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PubMed1982

Nosocomial bacteremia due to Acinetobacter calcoaceticus.

In 1980, 13 patients with positive blood cultures for Acinetobacter calcoaceticus were detected in an 800 bed university medical center. Twelve of the 13 isolates were identified as Acinetobacter calcoaceticus var. anitratus and one as var. lwoffi. In the same period there were 361 positive specimens of A. calcoaceticus. Eight of the patients were classified as having significant bacteremia (Group A) with a serious infection in which Acinetobacter was considered a significant pathogen. Five additional patients, however, (Group B) had fever and only one set of positive blood cultures. The significance of these positive isolates was unclear to the attending clinicians. All but one Group A patient appeared to have acquired their infection during hospitalization. In this group, one patient had an underlying pneumonia as the source of bacteremia. In the remaining patients bacteremia was related to some form of invasive catheterization. Seven patients responded rapidly to appropriate antimicrobial therapy and one patient with terminal cancer died as a result of infection. This report reviews the clinical spectrum of Acinetobacter bacteremia, which can range from mild, possibly self-limiting bacteremia to serious, life-threatening septicaemia, especially in compromised hospitalized patients.

Acinetobacter↗
PubMedDate not supplied

Staphylococcus aureus bacteremia in a Dutch teaching hospital.

During a period of 21 months an analysis was made of bacteremia caused by Staphylococcus aureus in a teaching hospital for adults. During the observation period staphylococcal bacteremia was detected in 77 patients, i.e. in 1.83 cases per 1,000 admissions. Not less than 81.8% of staphylococcal bacteremia cases were hospital-acquired. The age-specific attack rate increased consistently from the sixth decade onwards. The male/female ratio was 1.96: 1. If this ratio was related to the sex ratio of patients admitted to the hospital during the observation period, statistical significance was reached for the surplus of males. Staphylococcal bacteremia contributed to death in 14 of 47 patients, i.e. 18.2%. Intravascular infection was the most prevalent source of infection (25 of 77 cases, i.e. 32.5%). Serious complications were observed in 14 cases of staphylococcal bacteremia. Eight of these patients had endocarditis and four died. Tolerance was observed with nine of 77 strains and may have influenced the reaction to antimicrobial therapy in at least one case.

Adolescent↗
PubMedDate not supplied

Bacteremia in a Swedish university hospital: a one-year prospective study in 1981 and a comparison with 1975-76.

A one-year prospective study of bacteremia was carried out at a Swedish university hospital. Blood cultures were taken in 6.3% of all patients admitted to the hospital. 148 episodes of bacteremia were recorded in 142 patients, 59% of whom were males. The mean incidence of bacteremia was 4.3 episodes per 1,000 admissions. The incidence of contamination was 1.3%. Malignancy and urinary tract disorders were the most common diagnoses and surgical intervention, central venous catheters and cytostatic drugs the most common predisposing factors. The ratio of hospital to community-acquired bacteremia was 1.3:1. The fatality rate was 12.7%. Gram-negative rods belonging to the Enterobacteriaceae were the most common pathogens, followed by Staphylococcus aureus and Staphylococcus epidermidis. The antibiotic sensitivity pattern of the causative bacteria was quite favorable. No S. aureus strains were resistant to isoxazolyl penicillins or gentamicin. No Klebsiella strain and only one Escherichia coli strain was resistant to gentamicin. The results were compared to a one-year retrospective study carried out in the same hospital five years ago. The incidence of bacteremia had not increased between the two studies.

Adolescent↗
PubMed1990

Changes in the spectrum of organisms causing bacteremia and fungemia in immunocompromised patients due to venous access devices.

A significant increase in the use of vascular access devices has changed the spectrum of organisms causing bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. This paper documents the 1988 laboratory experience with bacteremia and fungemia and contrasts some of that data with information obtained in 1984. In 1988, 439 tunnelled-catheters and 355 ports were inserted in patients; 2,778 organisms were subsequently recovered from 933 episodes of bacteremia and fungemia. Fifty-percent of the episodes of bacteremia and fungemia were vascular access device-related. Compared to 1984, the relative incidence of bacteremia due to gram-positive organisms increased from 33 to 43%, polymicrobic cultures increased from 24 to 27%, and the number of organisms with colony counts greater than 100 cfu/ml increased from 24 to 44%. In 1988, device-related sepsis was often caused by Acinetobacter spp., Bacillus spp., Corynebacterium spp., pseudomonads other than Pseudomonas aeruginosa, and coagulase-negative staphylococci. Infection was also caused by species of flavobacteria, Micrococcus, and Rhodotorula. Efforts required for identification of many of the newer pathogens have escalated material and personnel costs.

Adult↗
PubMed1989

Importance of blood volume cultured in the detection of bacteremia.

The influence of the volume of blood cultured on the rate of detection of bacteremia was evaluated in a routine 12-tube blood culture system using 1693 samples from 1502 patients. Blood samples were drawn simultaneously into two transport tubes. The blood volume cultured was the only varying parameter. Generally, 17% more cultures with clinically significant microorganisms (both Enterobacteriaceae and gram-positive cocci) were found when blood from two instead of one tube was used (in most cases comparing 13-16 ml of blood with 6.5-8 ml). Of the most prevalent species, the maximum average extra yield was observed for Staphylococcus aureus (26%) followed by Escherichia coli (16%) and Streptococcus pneumoniae (12%). In adults most cases of bacteremia are low-grade. The grade of bacteremia in our patient population was on average as low as 0.25 CFU/ml blood. Therefore, all patients suspected of having bacteremia should have the benefit of a sufficient volume of blood cultured. Since the volume of blood cultured seems to be the single most important factor in the detection of bacteremia, it is imperative that the volume is the same in comparative studies of different blood culture systems.

Bacteria↗
PubMed1982

Bacteremia following dental cleaning in patients with and without penicillin prophylaxis.

The rate, type, and magnitude of bacteremia were studied in 56 patients undergoing dental cleaning with and without penicillin prophylaxis. Sixty-one percent of patients without penicillin prophylaxis were bacteremic 5 minutes following the procedure. Although a significant decrease in detectable bacteremia occurred in patients receiving penicillin prophylaxis, the recovery of streptococci was not significantly different in the two groups. Using the present sample of patients as a basis for statistical inference, the true rate of bacteremia in such patients could be between 41% and 79% with 95% certainty. The magnitude of bacteremia was low and positive quantitative pour plates occurred at 5 minutes and only in patients without penicillin prophylaxis. Of the 71 total bacterial isolates, 53 (74.6%) were anaerobes and 18 (25.4%) were aerobes. This study indicates that parenteral penicillin prophylaxis for dental cleaning decreased detectable bacteremia rates significantly and could be recommended for patients with valvular heart disease who are known to be vulnerable to endocarditis.

Adult↗
PubMed1976

Simultaneous antibiotic levels in "breakthrough" gram-negative rod bacteremia.

Of 237 cases of gram-negative rod bacteremia observed at the UCLA Medical Center during a 12 month period, 52 (22 per cent) occurred while the patient was receiving antibiotics which inhibited the infecting organism by disc diffusion tests. One half of the plasma samples available from 42 such patients with "breakthrough" bacteremia had subinhibitory circulating antibiotic levels when cultures were positive. Sepsis documented within 72 hours of initiation of therapy was usually due to antibiotic-sensitive Esch. coli and was associated with inadequate antibiotic levels; the patient was usually treated with a penicillin or cephalosporin. The source of bacteremia was most frequently the urinary tract or the biliary tree. In contrast, sepsis occurring more than 72 hours after the administration of antibiotics was frequently caused by multiple antibiotic-resistant Esch. coli in patients treated with gentamicin in adequate dosage and was associated with leukopenia or undrained purulent collections. Therapy ultimately failed in 20 cases (48 per cent): in early "breakthrough" bacteremia, failure was associated with subinhibitory antibiotic levels, and in late "breakthrough" bacteremias with inadequate drainage or impaired host defenses.

Anti-Bacterial Agents↗
PubMed1976

Pseudomonas bacteremia. Review of 108 cases.

The current circumstances associated with Pseudomonas aeruginosa bacteremia are reviewed in 108 episodes to assess the impact of new antimicrobial drugs on this infection. Since 1961, Pseudomonas bacteremia has apparently become more frequent with proportional increases in middle-aged patients. The respiratory tract has become the major source of infection. Clinical features are not characteristic, but infected patients are almost uniformly severely ill before blood stream invasion occurs. The use of gentamicin, carbenicillin and colistin has not changed the outcome of Pseudomonas bacteremia. Although better than no antimicrobial treatment, these drugs cannot be shown to be superior to any other available antibiotics. A reassessment is needed to evaluate the relationship between the in vitro action and the effectiveness of antibiotics in the treatment of Pseudomonas infection and the use of gentamicin, carbenicillin and colistin in these bacteremias. In view of the poor results with antibiotics, investigation into immunologic prophylaxis and therapy is needed. At the present time, control of the patients' underlying disease contributes most towards assuring survival with Pseudomonas bacteremia.

Anti-Bacterial Agents↗
PubMed1976

Salmonella heidelberg enteritis and bacteremia. An epidemic on two pediatric wards.

Symptomatic infection with Salmonella heidelberg developed in 55 children after their admission to the pediatric wards of two adjacent hospiatls in San Juan, Puerto Rico. Many of these children had been hospitalized for the treatment of diarrhea of unidentified etiology. In 25 of these patients, Salmonella bacteremia was documented. Five had clinically unsuspected and untreated bacteremia with no evidence of complications during the follow-up period of four and a half months. The remaining 30 had "standard" symptomatic infection due to S. heidelberg. Eight children died; four of these proved to be bacteremic. The index patient, who also introduced the infection into one of the hospitals, was identified. Person to person spread perpetuated the outbreak within and between the two hospitals for nearly four months. Although neonates with salmonellosis had a higher rate of bacteremia than other children, no other specific predisposing factors for Salmonella bacteremia were identified. Laboratory studies of the epidemic strain revealed neither invasive nor enterotoxic properties of the organisms, nor enhanced virulence in laboratory mice. Cohort nursing and isolation of patients with positive cultures halted the epidemic. Nontyphoid Salmonella bacteremia, sometimes clinically unsuspected and self-limited, should be recognized as a frequent accompaniment of Salmonella enteritis in young hospitalized children.

Blood↗
PubMed1980

Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients.

Clinical features and specific aspects of treatment were evaluated in 612 patients with gram-negative bacteremia observed over a 10 year period. Coagulation abnormalities or thrombocytopenia were observed in 64 per cent of the patients. Evidence of disseminated intravascular coagulation (DIC) was found in approximately 10 per cent of them but was of sufficient severity to be associated with subcutaneous or visceral bleeding in 3 per cent of them. The frequency of coagulation abnormalities, other than DIC, was greater in patients with more severe underlying disease but DIC occurred with similar frequency irrespective of the severity of underyling host disease. Coagulation abnormalities of all types were associated with increased fatality rates. Hypothermia was noted in 13 per cent of the patients at the onset of bacteremia but was transient and was not associated with increased fatality. Failure to mount a febrile response greater than 99.6 degrees F within the first 24 hours of bacteremia was associated with a significant increase in fatality rates. Prior corticosteroid therapy diminished the febrile response to bacteremia. Age, underlying host disease, granulocytopenia, congestive heart failure, diabetes mellitus, renal insufficiency, nosocomial infections, and antecedent treatment with antibiotics, corticosteroids, and antimetabolites significantly increased fatality rates. Appropriate antibiotic treatment reduced the fatality rate of those with bacteremia by approximately one-half among patients in each category of severity of underlying host disease. In addition, it was shown that early appropriate antibiotic therapy also reduced the frequency with which shock developed by one half. Even after development of shock, appropriate antibiotic therapy significantly reduced fatality rates. The use of combinations of antibiotics could not be demonstrated to significantly improve survival rates. Minimal differences in therapeutic efficacy could be demonstrated between individual antibiotics and various combinations of antimicrobials. Shock occurred in approximately 40 per cent of the patients and its frequency was not influenced by the species of etiologic agent. Contrary to previous reports, corticosteroid therapy in patients with shock did not enhance survival and treatment with an average of 4.0 g/day of hydrocortisone or its equivalents was associated with a significant increase in fatality rates.

Adolescent↗
PubMed1983

Bacteremia due to Fusobacterium species.

Twenty-six patients were identified as having bacteremia with Fusobacterium species over a five-year period at Boston City Hospital. They represented 0.9 percent of bacteremic patients and were equally divided as to sex. Bacteremia with Fusobacterium occurred primarily in young adults and in patients over 60 years of age and was not observed in children. In 16 patients (62 percent), Fusobacterium was the only blood culture isolate. The most common primary foci of infection were the female genital tract, the upper respiratory tract, the oral cavity, and the lower respiratory tract. Five patients had primary foci of infection that were initially occult. Three of these patients were found to have unappreciated oral and pharyngeal lesions, and one had a liver abscess; no primary infection was established in the remaining patient. Shock related to bacteremia developed in six patients (23 percent), four of whom had Fusobacterium species as the only blood culture isolate. Death occurred in three patients (12 percent), all of whom were over 60 years old. Metastatic infection occurred in only one patient in whom hematogenous osteomyelitis developed. Postpartum fusobacterial bacteremia was uniformly benign. Evaluation of bacteremia with Fusobacterium species in nonpostpartum patients, without an overt focus of infection, should be directed to a search for occult abscess, especially of the upper respiratory tract and oral cavity.

Adolescent↗
PubMed1986

Enterococcal bacteremia in two large community teaching hospitals.

This report reviews 55 episodes of enterococcal bacteremia at two large community teaching hospitals. Fifty-eight percent of the patients were older than 60 years, and 84 percent of the patients had some underlying illness. The most common sources of bacteremia were the urinary tract (24 percent), cutaneous wound infection (11 percent), and intra-abdominal infection (11 percent). Five patients had enterococcal endocarditis. Antimicrobial therapy in the week preceding enterococcal bacteremia (42 percent) and polymicrobial bacteremia (38 percent) were common. Despite the institution of appropriate antimicrobial therapy in 75 percent of the patients (41 of 55 patients), the overall mortality rate was 44 percent. Male sex and the presence of a rapidly or ultimately fatal underlying illness were the only factors that showed a statistical tendency toward adversely influencing the mortality risk in enterococcal bacteremia.

Age Factors↗
PubMed1990

Staphylococcus aureus bacteremia in patients with Hickman catheters.

PURPOSE: Determination of outcome and prognostic variables associated with Staphylococcus aureus bacteremia in patients with Hickman catheters. PATIENTS AND METHODS: At the University of Washington Medical Center, 37 patients with Hickman catheters and S. aureus bacteremia were studied by retrospective chart review. Clinical features associated with each episode of infection were determined, and the relationships among clinical features, therapy, and outcomes were explored. RESULTS: Only 18% of all Hickman catheter-associated S. aureus bacteremias and only 10% of those cases with exit site infections were cured without catheter removal. In seven of 41 episodes (17%), death or bacteremic relapse occurred. The best prognosis was found in infections with a low blood culture colony count (less than 1 colony/mL). CONCLUSION: Hickman catheter-associated bacteremia due to S. aureus has a worse prognosis than other Hickman catheter-associated bacteremias. Early catheter removal should be considered except in cases with a remote, noncatheter focus of infection or in infections with no catheter-related physical signs and blood culture colony counts of less than 1/mL.

Adult↗
PubMed1987

Radiation induced gram negative bacteremia and endotoxemia in rabbits: modification by anti-lipopolysaccharide hyperimmune equine plasma.

Lethal whole body irradiation damages the gut mucosa and leads to leakage of endotoxin or lipopolysaccharides (LPS) into the systemic circulation. Sixteen rabbits, irradiated with 900 rads 60Co, were randomly divided on day 4 into 2 groups, one of which received an intraperitoneal injection of normal saline (control) and the other (experimental) an equal volume of anti-LPS hyperimmune plasma. The time course of endotoxemia and bacteremia were determined for the duration of the experiment. While rabbits in both groups died within 13 days after irradiation, rabbits given saline died on average 2 days earlier, than rabbits given anti-LPS plasma. Plasma LPS concentrations rose to a small peak on day 2 prior to treatment. Thereafter plasma LPS in rabbits given saline increased forty fold by day 9. In contrast, in rabbits given anti-LPS plasma, LPS concentrations in the plasma remained within pretreatment limits (p 0.01). By day 12 after irradiation, plasma anti-LPS IgG had declined to 5.8% of pretreatment levels in rabbits given saline as compared to 46% in rabbits given anti-LPS plasma (p 0.005). Whilst both groups developed gram-positive bacteremia, rabbits given saline in addition also developed gram-negative bacteremia. No rabbits treated with Anti-LPS showed gram-negative bacteremia. Treatment with Anti-LPS plasma thus significantly protects radiated rabbits from the incidence of gram-negative bacteremia, development of high plasma LPS levels and hence endotoxemia, and prolongs survival to a certain extent.

Animals↗
PubMed1990

Bacteremia following laser and conventional surgery in hamsters.

The CO2 laser prevents bleeding by sealing blood and lymph vessels as it vaporizes tissue. Bacteremia following oral surgery might not occur under these conditions. To test this hypothesis, a 0.2-mm-deep incision 1 cm long was made in the right buccal cheek pouch of hamsters using either laser, electrosurgery, or a scalpel. Twenty minutes later, 1 mL of blood was taken from each animal by cardiac puncture, inoculated on a blood agar medium, and incubated anaerobically for 4 days; then the colonies were counted. Using an operational definition of bacteremia as five colonies or more per plate, there were no positive results out of 18 trials (0/18) for laser surgery, 7/8 for electrosurgery, and 8/12 for scalpel surgery. Based on the Student t test using the binomial distribution, the laser produced statistically less bacteremia than the other two methods (P less than .01). Because the five-colony cutoff was arbitrary, the nonparametric Wilcoxon Rank test was also used. Colony formation from blood from the laser group was significantly less than from the electrosurgery group (P less than .01) and the scalpel group (P less than .05). The laser surgery group was not statistically different from the control (nonsurgerized) group. These results suggest that there is a considerable bacteremia following scalpel and electrosurgery, but that laser surgery produces no bacteremia.

Animals↗
PubMedDate not supplied

Effects of causative organism and presence or absence of meningitis on white blood cell counts in children with bacteremia.

The records of 182 children with bacteremia due to Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis were reviewed to determine which variables other than the presence or absence of bacteremia might affect patients' white blood cell (WBC) counts. There were no significant or consistent effects of age, sex, race, or duration of illness on WBC counts. Significantly lower mean WBC counts were noted for patients with, versus those without, meningitis and patients with H influenzae type b bacteremia versus those with S pneumoniae bacteremia. As a screening test for bacteremia, the WBC count is less useful in children with either meningitis or infection caused by H influenzae type b than in children with nonmeningeal infections caused by S pneumoniae.

Analysis of Variance↗
PubMed1985

Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy.

The incidence of bacteremia associated with endoscopy varies widely for different endoscopic procedures. This study prospectively evaluates the incidence of bacteremia in patients undergoing elective endoscopic laser therapy for two diseases of the upper gastrointestinal tract. In five patients (eight treatment sessions) with arteriovenous malformations, no bacteremia developed. In 15 patients (26 treatment sessions) with esophagogastric carcinoma, bacteremia developed at some time during the procedure in six (40%). However, bacteremia appeared to be associated with the endoscopic insertion through the tumor rather than the laser treatment per se. These findings lead us to conclude that for patients undergoing endoscopy and laser therapy for esophagogastric malignancy, but not for those being treated for arteriovenous malformations, antibiotic prophylaxis to prevent endocarditis may be indicated.

Anti-Bacterial Agents↗
PubMed1977

Detection and quantitation of bacteremia in childhood.

Quantitative blood cultures were sought in 383 children, from whom routine blood cultures were obtained because of fever, by direct plating of 10 and 100 microliter blood onto solidified media. There were 14 positive cultures from 12 patients. These were 7 Hemophilus influenzae type b, 5 Streptococcus penumoniae, and 2 Staphylococcus aureus. The direct-plating technique permitted more rapid identification of positive cultures, and detected three episodes not identified by routine broth culture. Bacterial counts ranged from 20 to greater than 10(4) bacteria/ml blood. In the three cases of H. influenzae type b meningitis, bacteremia exceeded 10(3)/ml. Among nine patients in whom bacteremia was unassociated with meningitis, (bacteremia without evident localized disease 5, pneumonia 2, epiglottitis 1, peritonitis 1), bacteremia was less than 10(3)/ml. This technique may aid detection of bacteremia and help identify those children at highest risk for developing septic complications, such as meningitis.

Bacteriological Techniques↗