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PubMed2005

[Current aspects of Salmonella bacteremia cases in the Ibrahima Diop Mar Infectious Diseases clinic, Fann National Hospital Center (Senegal)].

OBJECTIVE: The aim of this study was to describe epidemiological, clinical and bacteriological aspects of Salmonella bacteremia in the Fann university hospital infectious diseases clinic. PATIENTS AND METHOD: This study was carried out on data recorded between January 1, 1996 and December 31, 2003. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Research of strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Fifty five cases of Salmonella bacteremia were recorded as follows: S.Typhi bacteremia (32 cases), S. Paratyphi C bacteremia (4 cases), S. typhimurium bacteremia (9 cases), S. enteritidis bacteremia (32 cases) and S. spp bacteremia (8 cases). All the strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin+clavulanic acid and 90 % of them were susceptible to cotrimoxazole. Bacteremia occurred in 50 HIV infected patients (49%). Salmonella other than Typhi bacteremia were more often present in patients with HIV (81% vs 36% in patients without HIV infection) (P = 0.00001). The lethality rate was 42%. This rate was higher in patients with HIV (56 vs 23% in patients without infection) (P = 0.002). CONCLUSION: The lethality rate of Salmonella bacteremia is high, especially in AIDS patients. Therefore, priority must be given to prevention and chemoprophylaxis with cotrimoxazole should be a good way to reduce the incidence of bacteremia in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Bacteremia in the chronic spinal cord injury population: risk factors for mortality.

BACKGROUND: Individuals with spinal cord injury (SCI) have a lifelong increased risk of systemic infection, which may be associated with episodes of life-threatening bacteremia. Information concerning specific organisms causing bacteremia, the sites of primary infection, and clinical predictors for mortality are necessary to provide optimal treatment. METHODS: A retrospective review of positive blood cultures collected over a 32-month period in chronic SCI patients treated at the Veterans Affairs Medical Center SCI Unit. RESULTS: One hundred and twenty-three episodes of bacteremia occurred in 63 patients during 83 hospitalizations; 30 patients had multiple episodes of bacteremia. There were 1,644 admissions during this period, yielding an incidence of bacteremia of 7.5% (5.8% after excluding positive cultures that were believed to be caused by contaminants). The patients (31 with paraplegia and 32 with quadriplegia) had a mean age of 59 +/- 2 years, and a mean duration of injury of 23 +/- 2 years. Bladder management technique consisted of indwelling bladder catheter (n = 53), ileal conduit (n = 6), intermittent catheterization (n = 2), and spontaneous voiding (n = 2). Episodes of bacteremia were nosocomial in 89 out of 123 episodes. Multiple debilitating factors were present, including pressure ulcers in 36 out of 63 patients, chronic ventilator dependency in 5 out of 63 patients, recent surgical procedures in 17 out of 63 patients, underlying malignancy in 5 out of 63 patients, and evidence of malnutrition in 29 out of 63 patients (serum albumin concentration < 2.5 g/dL). Early mortality rate (death within 30 days of bacteremia) occurred in 8 out of 63 patients (13%) and late mortality (> 1 month following a bacteremic episode) occurred in 10 additional participants, such that total mortality was 1 8 out of 63 (29%). The sources of bacteremia were urinary tract infection (n = 39), presumed contaminant (n = 28), decubitus ulcers (n = 21), intravascular catheter (n = 19), pneumonia (n = 5), and other (n = 11). Gram-negative rods accounted for 26 out of 39 episodes of bacteremia from a urinary source. Methicillin-resistant Staphylococcus aureus, methicillin-sensitive S aureus, and coagulase-negative staphylococci were the predominant organisms when intravascular catheters or pressure ulcers were the source of bacteremia. CONCLUSION: In this population, bacteremia predominantly was caused by hospital-associated organisms, and occurred mainly in malnourished patients who required hospitalization for major underlying debilitating conditions, particularly pressure ulcers. Chronic indwelling bladder catheters and chronic vascular catheter usage also were highly prevalent in patients with bacteremic episodes. Hypoalbuminemia was the strongest independent predictor for mortality.

Bacteremia↗
PubMed2005

Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection.

BACKGROUND: Staphylococcus aureus bacteremia often persists and causes metastatic infections. It is unknown whether the time between blood culture incubation and growth detection (i.e., the time to positivity) in a continuously monitored system--a probable surrogate marker of bacteremia severity--correlates with outcome. METHODS: We performed a prospective, observational study involving adult inpatients who had S. aureus bacteremia between 1 January 2002 and 30 June 2003 at a 600-bed teaching hospital. Measurements included time to positivity in initial blood culture series, duration of bacteremia, rate of metastatic infection, and outcome. RESULTS: A total of 376 S. aureus bacteremias (> or = 1 positive blood culture result) were reported for 357 patients aged 18-103 years (median age, 59 years); 64 bacteremias were excluded because blood was drawn after antibiotic therapy was started (n = 59) or through an intravascular catheter (n = 5). The source of infection was identified in 244 series (78.2%). Metastatic infection was detected in 25 bacteremias (8.0%). The mortality rate was 25.6%. The duration of bacteremia (determined in 251 series) was 1-59 days (median duration, 1 day; 70th percentile, 3 days). The time to positivity ranged from 4.2 to 98.2 h (median time to positivity, 15.5 h) and was significantly shorter for patients with an endovascular source of infection (14.9+/-5.4 vs. 19.5+/-10.6 h; P < .0005), extended duration (i.e., > or = 3 days) of bacteremia (14.1+/-4.2 vs. 18.6+/-9.2 h; P < .0005), and metastatic infection (12.9+/-5.9 vs 18.0+/-9.3 h; P = .007). Analysis of a range of cutoff values demonstrated that a time to positivity of < or = 14 h yielded the best sensitivity and specificity for predicting the source and outcome of infection. Logistic regression analyses revealed that a time to positivity of < or = 14 h was an independent predictor of an endovascular source of infection (P < .0005), extended bacteremia (P < .0005), metastatic infection (P < .0005), and attributable mortality (P = .017). CONCLUSIONS: Time to positivity in S. aureus bacteremia may provide useful diagnostic and prognostic information. Growth of S. aureus within 14 h after the initiation of incubation may identify patients with a high likelihood of endovascular infection sources, delayed clearance, and complications.

Adolescent↗
PubMed2001

Does the empiric use of vancomycin in pediatrics increase the risk for Gram-negative bacteremia?

BACKGROUND: Gram-negative bacteremia in children, a major cause of morbidity and mortality, may in part be induced by intensive treatment procedures and nonspecific use of antibiotics. Our primary objective was to study the causal relationship between the use of vancomycin and Gram-negative bacteremia, for which this antibiotic is not specifically indicated. METHODS: The study was conducted in a 105-bed tertiary care children's hospital in the period of 1994 to 1997. The study pertains to a cohort of children with suspected bacteremia, in whom a blood culture was performed during hospital stay. Using the bacteriologic laboratory registration system, we selected all pediatric cases with bacteriologically proved Gram-negative bacteremia (n = 105) and a random sample of 225 pediatric controls with negative blood cultures. Using logistic regression analysis we examined associations between Gram-negative bacteremia and the following factors: preceding use of antibiotics, antacids, corticosteroids, surgery, mechanical ventilation, parenteral nutrition, and invasive instrumentation; and the intensity of care assessed with the Therapeutic Intensity Scoring System (TISS 28). RESULTS: Gram-negative bacteremia was positively associated with the use of aminoglycosides, cephalosporins, surgical interventions, central venous catheters, parenteral nutrition, antacids and dexamethasone. The strongest association was with the use of vancomycin (odds ratio, 8.1; 95% confidence interval, 3.1 to 20.9). In a multiple logistic regression model containing all above-mentioned variables, the use of vancomycin remained positively and strongly associated with Gram-negative bacteremia (odds ratio, 3.88; 95% confidence interval, 1.34 to 11.21). Further adjustments and restrictions in the analysis did not materially change these findings concerning vancomycin. CONCLUSIONS: Among children suspected of bacteremia there are several drugs and clinical procedures influencing the risk for Gram-negative bacteremia. Empiric use of vancomycin is strongly and independently associated with Gram-negative bacteremia. The safety of using vancomycin solely on the basis of suspicion of bacteremia in children may not be warranted.

Adrenal Cortex Hormones↗
PubMed1995

Predicting bacteremia in older patients.

OBJECTIVE: To evaluate potential clinical predictors of bacteremia in hospitalized geriatric patients and to propose an individual risk score as an alternative to "subjective" clinical judgment for a more efficient approach in early recognition and treatment of bacteremia. DESIGN: A 16-month prospective study. SETTING: The University Geriatric Hospital of Geneva, Switzerland. PATIENTS: Four hundred thirty-eight patients aged 62 years or older in whom 558 episodes of bacteremia were suspected. MEASUREMENTS: The unit of evaluation was the blood culture episode, which was defined as a 48-hour period beginning with the drawing of the first blood for culture. An extensive precoded protocol, including clinical and biological data, was completed by the resident who requested the blood cultures. For each episode, the resident also provided a subjective assessment of the probability of bacteremia. Odds ratios and their variances were used to estimate the relative risks of potential predictors of bacteremia. The performance of a predictive clinical model based on risk score threshold was evaluated by means of a receiver-operating characteristic analysis. RESULTS: Of the 558 potentially bacteremic episodes investigated, 46 (8.2%) yielded positive blood cultures. The bacteremia rate was strongly associated with the type of episode: it reached 15.6% among the community-acquired (CA) episodes (those occurring within 48 hours of hospital admission) and 6.0% only among the hospital-acquired (HA) episodes (those occurring after the first two days of hospitalization). Predictors of bacteremia with highest relative risks included: bladder catheter removal, fever (> or = 38.5 degrees C), rigors, shock, total band count > or = 1500/mm3, and lymphocyte count < or = 1000/mm3. When assessed by episode type, it appeared that bladder catheter removal and rigors were good predictors of bacteremia in HA episodes only, whereas fever (> or = 38.5 degrees C) had a good predictive value in CA episodes only. The performance of the clinical model was two times better than the physician's subjective ability to predict bacteremia when the threshold of the risk score was fixed at two or more predictors per episode. CONCLUSIONS: These findings provide means to identify older hospitalized patients at high risk of bacteremia. Although the proposed predictive model will need further validation and more precise evaluation of the potential benefits, it may nevertheless be of some help in early recognition and treatment of bacteremia.

Age Factors↗
PubMed2006

Severe bacteremia results in a loss of hepatic bacterial clearance.

RATIONALE: Although it has been postulated that liver injury results in impaired clearance of bacteria from the blood, no prior study has evaluated hepatic bacterial clearance during sepsis. OBJECTIVES: We hypothesized that liver injury during the evolution of sepsis would result in impaired hepatic bacterial clearance. METHODS: Mild and severe bacteremia were generated in C57BL/6 mice by low- and high-dose intratracheal inoculation with Pseudomonas aeruginosa. MEASUREMENTS AND MAIN RESULTS: The mortality rates with mild and severe bacteremia were 20% and 60%, respectively. Hepatic bacterial clearance was preserved throughout the evolution of mild bacteremia but was lost late with severe bacteremia. The loss of hepatic bacterial clearance resulted in increased systemic bacteremia and mortality. Pretreatment with a caspase inhibitor resulted in preservation of hepatic bacterial clearance with severe bacteremia and eventual control of the bacteremia. When Kupffer cells were ablated before the onset of bacteremia, there was a loss of hepatic bacterial clearance. This converted an initially mild bacteremia into severe bacteremia with increased organ injury and mortality. CONCLUSIONS: These observations suggest that hepatic bacterial clearance may be lost during the evolution of sepsis, resulting in a failure to control bacteremia. Thus, the capacity of the liver to clear bacteria is an important determinant of the outcome in sepsis.

Animals↗
PubMed1997

Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.

BACKGROUND: Dual-lumen cuffed catheters are used for vascular access in patients undergoing hemodialysis. The incidence and appropriate management of catheter-related bacteremia are unknown. OBJECTIVE: To determine the incidence and outcome of catheter-related bacteremia and to assess the efficacy of catheter salvage. DESIGN: Prospective, observational study. SETTING: University hospital inpatient service and four affiliated outpatient dialysis units. PATIENTS: 102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996. MEASUREMENTS: Number of days that the catheter remained in situ, treatment (catheter removal or attempted salvage with antibiotic therapy), and outcome of bacteremia. Microbiological cultures were done to identify catheter-related bacteremia. RESULTS: 102 patients had a total of 16,081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 episodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 catheter-days]). Twenty-four catheters (39%) were removed immediately, and 38 (61%) were left in place during treatment. Only 12 (32%) of the 38 catheters were salvaged successfully. Salvage was less likely to succeed in patients with gram-positive bacteremia than in patients with gram-negative bacteremia, but this difference was not statistically significant (P = 0.14). Nine of the 41 patients (22%) who developed bacteremia had the following complications: osteomyelitis (6 patients), septic arthritis (1 patient), infective endocarditis (4 patients), and death (2 patients). All complications followed an episode of gram-positive bacteremia, and none was associated with attempted catheter salvage. CONCLUSIONS: Bacteremia frequently occurs in patients undergoing hemodialysis with dual-lumen catheters. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia in these patients, but attempted salvage may not increase the risk for complications.

Adult↗
PubMed1998

[Bacteremia caused by Stenotrophomonas maltophilia: a clinical-epidemiological study and resistance profile].

Over a 7-year period (1990-1996), the causal disease, predisposing factors, focus infection, clinical manifestations, complications and evolution of patients presenting bacteremia from Stenotrophomonas maltophilia were analyzed retrospectively in a university hospital. A microbiological study was carried out to determine the percentage of positive blood cultures per episode and the characteristics of bacteremia and to evaluate the antibiotic susceptibility of the isolated strains. Twenty-seven episodes of bacteremia from S. maltophilia were identified in 26 patients, half of whom were women, and the median age was 40 years. A total of 48% of the patients had blood malignancy (12 cases), with acute myeloid leukemia (5 cases) being the most frequent. Seven patients (27%) needed to be admitted to an intensive care unit for some type of vital support and/or intensive treatment. The previous administration of large spectrum antimicrobials (21/26) and the presence of a catheter or central catheter (19/26) were the most frequently found predisposing factors (81% and 73%, respectively). One-quarter of the patients had received treatment with carbapenems. Immunodepression caused by chemotherapy or corticosteroids occurred in 65% of the cases. Half of the patients had undergone a major surgical procedure or had been intubated and submitted to mechanical ventilation. One-third presented granulocytopenia on the detection of bacteremia and 6 of the 12 patients with blood malignancy showed severe neutropenia (<500 neutrophils/mm3). The bacteremia was acquired in hospital in 78% of the cases (21/27). In 26% of these cases, S. maltophilia was diagnosed as the probable cause of bacteremia; in 34% this was just a possibility. The origin of the bacteremia was unknown in 11 cases (40%). Infection from the vascular catheter was the most frequent focus infection (7 cases). An average of 3.6 blood cultures were performed per patient, out of a total of 92, and 54% showed positive. The average time of growth for S. maltophilia in the blood culture bottles was 30 hours. One-third of the bacteremia episodes from S. maltophilia were polymicrobial (9/27). Clinical evolution was favorable in 18 patients, while 8 died (31%), 5 cases (20%) from causes directly related to the bacteremia (4 from septic shock). The mortality associated with the polymicrobial bacteremia was not significantly different from that for single microbial bacteremia from S. maltophilia. Ninety percent of the isolated strains showed susceptibility to co-trimoxazole, 77% to ticarcillin-clavulanic acid, 60% to ciprofloxacin, 62% to ceftazidime, 20% to amikacin and just 18% to imipenem.

Adolescent↗
PubMed1979

Serologic diagnosis of access device-related staphylococcal bacteremia.

Staphylococcal bacteremia occurs frequently in patients undergoing long-term hemodialysis (dialysis patients). Although such bacteremia is frequently uncomplicated, it may be associated with endocarditis, metastatic infection or suppuration at the access site requiring excision of the access device for control of the infection (complicated bacteremia). To distinguish patients with uncomplicated bacteremia from those with complications, we measured staphylococcal teichoic acid antibodies by agar-gel diffusion and immunoglobulin G (IgG) antibodies by radioimmunoassay in 18 patients with staphylococcal bacteremia undergoing long-term hemodialysis. Although teichoic acid antibodies were not detected in five patients with uncomplicated bacteremia, they were observed in only three of 13 patients with complicated bacteremia. IgG staphylococcal antibodies were present in 10 of 13 patients with complicated bacteremia compared to none of five patients with uncomplicated bacteremia compared to none of five patients with uncomplicated bacteremia (p less than 0.05). Thus, radioimmunoassay was spuerior to agar-gel diffusion in identifying dialysis patients with complicated bacteremia. In patients with increased concentrations of IgG staphylococcal antibodies by radioimmunoassay, the diagnosis of endocarditis, metastatic infection and suppuration at the access site should be considered. Prolonged antibiotic therapy and/or operative removal of the access device may be necessary.

Antibodies, Bacterial↗
PubMed1990

Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units.

BACKGROUND AND METHODS: Coagulase-negative staphylococci are now the chief cause of bacteremia in neonatal intensive care units. To investigate potential risk factors for this nosocomial infection, we conducted a case--control study among 882 infants treated in two neonatal intensive care units during 1982. RESULTS: The 38 case patients and 76 controls were similar with respect to 27 indicators of the severity of the underlying illness. In addition, of the 20 potential risk factors for bacteremia that we investigated, only 2 met conventional criteria for causality. Infants with coagulase-negative staphylococcal bacteremia were 5.8 times as likely as controls (95 percent confidence interval, 4.1 to 8.3) to have received intravenous lipid emulsion before the onset of bacteremia. Because the use of lipids was common, 56.6 percent of all of the cases of nosocomial bacteremia could be attributed to lipid administration. Infants with bacteremia were also 3.5 times as likely as controls (95 percent confidence interval, 1.4 to 8.3) to have had a percutaneously inserted central venous catheter (attributable risk, 14.9 percent). The induction time for bacteremia after lipid administration, usually through peripheral catheters, was often less than one day. In contrast, the average induction period for nosocomial bacteremia associated with the use of central catheters, which were rarely used for lipid administration, was at least 5.5 days. Similar analyses of data on an additional 31 neonates treated in 1988 confirmed the strong and apparently independent association of coagulase-negative staphylococcal bacteremia with the intravenous administration of lipids (adjusted odds ratio, 5.3; 95 percent confidence interval, 3.5 to 6.7). CONCLUSIONS: The risk of coagulase-negative staphylococcal bacteremia in infants in neonatal intensive care units can be attributed primarily to the intravenous administration of lipid emulsions. Since lipids are critical for the nutritional support of premature infants, further studies are needed to examine the pathogenesis and prevention of lipid-associated bacteremia.

Catheterization, Central Venous↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus bacteremia in children.

We reviewed the records of 20 patients with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) and 49 patients with methicillin-susceptible S. aureus (MSSA) bacteremia occurring during a 39-month period. Sixteen of the MRSA bacteremias were clinically significant, as were 42 of the MSSA bacteremias. MRSA bacteremia was almost always nosocomial and occurred mainly in very young patients who were often prematurely born and severely compromised by underlying diseases. In contrast patients with MSSA bacteremia were frequently older children who had no underlying disease and acquired their bacteremic illness in the community. The seven patients with nosocomial MSSA bacteremia had characteristics similar to those of the patients with MRSA bacteremia. Fatality rates for patients with clinically significant bacteremia were 50% for MRSA and 2% for MSSA. Treatment of MRSA bacteremia with vancomycin was effective, provided it was begun early. At hospitals with endemic MRSA it may be necessary to use vacomycin in the initial treatment of nosocomial bacteremia in high risk patients until the identity and antimicrobial susceptibility of the bloodstream pathogen can be determined.

Cross Infection↗
PubMed1991

Role of bacterial association with Kupffer cells in occurrence of endogenous systemic bacteremia.

Bacteremia in immunocompromised hosts often arises from their endogenous intestinal flora. We produced experimental endogenous bacteremia by administering cyclophosphamide and ampicillin to conventional and specific-pathogen-free mice. The frequencies of bacteremia and mortality in the conventional mice were significantly higher than for the specific-pathogen-free mice. Pseudomonas aeruginosa was the major pathogen causing systemic bacteremia in conventional mice and was associated with a high mortality rate. Morganella morganii caused systemic bacteremia in both conventional and specific-pathogen-free mice. In contrast, Escherichia coli, enterococci, or other species most often caused portal bacteremia only. To determine the mechanism of occurrence of systemic bacteremia, we investigated bacterial blood clearance in mice and association with murine Kupffer cells, using several bacterial strains isolated from mice with bacteremia. Blood clearance rates and the abilities of isolated Kupffer cells to associate with bacteria were significantly greater for the organisms causing portal bacteremia than for those causing systemic bacteremia. There were no significant differences between the blood clearance rates in carrageenan-treated mice and that in normal mice. Moreover, association at 4 degrees C was not different from that at 37 degrees C. The results suggest that blood clearance of bacteria reflects bacterial adherence to Kupffer cells and that the resistance of bacteria to association with Kupffer cells plays an important role in the occurrence of overwhelming systemic bacteremia in this animal model.

Agglutination↗
PubMedDate not supplied

Bacteremia in infants with Salmonella enterocolitis.

In order to determine the incidence of Salmonella bacteremia in children with Salmonella enterocolitis and to predict the risk factors of bacteremia, we conducted a prospective study on 264 infants and children with Salmonella enterocolitis from January 1, 1988 to December 31, 1989. They were admitted to the Pediatric Department of Mackay Memorial Hospital with the chief problem of diarrhea. The rectal swab cultures were all positive for nontyphoidal Salmonella. Blood cultures were done immediately when Salmonella enterocolitis was confirmed. Clinical features including age, clinical symptoms, laboratory data, and serogroup were all recorded and analyzed to predict the risk factors of bacteremia in Salmonella enterocolitis. Twenty patients had bacteremia. Among them, 4 had meningitis simultaneously. There was one death, resulting in a 5% mortality in the bacteremia group. The overall rate of bacteremia was 7.6%. For those less than 3 months of age, it was 11.5%. We were unable to find any relationship between the bacteremia and the risk factors such as age, body temperature, clinical symptoms, white blood cell counts and differential counts. Interestingly, it was noted that Salmonella serogroup D1, a highly virulent and invasive Salmonella serogroup, was more closely related to the occurrence of bacteremia. It accounted for 40% of all cases of bacteremia. In conclusion, this study showed that the incidence of bacteremia in cases of Salmonella enterocolitis was 7.6% and the only risk factor of bacteremia was a culture of Salmonella serogroup D1. Therefore, in cases of Salmonella serogroup D1 enterocolitis, antibiotics treatment may be considerable.

Adolescent↗
PubMed1988

Enterococcal bacteremia: clinical features, the risk of endocarditis, and management.

The enterococci, members of the group D streptococci and the predominant aerobic streptococci of the gastrointestinal and female genital tracts, have long been recognized as significant pathogens in infective endocarditis. Over the past 2 decades, enterococci have become increasingly important nosocomial pathogens, related to their intrinsic resistance to many antibiotics, especially the cephalosporins, and the greatly increased use of antimicrobial therapy in hospitals. Recent reports have documented an alarming increase in the frequency of high-level resistance to aminoglyclosides, and strains resistant to ampicillin by production of a beta-lactamase and to vancomycin have now been encountered. We have reviewed the clinical features and course of 153 cases of enterococcal bacteremia occurring in a university hospital over the 14-year period, 1970 to 1983, 1) to understand better the importance of enterococci as human pathogens, 2) to identify the clinical features of enterococcal bacteremia, 3) to isolate those findings that help to identify associated endocarditis, and 4) to develop guidelines for more effective antimicrobial therapy of bacteremic enterococcal infections. The annual incidence of enterococcal bacteremia in our center rose three-fold over the period reviewed. In 65 cases (42%), bacteremia was polymicrobial, caused by Enterococcus and at least 1 other microorganism, usually an aerobic gram-negative bacillus. Most bacteremias were nosocomial and derived from infections of the urinary tract (29 cases), intravenous catheters (24 cases), intra-abdominal infections or surgical wounds (46 cases), burn wounds (25 cases), or cholangitis (21 cases); only 1 case originated from a pneumonia. Endocarditis was identified in association with 12 of 35 community-acquired bacteremias, but only 1 of 118 bacteremias acquired in the hospital (P less than .001). Endocarditis was also significantly associated with pre-existent valvular heart disease and cryptogenic bacteremia, and was negatively associated with polymicrobial enterococcal bacteremia (no endocarditis in 65 cases, P less than .001). Isolated enterococcal bacteremia produced an indolent infection rarely associated with shock (3 of 64 cases evaluated, all cases due to valve destruction by endocarditis); conversely, with polymicrobial enterococcal bacteremia, primarily with gram-negative bacilli, shock or disseminated intravascular coagulation developed in 50% of cases (P less than .001).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1981

Bacteremia in a small non-urban community hospital.

Forty-six episodes of bacteremia were observed during a three-year period at a small, non-urban community hospital. The incidence of bacteremia was 4.3 episodes per 1,000 admissions; this rate is similar to the incidence of bacteremia in large, urban community hospitals but lower than the incidence of bacteremia in municipal or academic hospitals. Eleven percent of bacteremias were hospital acquired, an incidence of 0.5 hospital acquired bacteremias per 1,000 admissions. The low incidence of hospital acquired bacteremia was a reflection of the low incidence of nosocomial, aerobic, gram-negative bacteremia (0.1 per 1,000 admissions). Thirteen percent of bacteremic patients died. The mortality in patients with community acquired bacteremia (10%) was lower than that reported from larger, urban hospitals; the mortality in patients with hospital acquired bacteremia (40%) was similar to that reported from larger, urban hospitals. The lower rates of bacteremia and associated mortality that were observed appear to be due to the lesser severity of underlying diseases in these patients.

Adult↗
PubMed1995

Risk factors for the development of bacteremia in nursing home patients.

BACKGROUND: While bacteremia has been studied in hospitalized elderly, there have been few studies in nursing home patients. We hypothesized that the presence of functional impairment would be associated with the development of bacteremia. OBJECTIVE: To determine risk factors for bacteremia in nursing home patients. DESIGN: Case-control study. Admission characteristics of cases and controls were compared. For cases, characteristics of the illness, mortality rates, origin of bacteremia, and organisms were recorded. SETTING: A 320-bed long-term care hospital and nursing home. SUBJECTS: Cases were patients with at least one blood culture positive for pathogenic organisms. The next patient admitted after the admission date of a case entered the control group. MAIN OUTCOME MEASURE: Admission characteristics of patients associated with the development of bacteremia. Clinical characteristics of cases and admitting characteristics associated with death caused by bacteremia were also determined. RESULTS: Twenty-six cases were identified, for an incidence of 0.24 per 1000 patient-days. There were significant associations between the development of bacteremia and the presence of a urinary catheter (P = .002 by chi 2 analysis) or urinary incontinence (P = .01 by chi 2 analysis). Men (P = .09) and patients with tracheostomies (P = .08 by chi 2 analysis) were somewhat more likely to develop bacteremia, but these associations were not statistically significant. The only admission characteristic of cases that was associated with death caused by bacteremia was hypocholesterolemia (3.79 mmol/L [147 mg/dL] in patients who died vs 5.05 mmol/L [195 mg/dL] in patients who survived, P = .03 by t test). CONCLUSIONS: Nursing home patients with urinary incontinence or a urinary catheter are at increased risk of bacteremia.

Aged↗
PubMed1998

Enterococcus faecium bacteremia: does vancomycin resistance make a difference?

BACKGROUND: Enterococcus faecium has received increased attention, primarily due to the emergence of vancomycin resistance. The purpose of this investigation was to study the epidemiological characteristics of vancomycin-resistant E faecium (VRE) bacteremia and to determine the clinical impact of vancomycin resistance on the outcome of patients with this infection. METHODS: We retrospectively analyzed the clinical features and outcome of 53 patients with E faecium bacteremia. RESULTS: From January 1992 until December 1995, there were 32 episodes of bacteremia caused by vancomycin-susceptible E faecium (VSE) and 21 caused by VRE. An intra-abdominal site was the most common source of bacteremia in both groups. All of the VRE and 78% of VSE bacteremia cases were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (P<.001), as were indwelling bladder catheters (P=.01). Fifty-nine percent of the patients with VSE bacteremia survived vs 24% with VRE (P=.009), despite similar severity-of-illness scores. In 62% of the patients with VRE sepsis, death was related to the bacteremia (P=.01). Patients infected with VRE had longer hospitalizations than those with VSE (34.8 vs 16.7 days, respectively) (P=.004), were more likely to be on the medical service (P=.03), and on the average, had hospitalization costs of more than $27,000 per episode than did patients with VSE bloodstream infection ($83,897 vs $56,707, respectively) (P=.04). CONCLUSIONS: Vancomycin-resistant E faecium bacteremia is a complication of prolonged hospitalization in debilitated patients. Vancomycin resistance has a negative impact on survival in patients with E faecium bacteremia and leads to higher health care costs.

Anti-Bacterial Agents↗
PubMed2002

Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus.

BACKGROUND: Staphylococcus aureus bacteremia carries high mortality rates. The clinical impact of methicillin resistance remains controversial: outcome comparisons between patients with bacteremia involving methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) S aureus are difficult to perform because of important differences in severity of illness. METHODS: A retrospective cohort analysis and 2 independent case-control analyses were performed to determine and compare outcomes and attributable mortality rates of MSSA (n = 38) and MRSA bacteremia (n = 47) in critically ill patients. For the case-control studies, matching (1:2 ratio) was based on the APACHE (Acute Physiology and Chronic Health Evaluation) II classification: APACHE II score (+/-1 point) and diagnostic category. RESULTS: Patients with MRSA bacteremia had more acute renal failure and hemodynamic instability than patients with MSSA bacteremia. They had a longer intensive care unit stay and ventilator dependency. Patients with MRSA bacteremia had a higher 30-day mortality rate (53.2% vs 18.4%) and in-hospital mortality rate (63.8% vs 23.7%) (P<.05). Multivariate survival analysis demonstrated acute renal failure, length of mechanical ventilation, age, and methicillin resistance to be independently associated with mortality (P<.05). The attributable mortality rate for MSSA bacteremia was 1.3%: mortality rates for cases and controls were respectively 23.7% and 22.4% (P =.94). The attributable mortality rate for MRSA bacteremia was 23.4%: mortality rates for cases and controls were respectively 63.8% and 40.4% (P =.02). The difference (22.1%) between both attributable mortality rates was significant (95% confidence interval, 8.8%-35.3%). CONCLUSION: In critically ill patients, after accurate adjustment for disease severity and acute illness, we found MRSA bacteremia to have a higher attributable mortality than MSSA bacteremia.

Acute Kidney Injury↗