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PubMed2001

Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital.

BACKGROUND: Group B streptococcal bacteremia in nonpregnant adults continues to be a significant infection. METHODS: We reviewed medical records of nonpregnant adult patients with group B streptococcal bacteremia from 1995 to 1999 and compared the findings with data from a similar study in our institution between 1980 and 1984. RESULTS: There were 36 episodes of group B streptococcal bacteremia. The mean age was 70 years. Most of the cases (94%) were community-acquired. The most common underlying disease was diabetes mellitus (49%). The most common sources of group B streptococcal bacteremia were pneumonia and soft tissue infections. The overall mortality rate was 16.7%. CONCLUSIONS: Group B streptococcal bacteremia is still found mainly in the elderly, with significant underlying disease, particularly diabetes mellitus. The spectrum of infection has included lymphadenitis, ascending cholangitis, mastitis, prostatitis, and toxic shock syndrome. The mortality has decreased significantly during the past 15 years (16.7% vs 67.9%).

Adult↗
PubMed2003

Methicillin-resistant/methicillin-sensitive Staphylococcus aureus bacteremia.

OBJECTIVE: To examine the differences between the clinical presentation, management and outcome of persons bacteremic with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), after controlling for age, sex and primary diagnosis. METHODS: A review of the clinical records and laboratory data of all MRSA and MSSA bacteremic patients. Fifty matched case-control pairs were further analyzed looking for differences between the 2 populations. The study was carried out in a 500-bed adult tertiary care institution in southwestern Ontario, Canada, between 1994 and 1999. RESULTS: On univariate analysis a) duration of hospitalization prior to bacteremia, b) concomitant polymicrobial bacteremia, c) time to appropriate treatment, were significantly greater in the MRSA infected population. Attributable mortality was also higher, 36%-20%, but this did not achieve significance (p=0.1). On multiple logistic regression analysis, a), b) and c) remained significantly different. CONCLUSION: In a 1:1 matched case-control study of Staphylococcus aureus bacteremia, those infected with MRSA became bacteremic later in their hospital stay, more often had a polymicrobial bacteremia and were appropriately treated later. Although mortality attributable to the MRSA bacteremia was greater, this difference did not achieve significance.

Bacteremia↗
PubMedDate not supplied

[Bacteremia in 2 hospitals in Rosario, Argentina].

Bacteremia is associated with high morbidity and mortality. Nosocomial bacteremia is associated with an attributable mortality of 35%. In order to characterize the etiological agent of bacteremia cases during two time periods, 6605 patients were studied as follows: 1) from 1980 to 1982 (n = 2401) and 2) from 1988 to 2000 (n = 4204). A total of 596 cases of bacteremia were detected. The most frequent agents were Staphylococcus aureus, negative coagulase (CNS) Staphylococcus, Klebsiella pneumoniae and Escherichia coli. In the second period, an increase in the frequency of bacteremia caused by gram positive bacteria, particularly gram-positive cocci, was noted. Conversely, gram negative bacteria diminished significantly in the second period, specially enterobacterial species. Methicillin-resistant S. aureus and CNS were significantly more frequently isolated in the second period. Infrequent agents of endocarditis, such as Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and Corynebacterium urealyticum, were isolated.

Argentina↗
PubMed2004

Enterococcal bacteremia in a teaching hospital in the Central region of Saudi Arabia.

OBJECTIVE: To study enterococcal blood stream infection including the different species isolated, their antibiotic resistance associated risk factors and outcome of treatment. METHODS: A retrospective and prospective study was carried out over a 12 month period between June 2001 and May 2002 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Sixty episodes of enterococcal bacteremia with clinical significance detected in adults and neonates were included. Statistical analysis of the epidemiological characteristic, etiologic risk factors and mortality were determined. RESULTS: Fifty-four (90%) of the episodes were hospital acquired. Fifty-five percent of patients were elderly males and 20% were neonates. Patients usually have severe underlying diseases (57%) and the mortality rate was 28%. The estimated duration of hospital stay after acquiring the Enterococcal bacteremia was 40 days. The source of bacteremia remained undetermined in 72% of the episodes. Gastrointestinal tract, urinary tract and intravascular catheter were the most frequently recognized associated sites of infection. Thirty-three patients (55%) had previously received antimicrobial agents (mainly cephalosporins). In this study, intravascular catheter (p=0.0002), urinary catheter (p=0.00001), mechanical ventilation (p=0.002), previous surgery (digestive tract surgery (p=0.01) and prior stay in an intensive care unit (p=0.03) were the factors associated with Enterococcal bacteremia and mortality. CONCLUSION: Efforts to reduce the occurrence of enterococcal bacteremia should be focused on appropriate use of cephalosporins and external devices.

Adult↗
PubMed2004

Epidemiology of community-acquired Staphylococcus aureus bacteremia.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen which has been isolated with increasing frequency in recent decades. Community-acquired MRSA (CA-MRSA) infections have also become increasingly important in recent years. This study retrospectively analyzed the risk factors, duration of hospitalization, yearly trend and seasonal variation in prevalence, and antibiotic susceptibility of isolates of community-acquired S. aureus (CASA) bacteremia and CA-MRSA bacteremia from patients treated in a teaching hospital in northern Taiwan. A total of 104 clinical isolates of CASA bacteremia were collected between January 1999 and December 2001. Among these, 35 (33.7%) were identified as MRSA. After multivariate analysis, the independent risk factors for developing CA-MRSA bacteremia were diabetes mellitus (p=0.028), chronic obstructive lung disease (p=0.037), and renal insufficiency (p=0.041). Only 6 (17.1%) patients in the MRSA group had no identified risk factors. Most of the isolates of CA-MRSA had a high degree of resistance to most antibiotics, including clindamycin (71.4%), trimethoprim-sulfamethoxazole (65.7%), and chloramphenicol (41.2%). No major trend or seasonal variation in the prevalence was found during the study period. No difference in mortality related to resistance pattern was found. Although CA-MRSA is not the major pathogen in community-acquired bacteremia, it should be included in the differential diagnosis of Gram-positive bacterial bloodstream infection, especially in those patients with risk factors. Early empiric therapy with glycopeptides in these patients may reduce morbidity and mortality.

Adult↗
PubMed1992

[Bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA)].

Bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) is most likely to occur in compromised patients with prolonged hospitalization who are receiving antibiotics, particularly beta-lactam ones. The clinical picture of MRSA bacteremia is almost the same as that of bacteremia due to methicillin-sensitive S. aureus. There seems to be no significant difference in prognosis between the two types of staphylococcal bacteremia when patients in the same disease category are considered. Vancomycin is at present the only antibiotic for the treatment of MRSA bacteremia. It is therefore important to use the drug adequately so as to prevent its adverse effects and delay the appearance of resistant organisms.

Bacteremia↗
PubMed2004

Changing pattern of neonatal bacteremia. Microbiology and antibiotic resistance.

OBJECTIVE: To determine the most important causative agents of bacteremia in a neonatal intensive care unit (NICU); their changing distribution and their antibiotic susceptibility patterns over a 5-year period. METHODS: This study was performed between January 1997 and January 2001 at the Microbiology Section, Tripoli Medical Center, Tripoli, Libya. During this period 1431 Oxoid Signal Blood Cultures sets were obtained from 1092 NICU with suspected bacteremia. Conventional methods, API 20 E and API 20 NE were used to identify the isolated bacteria. The Kirby-Bauer disk diffusion method was performed to assess their antibiotic susceptibilities in accordance with National Committee for Clinical Laboratory Standards. RESULTS: During the study period, 801 sets out of the total 1431 blood cultures were positive for microbial growth, which represented 648 cases of neonatal bacteremia from a total of 1092 cases. From the total number of isolates, the members of Enterobacteriaceae Serratia, Klebsiella and Enterobacter spp were the most common cause of bacteremia. The coagulase negative and positive Staphylococci were also frequently isolated. A changing pattern of causative pathogen was observed during this study between members of the 3 leading genera of Enterobacteriaceae. Antibiotic susceptibility testing showed a high level of resistance among the most common pathogens. Resistance to aztreonam, imipenem, ciprofloxacin and piperacillin/tazobactam was less frequently encountered. Staphylococcus resistance to anti-staphylococcal antibiotic and due to hyperproduction of penicillinase enzyme was also high and all isolates were remained sensitive to vancomycin. CONCLUSION: Gram-negative bacteria especially members of the Enterobacteriaceae are important causes of bacteremia in NICUs. Although most isolates remain sensitive to the new antibiotics, emergence of resistant strains cannot be excluded in the future. For that reason, new strategies and continuous surveillance are required to monitor the changing epidemiology of pathogens, antibiotic susceptibilities and antibiotic use needed to overcome the increasing incidence of resistance to conventional drugs.

Anti-Bacterial Agents↗
PubMed2005

Serratia marcescens bacteremia at a medical center in southern Taiwan: high prevalence of cefotaxime resistance.

Antimicrobial resistance of isolates and risk factors for mortality were retrospectively investigated in 71 adult patients with Serratia marcescens bacteremia. During the 4-year study period, 78 clinically significant episodes of S. marcescens bacteremia occurred in 71 patients. The mean age of the patients was 65 years (range, 25-86 years) with a male predominance (45 patients, 63%). Most of the bacteremic episodes were nosocomial (78%), and 34% were polymicrobial. The overall mortality rate within 2 weeks after the onset of bacteremia was 41%. The presence of malignancy and critical illness at initial presentation were independent risk factors for mortality. By disk susceptibility test, 72 isolates were resistant to cefotaxime (92%) but susceptible to ceftazidime (99%). All isolates were susceptible to meropenem. Among the 47 patients with monomicrobial S. marcescens bacteremia, the mortality rate within 5 days of onset in patients receiving appropriate empirical antimicrobial therapy was lower than that in patients receiving inappropriate therapy although this difference was not significant (14% vs 28%, p = 0.27). Among the patients with cefotaxime-resistant but ceftazidime-susceptible S. marcescens bacteremia treated with ceftazidime, 6 of 7 patients (86%) survived for more than 2 weeks, suggesting the potential effectiveness of ceftazidime in the treatment of cefotaxime-resistant Serratia infections. Further clinical studies are required to delineate the clinical role of ceftazidime therapy for infections caused by S. marcescens with this resistant phenotype.

Adult↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus bacteremia in neonatal intensive care units: genotyping analysis and case-control study.

To assess the relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates and to identify the risk factors for the acquisition of MRSA bacteremia in infants hospitalized in neonatal intensive care units (NICUs), 21 bloodstream isolates from 21 infants were genotyped and other 21 infants without MRSA bacteremia were matched for a case-control study. Two genotypes (A and C) were identified by pulsed-field gel electrophoresis and three genotypes (I, II and III) by infrequent-restriction-site polymerase chain reaction. Genotype C-III in 9 isolates and genotype A-I in 7 isolates were the two most common genotypes. The presence of skin infection at onset, prolonged prior duration of central venous catheter indwelling and prolonged hospital stay were significantly associated with MRSA bacteremia in these infants. With multiple logistic regression analysis, the presence of skin infection at onset was the only significant risk factor of MRSA bacteremia, with an odds ratio of 20.8 (95% CI 2.95-145.4, p =.002). Conclusively, two major clones of MRSA prevailed in our NICUs, and the presence of skin infection at onset was the risk factor for the acquisition of MRSA bacteremia in these infants.

Bacteremia↗
PubMed2006

[Catheter lock solution--taurolock for prevention of catheter-related bacteremia in hemodialysis patients].

BACKGROUND: Bacteremia and thrombosis are the major complications of tunneled cuff central vein catheters (TCC) used for haemodialysis. Bacterial biofilm is the source of catheter related bacteremia (CRB). Instillation of catheter lock solution (CLS) containing antibiotic-anticoagulant solution can cure and prevent CRB. The aim of this publication is to report our experience with the use of CLS - TauroLock (Taurolidine and 4% citrate) in the prevention of catheter related bacteremia in hemodialysis patients. METHODS: Thirteen patients with TCC on chronic hemodialysis were included in the study. Group A: 5 patients with previous inserted catheters and history of at least one bacteremia episode before the study. Group B: 8 patients with new catheters. At the end of each dialysis the catheters were locked with TauroLock until the next dialysis session. RESULTS: In Group A, the catheter related bacteremia (CRB) was reduced from 9.5-episodes\1000 patients days prior to the study to 1.15 episodes\1000 patients days through 867 days of treatment. In Group B, there were not any CRB during 1179 treatment days in the 8 patients. Due to catheter patency problems, 2500 IU of heparin was added to the TauroLock solution in 3 patients (60%) of group A and in 7 patients (87.5%) of group B and Urokinase instillation in 1 and 3 patients of group A and B respectively. CONCLUSION: The catheter lock solution TauroLock significantly decreased the rate of CRB in HD patients with TCC, to complete prevention in new TCC. Addition of heparin to the TauroLock solution should be considered to maintain catheter patency.

Adult↗
PubMedDate not supplied

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. II. Clinical observations].

A study was made of 92 bacteremia episodes among patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) between June 1986 and September 1989. A single microorganism was isolated in 84 episodes (91.3%), the most common being: Staphylococcus aureus (21.7%), Escherichia coli (18.5%), Enterococcus (9.8%), Pseudomonas aeruginosa (6.5%), and Proteus mirabilis (5.4%). The episodes were of both hospital and community origin: 54.3% vs. 45.7%. Their main sources were: the urinary tract (16.3%), abdominal infections (14.2%), endocarditis (7.6%), and the respiratory tract (5.5%). No source could be identified in 26%. Brucellosis, salmonellosis and listeriosis together constituted 8.7% of the episodes. Abdominal infections were primarily responsible for the 8 cases (8.7%) of polymicrobial bacteremia. The overall mortality was 18.5% (6.5% community vs. 12% hospital episodes). Mortality directly due to bacteremia was 8.7%. Bacteremia was the direct or indirect cause of death in 22.6% of patients greater than or equal to 65, compared with 19% and 10% in those aged 35-64 and 15-44 respectively. The patient's clinical picture at the time of infection was a prognostic factor: mortality was much lower in subjects previously healthy or free from basic diseases (11.8%) than in those with non-rapidly-fatal diseases (21.7%) or rapidly-fatal diseases (54.5%). Bacteremia-linked mortality (direct and indirect) was higher in Gram-positive vs Gram-negative infections: 22.2% vs 15.8%. Mortality was 12.5% in the group of patients with polymicrobial infections.

Adolescent↗
PubMed1995

[Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults].

In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994). Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS). Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03). Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04). Nine (41%) patients with GBSB were i.v. drug abusers; nevertheless, none of the subjects with GBSB were i.v. drug abusers (p < 0.001). The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02). Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia. In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis.

Adult↗
PubMedDate not supplied

[Bacteremia in 13 general hospitals of the province of Barcelona. Prospective study of 1,674 episodes. Group of Microbiologists of the County Hospitals of Catalonia].

BACKGROUND: Clinical and microbiological description of bacteremias seen in 13 regional hospitals of Barcelona. METHODS: From January to December of 1991 a multicenter prospective study of bacteremia in regional hospitals was performed. The filiation, clinical findings and microbiological results were registered according to a common protocol. RESULTS: We studied 1674 episodes of bacteremia (13.8 per 1000 admissions). Patients were distributed into 3 groups according to age: under 14: 204 patients, between 14 to 65: 759 and over 65: 711 patients. Men account for 55% and women for 45% of episodes. The bacteremia was hospital-acquired in 24.4% of cases. The most common foci of infection were: urinary tract (32%), respiratory tract (14%), intestinal tract (8%), intravascular catheter (7%), biliary tract (7%) and unknown (10%). The most commonly isolated strains were: Escherichia coli 544 cases, Streptococcus pneumoniae 212, Staphylococcus aureus 139, coagulase negative staphylococi 85, Non-typhoid Salmonella 66, Neisseria meningitidis 63, Pseudomonas sp. 59, Enterococcus sp. 59 and Bacteroides sp. 58. Polimicrobial bacteremia was detected in 83 episodes (5%). Related mortality rate was 9.6% (161 patients).

Adolescent↗
PubMed1995

Hemophilus influenzae bacteremia in elderly men with Kaposi's sarcoma: two case reports and a review of the literature.

Hemophilus influenzae is a common pathogen responsible for respiratory infections, meningitis, and bacteremia in children, and a rare cause of bacteremia in adults. We report two cases of H. influenzae bacteremia in elderly men with Kaposi's sarcoma. Both of the patients described are elderly men with no other stigmata of the acquired immune deficiency syndrome. Both Kaposi's sarcoma of the elderly and adult H. influenzae bacteremia are relatively uncommon, and the coappearance of these syndromes may suggest a common immune defect predisposing to these syndromes, or Kaposi's sarcoma may provide a portal of entry for this organism. We suggest that patients with Kaposi's sarcoma who may have bacteremia receive appropriate antibiotic treatment for H. influenzae until a causative agent is isolated.

Aged↗
PubMed1994

Incidence of bacteremia associated with chorionic villus sampling.

OBJECTIVE: To assess the frequency of transient bacteremia among women undergoing transabdominal and transcervical chorionic villus sampling (CVS). METHODS: One hundred fourteen women undergoing CVS consented to participate in a university review board-approved study protocol. Exclusion criteria included known cardiac valve anomaly or replacement (or other prosthetic) and antibiotic use within the preceding 21 days. Blood cultures (aerobic and anaerobic) were drawn by a single operator on all patients, before CVS and within 15 minutes after completing CVS. Either the catheter tip or needle tip aspirate from each procedure was also sent for culture. RESULTS: Post-procedure bacteremia was detected in two (1.8%) of the patients undergoing CVS. These two patients both had their procedures performed transcervically, resulting in a 4.1% (two of 49) bacteremia rate after transcervical CVS, compared to none (zero of 65) in the transabdominal group (P = .36). The incidence of positive cultures from sampling instruments was also higher in the transcervical group (16.3 versus 0%; P = .003), but did not result in comparable rates of bacteremia among patients with positive instrument cultures. CONCLUSIONS: In this study, CVS was associated with a low rate of bacteremia, regardless of the procedure route. Recommendations for antibiotic prophylaxis in women with abnormal cardiac valves should parallel those for spontaneous vaginal delivery and other comparable genitourinary procedures.

Bacteremia↗
PubMed1993

[Relation between the level of infection in Ixodes ricinus with Francisella tularensis and the level of bacteremia in the host].

The dynamics of bacteremia on white mice subcutaneously infected with an inoculum of 100 and 10 cells of F. tularensis (strain 273) was compared in two parallel experiments. The rise of bacteremia was relatively uniform, about 3 logarithms a day in both groups of animals, so that it reached values of 10(9)-10(10) cells per 1 ml of blood ante finem. Larvae of Ixodes ricinus were fed on white mice in different stages of bacteremia, so that groups of ticks with different degrees of infection were obtained. Our results of quantitative examination show an evident correlation between the degree of bacteremia of the host and the degree of infection of ticks. The highest values of positivity 10(6)-10(7) cells were recorded in larvae, which finished their feeding on the day of the host's death, during the time when bacteremia was reaching the highest degree 10(10) cells per ml of the blood. Persistence of the agent in the organism of infected larvae could be observed up to hatching, under given experimental conditions one month after infection. In nymphs developed from larvae with the highest degree of infection this ability was preserved in about one third of individuals still after 5 months of starvation. In ticks with low degrees of infection it disappeared during the experiments.

Animals↗
PubMed1993

Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia.

OBJECTIVE: To quantify the effect of antibiotic therapy on the probability of subsequent bacterial meningitis in children with fever without source treated as outpatients. DESIGN: Bayesian meta-analyses. REPORTS INCLUDED: All reports of the organism-specific prevalence of occult bacteremia in children with fever without source treated as outpatients, and the organism-specific prevalence of subsequent meningitis in children with occult bacteremia initially treated as outpatients stratified by type of antibiotic therapy. RESULTS: The mean probabilities of subsequent meningitis in children with occult bacteremia were 9.8%, 8.2%, and 0.3% in the no antibiotic, oral antibiotic, and parenteral antibiotic therapy groups, respectively. All cases of bacterial meningitis in children with occult bacteremia treated with oral antibiotics were due to Haemophilus influenzae. There were no cases of culture-positive bacterial meningitis in 139 bacteremic children treated with ceftriaxone (mean probability, 0.3%; 95% confidence interval, 0.0% to 1.5%). The mean probabilities of bacterial meningitis in a child with fever without source treated as an outpatient without antibiotics were: Streptococcus pneumoniae, 0.21%; and H influenzae, 0.06%. CONCLUSIONS: Antibiotic therapy is effective in preventing meningitis in children at risk of occult bacteremia.

Administration, Oral↗
PubMed1995

Bacteremia in acute pancreatitis of different etiologies.

To evaluate the rationale of using antibiotics in acute pancreatitis and to determine whether the indication for their use depends upon the etiology of the pancreatitis, the records of 202 patients with acute pancreatitis were retrospectively reviewed. The incidence of abnormal body temperature, leukocytosis, bacteremia and the results of biochemistry tests in different etiologies of the disease were investigated. Pancreatitis was found to be alcohol-related (47 patients), gallstone-related (105 patients), idiopathic (26 patients) and miscellaneous (24 patients). On admission, 83 patients had abnormal body temperature and 146 patients showed leukocytosis. Bacteremia occurred in 20 patients. Of these, 15 had gallstone-related pancreatitis, two had pancreatic cancers and one developed bacteremia after endoscopic retrograde cholangio-pancreatography (ERCP). These 18 patients had abnormal biochemistry results (including high serum levels of direct bilirubin, alkaline phosphatase and gamma-glutamyltransferase) and dilated bile ducts on imaging studies, indicating biliary infections. The remaining two patients with bacteremia included one alcoholic patient and one patient with idiopathic pancreatitis. The most commonly involved pathogens were Escherichia coli and Klebsiella pneumoniae. In addition, eight patients (4%) developed secondary pancreatic infections during hospitalization; the blood cultures of seven of these patients were negative on admission. Although fever and leukocytosis are not good predictors of infection in acute pancreatitis our results showed that bacteremia is common in patients whose pancreatitis is related to gallstones, ERCP or pancreatic malignancy with obstructive jaundice. We recommend that antibiotics be used only in this subset of acute pancreatitis patients.

Acute Disease↗