recovered spontaneously without intravenous antibiotic therapy. A previously healthy 17-month-old girl was brought to our hospital with the complaint of high fever. Although her clinical condition did not present any of meningeal signs, the laboratory data on the first day showed prominent leukocytosis and sepsis work-up was done. Two days later (third day of illness), blood culture grew Haemophilus influenzae sensitive to ampicillin and the strain isolated from blood was identified as Hib. The febrile condition soon disappeared and bacteremia resolved with the negative result of the next blood culture. It is not clear about the precise mechanisms of this phenomenon, however, it is an extremely rare case for Hib bacteremia to resolve spontaneously.

Bacteremia↗
PubMed1993

Significant decrease of gram-negative anaerobic bacteremia in a major hospital from 1967-73 to 1981-89: an effect of the introduction of metronidazole?

Declining rates of anaerobic bacteremia are reported from medical centres all over the world. At Odense University Hospital the frequency of Gram-negative anaerobic bacteremia decreased from 1.62% in 1967-73 to 0.83% in 1981-89 (p < 0.001). Metronidazole prophylaxis prior to bowel surgery seems to be the most important explanation, as the association of Bacteroides bacteremia with surgery decreased from 80% to 48% (p < 0.01) and no cases of Bacteroides bacteremia occurred during metronidazole treatment without the presence of abscess or gangrene. A contributory factor may be improved methods for abscess localization and drainage. Other drugs having an effect on anaerobes seem of minor importance. A new category of patients seems to be those who have undergone aorto-femoral bypass operation for aneurysm of the aorta. They contract anaerobic Gram-negative bacteremia from infected hematomas or intestinal gangrene.

Adolescent↗
PubMed1993

Alpha-hemolytic streptococcal bacteremia: a review of 203 episodes during 1980-1991.

This is a review of 203 episodes of alpha-hemolytic streptococcal bacteremia during a 12-year period (1980-91) in a large community teaching hospital in the USA. There were 87 male and 116 female patients, with ages ranging from newborn infants to a 96-year-old; 118 patients (58.1%) were 60 years or older. 31 patients had endocarditis, 93 had bacteremia, and 79 had polymicrobial bacteremia. Streptococcus sanguis, S. mitis, S. salivarius and S. intermedius accounted for 80% of the strains. Some strains were resistant to tetracycline, nafcillin, erythromycin or clindamycin. The overall mortality was 29.6% (60 of 203 patients). There was no significant difference in the mortality among patients with endocarditis, bacteremia, and polymicrobial bacteremia. Factors that adversely influenced the mortality rate were old age (60 years and older) and rapidly fatal or ultimately fatal underlying conditions.

Adolescent↗
PubMed1997

A clinical study of beta-haemolytic groups A, B, C and G streptococcal bacteremia in adults over an 8-year period.

All of the 88 episodes of beta-haemolytic streptococcal bacteremia (2.9% of all bacteremias) in adult patients during the years 1987-94 in a university hospital were reviewed. 38 bacteremias (43%) were caused by group A, 24 (27%) by group B, 3 (4%) by group C, and 23 (26%) by group G beta-haemolytic streptococcal. There was a statistically significant increase in group A and decrease in group C and G bacteremias (p < 0.02) compared to an earlier 8-year period in the same hospital, although the total number of streptococcal bacteremias remained the same. The most common T types of group A streptococcal strains were T11 (26%), T28 (14%), T6 and T1 (11% each), and T12 (8%). Cardiovascular disease, skin lesions, malignancy, and alcohol abuse were the most common underlying conditions. The most usual types of infection were skin (47%) and respiratory tract infections (23%). The overall mortality was 16%. It was highest in group A (24%) and lowest in group C (0%), 38% of patients with pneumonia died. All streptococcal strains were sensitive to penicillin, vancomycin, and cephalosporins. 11% of group A and 12% of all the strains had decreased sensitivity to erythromycin, 14 and 38% to tetracycline, and 0 and 2% to clindamycin, respectively.

Adolescent↗
PubMed2004

Rapid molecular diagnosis of lactobacillus bacteremia by terminal restriction fragment length polymorphism analysis of the 16S rRNA gene.

OBJECTIVE: Bacteremia due to lactobacilli is uncommon, yet it is increasing in frequency, especially among immunosuppressed patients. In the clinical laboratory, lactobacilli must be subcultured from positive blood cultures before identification by traditional biochemical methods. Delays in diagnosis are significant because the organisms are inherently resistant to vancomycin, a drug frequently prescribed for empiric therapy for gram-positive bacteremia. Recently, we developed a rapid terminal-restriction fragment length polymorphism (T-RFLP) diagnostic assay based on species-specific variations in the bacterial 16S rRNA gene. We sought to apply this technique to the identification of Lactobacillus spp. from three cases of bacteremia. DESIGN: The results of the T-RFLP analysis are compared with two standard biochemical identification methods. METHODS: Lactobacillus strains were isolated from positive clinical blood cultures. Initial suspect cultures were subcultured and characterized using an automated substrate hydrolysis system and Lactobacillus carbohydrate fermentation profiles. Further biochemical and molecular analyses were performed from isolates propagated in Lactobacillus MRS broth. DNA was extracted and the 16S rRNA gene sequenced. Two sets of fluorescent labeled primers targeting the 16S rRNA gene were used for polymerase chain reaction (PCR) with chromosomal preparations from reference strains and blood isolates. The PCR products were digested with restriction enzymes and terminal-restriction fragment profile analysis performed. RESULTS: T-RFLP analysis correctly identified the Lactobacillus species in each case. T-RFLP analysis could be completed within 8 hours of obtaining a positive blood culture as compared to more than the 24 to 48 hours required for traditional culturing and biochemical characterizations. CONCLUSION: T-RFLP analysis allows for rapid identification of Lactobacillus directly from positive blood cultures and circumvents the requirement for subculture. Reduced diagnostic time has implications for duration of infection, the cost of patient care, length of hospitalization, development of broad-spectrum antibiotic resistance, and mortality due to bacteremia. T-RFLP profiling represents a highly reproducible and predictive source for identification of many organisms associated with bacteremia.

Bacteremia↗
PubMed2005

Vancomycin-resistant enterococcal bacteremia in a hematology unit: molecular epidemiology and analysis of clinical course.

An increase in vancomycin-resistant enterococcal (VRE) bacteremia in hemato-oncological patients (n=19) in our institution from 2000 through 2001 led us to analyze the molecular epidemiologic patterns and clinical features unique to our cases. The pulsed field gel electrophoresis of the isolates revealed that the bacteremia was not originated from a single clone but rather showed endemic pattern of diverse clones with small clusters. A different DNA pattern of blood and stool isolates from one patient suggested exogenous rather than endogenous route of infection. Enterococcus faecium carrying vanA gene was the causative pathogen in all cases. Patients with VRE bacteremia showed similar clinical courses compared with those with vancomycin-susceptible enterococcal (VSE) bacteremia. Vancomycin resistance did not seem to be a poor prognostic factor because of similar mortality (5/8, 62.5%) noted in VSE bacteremia. Initial disease severity and neutropenic status may be major determinants of prognosis in patients with VRE bacteraemia.

Adolescent↗
PubMed1995

Bacteremia with nontyphi Salmonella and therapeutic implication.

OBJECTIVES: The recent decades witnessed the increased incidence of bacteremia with nontyphi Salmonella, especially in patients with underlying diseases. To evaluate clinically the patients with bacteremia by nontyphi Salmonella, we investigated the clinical records of the patients. METHODS: Retrospective study was performed on 30 cases of bacteremia with nontyphi Salmonella admitted to Soon Chun Hyang University Hospital from 1987 to 1993, and we analyzed with regard to age distribution, underlying diseases, clinical presentation and fatality. RESULTS: Children below 2 years of age were seven patients and patients over 55 years of age were 8 patients. The male to female ratio was 3:2. Only five cases were nosocomially acquired. More than two-thirds (21 patients) had no discernible other illness at the time of their bacteremia. A quarter of the patients presented without gastrointestinal manifestation. There were four deaths in the 30 patients with nontyphi Salmonella septicemia (13.3%). CONCLUSIONS: We investigated the clinical characteristics of 30 cases of non-typhi Salmonella bacteremia, which has a relatively high incidence nowadays while, to the contrary, Salmonella typhi trends toward being on the decrease in Korea.

Adolescent↗
PubMed1993

Occult bacteremia in the 3-month-old to 3-year-old age group.

Occult bacteremia precedes many serious infections in children. The vast majority of patients with occult bacteremia have an elevated temperature (> or = 39 degrees C), but fever is an extraordinarily common presenting complaint in the 3- to 36-month-old age group, which is at highest risk for S pneumoniae, H influenzae type b, and N meningitidis bacteremia. On examination, most patients with bacteremia will have no findings that distinguish them from nonbacteremic children. A white blood cell count of > 15,000/microL in a child with fever will identify about two thirds of children with occult bacteremia. Blood culture remains the most definitive test. It is important to establish a rational strategy to identify and treat these children before significant sequelae occur.

Algorithms↗
PubMed1993

An outbreak of gram-negative bacteremia traced to contaminated O-rings in reprocessed dialyzers.

OBJECTIVE: To investigate an outbreak of gram-negative bacteremia in an outpatient hemodialysis unit and to identify the source of contaminating bacteria and the route by which bacteria gained access to the bloodstream. DESIGN: A matched-pair, case-control study and a bacteriologic investigation of the hemodialysis unit and the implicated dialyzers. SETTING: A university outpatient hemodialysis unit. PATIENTS: Eleven patients receiving long-term hemodialysis who had a total of 12 episodes of primary gram-negative bacteremia and 12 matched controls. MEASUREMENTS: Clinical and demographic data were obtained for patients and controls. Dialysis unit procedures were observed for compliance with aseptic technique. Cultures of potential environmental sources of bacteria were obtained. Hemodialyzers from bacteremic and nonbacteremic patients were dismantled, and the component parts were cultured. Inoculation of O-rings (from Hemoflow F-80 dialyzer) with bacteria and simulated dialysis were done. RESULTS: During January to October 1988, 12 episodes of primary gram-negative bacteremia caused by Pseudomonas cepacia, Xanthomonas maltophilia, Citrobacter freundii, Acinetobacter calcoaceticus var. anitratus, or Enterobacter cloacae occurred in 11 patients. In 11 episodes, symptoms developed within 3 hours of starting hemodialysis. Intravenous antibiotics were administered for 11 episodes, 3 episodes resulted in hospitalization, and all patients recovered. Case patients were more likely to have received high-flux dialysis with Hemoflow F-80 dialyzers (odds ratio congruent to 11) than were controls. O-rings from dialyzers used by bacteremic patients were culture positive for the organism responsible for bacteremia. Three of the four dialyzers were disinfected using the standard automated method and were recultured 72 hours later; the O-rings of all three dialyzers remained culture positive. Simulated dialysis using dialyzers with contaminated O-rings caused blood pathway contamination despite intervening reprocessing. When the disinfection method for F-80 dialyzers included removal and complete disinfection of the O-rings, O-ring and blood pathway cultures were consistently negative. After this procedure was made routine, no episodes of primary gram-negative bacteremia occurred during the next 6 months. CONCLUSIONS: Because dialyzers with removable headers and O-rings are widely used in patients receiving long-term hemodialysis, disinfection procedures should include measures to ensure adequate disinfection of O-rings.

Adult↗
PubMed1993

Short-course therapy of catheter-related Staphylococcus aureus bacteremia: a meta-analysis.

OBJECTIVE: To determine, through structured methodologic review of published articles, the effectiveness of short-course (< or = 2 weeks) antibiotic therapy for catheter-related Staphylococcus aureus bacteremia. DATA SOURCES: English-language publications on catheter-related S. aureus bacteremia identified using MEDLINE (1966 to the present) and bibliographic review of relevant articles and textbooks. STUDY SELECTION: Any study reporting outcome data for patients with catheter-related S. aureus bacteremia who were treated with short-course therapy. DATA EXTRACTION: Epidemiologic criteria were applied to assess the quality of protection provided by each study against four important types of biases. In addition, the statistical precision of each study was assessed. DATA SYNTHESIS: Eleven studies were identified. Reported late complication rates varied from 0% to 29%; the pooled estimate of the late complication rate was 6.1% (95% Cl, 2.0% to 10.2%). Ten of the 11 studies were uncontrolled. Only three provided adequate protection against treatment allocation bias. None of the studies adequately defined the illness under study, and only four provided adequate follow-up. The relapse rates in all 11 studies had low statistical precision. The complication and mortality rates for catheter-related S. aureus bacteremia when published data were pooled, regardless of duration of therapy, were 24% and 15%, respectively. CONCLUSIONS: The available data regarding the safety of short-course therapy for catheter-related S. aureus bacteremia are potentially flawed by both bias and statistical imprecision. The optimal duration of treatment remains unknown. Short-course therapy should be viewed with caution in treating this serious infection until randomized trials determine the comparative rates of late complication.

Anti-Bacterial Agents↗
PubMed1999

Cost-effectiveness of transesophageal echocardiography to determine the duration of therapy for intravascular catheter-associated Staphylococcus aureus bacteremia.

BACKGROUND: The appropriate duration of therapy for catheter-associated Staphylococcus aureus bacteremia is controversial. Conventional practice dictates that all patients receive prolonged courses of intravenous antibiotics. Some clinicians recommend abbreviated therapeutic courses, but an alternate approach involves prospectively identifying patients for whom abbreviated therapy is appropriate. OBJECTIVE: To determine the cost-effectiveness of transesophageal echocardiography (TEE) in establishing duration of therapy for catheter-associated S. aureus bacteremia. DESIGN: Cost-effectiveness analysis. DATA SOURCES: MEDLINE search of literature; clinical data from patients with S. aureus bacteremia (n = 196) and patients with endocarditis (n = 60); and costs obtained from the study institution, regional home health agency, and national estimates of professional and technical fees. TARGET POPULATION: Patients with catheter-associated S. aureus bacteremia on native heart valves without intravenous drug use or clinically apparent metastatic infection, immunosuppression, or indwelling prosthetic devices. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Antibiotic treatment based on TEE results compared with 2- or 4-week empirical therapy. OUTCOME MEASURES: Quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: Compared with empirical short-course therapy, the TEE strategy cost $4938 per quality-adjusted life-year (QALY) gained. The effectiveness of the TEE strategy and the effectiveness of the long-course strategy were sufficiently similar that the additional cost of empirical long-course therapy ($1,667,971 per QALY) was higher than that which society usually considers cost-effective. RESULTS OF SENSITIVITY ANALYSES: In a four-way sensitivity analysis (endocarditis prevalence, TEE cost, short-course relapse rate, and TEE specificity), compared with empirical short-course therapy, the TEE strategy results ranged from cost savings to $155,624 per QALY. CONCLUSION: Within the limitations of existing empirical data, this study suggests that for patients with clinically uncomplicated catheter-associated S. aureus bacteremia, the use of TEE to determine therapy duration is a cost-effective alternative to 2- or 4-week empirical therapy.

Anti-Bacterial Agents↗
PubMed1998

Serratia marcescens bacteremia: clinical features and antimicrobial susceptibilities of the isolates.

From July 1996 to June 1997, 22 adult patients with Serratia marcescens bacteremia were retrospectively studied at China Medical College Hospital. All patients had severe underlying disease, most commonly diabetes mellitus. Eighteen (82%) patients had nosocomial infection. Clinical syndromes included primary bacteremia (68%), pneumonia (14%), urinary tract infection (9%), suppurative thrombophlebitis (5%) and surgical wound infection (5%). Twelve patients had central venous catheters in place at the onset of bacteremia, but only one case met the definition of catheter-related infection. In 14 (64%) patients, portal of entry of S. marcescens infection was unknown. Five (23%) patients had concurrent polymicrobial bacteremia. The overall mortality rate was 50% (11/22). Seven (32%) of the 22 patients died of S. marcescens bacteremia. All isolates were resistant to ampicillin and cephalothin and susceptible to imipenem. Ninety-five percent of strains were susceptible to moxalactam, 68% to amikacin, 55% to ceftazidime, 45% to aztreonam, 32% to ceftriaxone, 27% to gentamicin, 18% to cefoperazone and cefotaxime, and 9% to piperacillin. MICs of various antibiotics demonstrated that ciprofloxacin and imipenem had good activities against S. marcescens, with MIC90 of 0.19 microg/mL and 1.0 microg/mL, respectively. Due to increasing multidrug resistance, choosing appropriate antimicrobial agents such as moxalactam, imipenem, and ciprofloxacin should be highly recommended for the treatment of S. marcescens infections.

Adolescent↗
PubMed2000

[Bacteremia caused by Stenotrophomonas maltophilia: epidemiology, clinical features, and prognosis factors].

The epidemiologic, clinical and prognostic characteristics of Stenotrophomonas maltophilia bacteremias for a six-year period (January 1993 to December 1998) were reviewed. Twenty episodes of S. maltophilia bacteremia were include, which represented 0.62% of all bacteremias caused by gram-negative rods during that period. Seventy percent of bacteremias were clinically significant. The most common predisposing factors were the previous use of antimicrobial agents and the presence of vascular catheters. In most cases (57%), the origin of bacteremia was the intravascular catheter. The course of patients was favorable and all patients cured.

Adult↗
PubMedDate not supplied

[Trends for bacteremia and risk factors for death in a tertiary hospital in Mexico City. 1981-1992].

OBJECTIVE: To describe the trends and risk factors of death for bacteremia in adult from a tertiary-care center from 1981 to 1992. MATERIAL AND METHODS: We randomly included 20% of bacteremic episodes per year. RESULTS: 47,618 blood-cultures from 19,530 patients, 3428 patients (17.6%) had bacteremia (285/y). From 600 episodes (50/y), 307 were from men, 368 were hospital-acquired (HA), and 88% were monomicrobial. Diabetes mellitus was seen in 103 cases, cirrhosis of the liver in 98, and AIDS in 33, among others. The main microorganisms were: Escherichia coli (177), Klebsiella pneumoniae (53), Enterobacter (50), Salmonella (45) and Pseudomonas aeruginosa (35); coagulase-negative staphylococci (CNS) (116), Staphylococcus aureus (56), and enterococci (22), and Candida (20). CNS decreased during the study (p < 0.01), but Candida spp., Stenotrophomonas maltophilia and enterococci increased (p < 0.01). The crude mortality of the HA bacteremia was 70.8%, and 29.2% in the case of community-acquired, the mortality attributable to HA bacteremia was 41.6%. The main risk factors were: cardiac valvular disease (p < 0.001), stay at the intensive-care unit (p < 0.001), sepsis (p < 0.001), and pneumonia (p < 0.001). DISCUSSION: Bacteremia had a significant impact on mortality during the study period that has not change despite opportune therapy, Enterococci and candida have emerged as significant pathogens.

Adult↗
PubMed2000

Staphylococcus aureus bacteremia.

OBJECTIVES: To study the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, to determine the source of infection, risk factors, the outcome of treatment and to compare our results with those reported in the literature. METHODS: A retrospective study in which the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia in the period from June 1996 to December 1998 were analyzed. RESULTS: A total of 103 episodes of Staph.aureus bacteremia were diagnosed in 95 patients with a mean age of 33.61 years (range 2 months to 90 years) and male:female ratio of 1.9:1. More than 50% of patients were Saudi nationals. Hospital-acquired infection was detected in 74% of the episodes versus 25% community-acquired. Methicillin resistant Staph.aureus was found in 29% of the episodes. Intravenous catheters and wounds were the main sources of bacteremic episodes (29% and 21%). The overall mortality was 32% with significant association with old age, diabetes mellitus and hemodialysis for renal failure. Risk factors such as surgical wounds, diabetes mellitus and malignancy, were more frequently associated with hospital-acquired than community-acquired bacteremia. Infective endocarditis was higher in patients with community-acquired bacteremia who had unknown source of infection. CONCLUSIONS: As discussed in the text, our results are comparable with those reported in the literature. Insertion of intravenous catheters under aseptic precaution, better care and judicious limitation of patients length of exposure to central line, in addition to proper wound dressings could reduce the frequency of blood stream infections.

Adolescent↗