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PubMed1978

Nitroblue tetrazolium and Limulus assays for bacteremia after dental extraction: effect of topical antiseptics.

Bacteremia that occurs after dental extraction is common. This study assessed the effect of topical antisepsis on the incidence and magnitude of post-extraction bacteremia. On hundred patients scheduled for elective tooth extraction were randomized among four groups: contr-l, mouthrinsing with sodium-p-toluene sulfonchloramide (chloramine-T), toothbrushing with chloramine-T, and irrigation with Lugol's solution. The results showed that 84% of the control group and 59% of the treatment groups had positive blood cultures (290 organisms isolated) after dental extraction. The duration and magnitude of these bacteremias were diminutive as documented by the six serial blood cultures taken for each patient, colony counts per milliliter of blood, and nitroblue tetrazolium and Limulus assays. Brushing the teeth or rinsing the mouth with chloramine-T before dental extraction significantly reduced the incidence of bacteremia (P less than .025) and the number of different organisms recovered from each patient (P less than .05). Thus, topical treatment with chloramine-T is a simple and effective means of reducing the incidence of postextraction bacteremia.

Adolescent↗
PubMed1980

Dental flossing and its relationship to transient bacteremia.

This study was designed to determine the role of dental flossing in producing transient bacteremias. An improved protocol that provides for repeated samplings of blood was developed. Four patients had 32 blood cultures taken (16 before flossing and 16 after). Two of the patients had no periodontal disease and two had only marginal gingivitis. The results showed that the patients who flossed daily developed no bacteremias but that patients who delayed flossing from 1 to 4 days developed bacteremias 86% of the time. It is important that patients who have a history of rheumatic fever and those who have internal prosthetic devices be cautioned regarding sporadic flossing. While gingival bleeding was not significantly related to bacteremias in this study, further investigation is needed to ascertain how flossing in various types of periodontal disease relates to bacteremias.

Adult↗
PubMed2004

Diabetes and outcome of community-acquired pneumococcal bacteremia: a 10-year population-based cohort study.

OBJECTIVE: Patients with diabetes may carry a higher case fatality of invasive pneumococcal infection compared with nondiabetic patients due to decreased immunity, risk of metabolic derangement, or angiopathy. We conducted a population-based cohort study to assess the impact of diabetes on mortality within 90 days in patients with pneumococcal bacteremia. RESEARCH DESIGN AND METHODS: All patients with community-acquired pneumococcal bacteremia in North Jutland County, Denmark, from January 1992 to December 2001 were retrieved from the County Bacteremia Registry. Using civil registry numbers, patients with diabetes were identified by record linkage with the County Prescription Database (for antidiabetic drugs) and the County Hospital Discharge Registry. Mortality within 90 days was determined through the Central Population Registry. Mortality rates were compared for diabetic and nondiabetic patients and adjusted for sex, age, and comorbidity. RESULTS: Among 628 patients aged >15 years with community-acquired pneumococcal bacteremia, 63 (10.0%) had diabetes. The diabetic patients were slightly older (median age 71.7 years) than the nondiabetic patients (67.0 years), and the proportion of patients with comorbidity was higher in the diabetic group (59 vs. 46%). Mortality in diabetic patients compared with nondiabetic patients was 11.1 vs. 16.5% after 30 days and 16.0 vs. 19.5% after 90 days, respectively. After adjustment for sex, age, and comorbidity, the mortality rate ratio for diabetic patients was 0.6 (95% CI 0.3-1.2) compared with the nondiabetic patients. CONCLUSIONS: Diabetic patients with community-acquired pneumococcal bacteremia appear not to have a higher case fatality than nondiabetic patients.

Adolescent↗
PubMed1987

Staphylococcus aureus bacteremia: significance of hyperbilirubinemia.

We studied 233 consecutive episodes of Staphylococcus aureus bacteremia in 230 patients between 1980 and 1984 at a community teaching hospital. Bacteremia was community-acquired in 78 episodes, acquired from nursing homes in 22 episodes and hospital-acquired in 133 episodes. The over-all mortality was 48.9%. Patients greater than or equal to 60 years had higher mortality (62.0%) than patients less than 60 years old (25.3%). Hospital-acquired bacteremia was associated with a higher mortality (59.4%) than community-acquired bacteremia (29.5%). The respiratory tract as the portal of entry of bacteremia was associated with a higher mortality (80.4%), as compared to 53.5% when the portal of entry was undetermined, and 28.1% when the portal of entry was other sources. Increasing serum creatinine levels were associated with increasing mortality: less than 88.4 mumol/l (26.5%), 97.2-168.0 mumol/l (51.1%), and greater than 176.8 mumol/l (67.9%). Increasing serum bilirubin levels were also associated with increasing mortality: less than 17.1 mumol/l (40.6%), 18.8-49.6 mumol/l (57.1%), and greater than 51.3 mumol/l (84.2%). Very high leukocyte counts were associated with higher mortality: greater than 20 X 10(9)/l (73.9%), 10-20 X 10(9)/l (37.4%), and less than 10 X 10(9)/l (45.8%).

Age Factors↗
PubMed1989

Salmonella bacteremia in renal transplant recipients.

Three cases of salmonella bacteremia in renal transplant recipients are reported. Two patients had prolonged salmonella infections with recurring bacteremia. The longest interval between bacteremic relapses was 15 years. 27 cases from the literature of salmonella bacteremia in renal transplant recipients are reviewed. The courses of salmonellosis in renal transplant recipients are more serious than in other non-compromised patients, being complicated by bacteremia in 70% of the cases. Renal transplant recipients have prolonged carrier states and frequent relapses or recurrences of salmonellosis. 45% of the salmonella bacteremias in renal transplant recipients are seen after a high dose methylprednisolone treatment for graft rejection episodes.

Adult↗
PubMed1989

Central nervous system complications in patients with bacteremia.

The occurrence of central nervous system (CNS) complications was studied retrospectively in 150 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci or Escherichia coli. The incidence and clinical manifestations of different CNS complications were noted during 1 month after the bacteremia. Special attention was paid to vascular complications (infarction or hemorrhage), infections (meningitis or brain abscess) and mental changes when they were the only signs of CNS origin (lowered level of consciousness, confusion or delirium). The risk of cerebral infarction was elevated in the patients with bacteremia during the first month after the positive blood culture as compared with the overall risk of stroke in the general population. 10/150 patients (7%) developed cerebral infarction during that month. Two of these cases were associated with bacterial meningitis and 1 with endocarditis. Mental changes as a main symptom of CNS origin occurred in 27% of patients with bacteremia. Increasing patient age predisposed to this complication. Mental changes were not associated with any bacterial species studied. Altogether 40% of the patients developed CNS complications, which were a significant risk factor for death during the first month after the bacteremia.

Adolescent↗
PubMed1989

Serratia bacteremia: a review of 44 episodes.

This report reviews 44 episodes of serratia bacteremia over a 9-year period (1980-1988) in a community-teaching hospital in the USA. The median age of patients was 64 years and 34% of the patients were older than 70 years. Nosocomial acquisition of bacteremia occurred in 70% of episodes, and 11% of patients were admitted from nursing homes. Nine episodes (20%) were polymicrobial bacteremia. The major portals of entry were the lower respiratory tract (11 episodes) and the urinary tract (6 episodes). The overall mortality was 52%. Factors that adversely influenced the mortality rate were rapidly fatal and ultimately fatal underlying conditions (p less than 0.001), platelet counts less than or equal to 100 x 10(0)/l at the onset of bacteremia (p less than 0.01), and total serum bilirubin greater than 18 mumol/l at the onset of bacteremia (p less than 0.01). All serratia strains tested were susceptible to gentamicin, kanamycin, amikacin and ceftizoxime.

Aged↗
PubMed1989

Coagulase-negative staphylococcal bacteremia. Mortality and hospital stay.

OBJECTIVE: To determine the attributable mortality and the excess length of hospital stay resulting from coagulase-negative staphylococcal bacteremia. DESIGN: Matched historical cohort study. SETTING: Large university-based tertiary care center. PATIENTS: Of 171 patients with hospital-acquired coagulase-negative staphylococcal bacteremia identified by prospective surveillance of nosocomial infections from 1 July 1984 to 30 June 1987, 118 met criteria for the study and were matched to a control patient by age, sex, primary diagnoses, operative procedures, and date of admission. MEASUREMENTS AND RESULTS: Success was achieved in 621 of 650 (96%) variables used for matching. Staphylococcus epidermidis accounted for 92% of the bacteremias. Twenty cases (17%) had evidence of septic shock, and 10 had disseminated intravascular coagulation. The mortality rate in cases was 36 of 118 (30.5%) compared with 20 of 118 (16.9%) in controls. The attributable mortality was 13.6% (95% CI, 4.2 to 22.9) and the risk ratio for dying was 1.8 (95% CI, 1.2 to 2.7; P = 0.006). The median length of stay was 46 days for cases and 37.5 for controls (P = 0.0002). CONCLUSIONS: Coagulase-negative staphylococci, the leading organisms causing hospital-acquired bacteremias, are associated with mortality in excess of that due to the underlying diseases alone. Moreover, they significantly prolong the length of hospital stay. These findings show the importance of coagulase-negative staphylococcal bacteremia in hospitalized patients.

Adolescent↗
PubMed1998

Studies on Methicillin-Resistant Staphylococcus aureus Bacteremia Due to Laboratory Medical Analysis.

We encountered 64 patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia between April 1993 and March 1994. Mean patient age was 54 years. There were 46 males and 18 females. Underlying diseases mainly consisted of traffic accident (10 patients), valvular heart disease (5 patients), chronic renal failure (5 patients), leukemia (5 patients), pneumonia (3 patients), and malignant lymphoma (3 patients). The common clinical laboratory findings of MRSA bacteremia included decreses in total protein, albumin and hemoglobin as well as increases in white blood cells (neutrophils) and C reactive protein. In particular, an increase in C reactive protein by 10 mg/dl or more may be useful for diagnosing bacteremia. Laboratory findings were compared between surviving and non-surviving patients. There were significant differences in albumin, cholesterol, bilirubin, creatinine, and CRP. In 18 patients (28.1%), bacteremia was caused by infection due to contamination of central venous catheters. Since medical treatment with intra-vascular devices may cause bacteremia, sufficient caution is needed.

Journal Article↗
PubMed1998

Nosocomial Primary Bacteremia: Clinical and Laboratory Characteristics in Adults and Children.

A prospective study was carried out to evaluate the main clinical and laboratory manifestations of nosocomial primary bacteremia among adults and children at the Heart Institute, University of Sao Paulo School of Medicine, Brazil during 1993. Forty occurrences of bacteremia were analyzed; 27 in adults and 13 in children. Among adults, although fever, rigors and alterations in leukocyte count were frequently recorded, rigors and fever were absent in 30% of the cases and the frequency of any associated clinical manifestations was only 55%. Among children, fever occurred most frequently, but rigors were not recorded. It is concluded that the diagnosis of nosocomial bacteremia is imprecise due to frequent absence of the main clinical correlates of bacteremia. Blood cultures should be obtained in patients who are in a setting associated with bacteremia, even if typical clinical signs and symptoms are not presented, and that frequent updating of guidelines for empiric treatment is needed. We also suggest that separate guidelines be established for children and adults because of the differences in the clinical findings in these two groups.

Journal Article↗
PubMed1991

Serratia marcescens bacteremia.

Serratia marcescens bacteremia has become ubiquitous recently. S. marcescens bacteremia, either hospital- or community-acquired, can no longer be treated as insignificant. We reviewed 23 episodes of S. marcescens bacteremia in 1985. Among them, 17 patients (74%) were hospital-acquired infections, while 6 (26%) were community-acquired. Nine patients died, and the case fatality rate was 39%. Eleven patients (48%) had no clinically apparent source of infection, 5 (22%) had urinary tract infection, 3 (13%) had pneumonia, 2 (9%) had biliary tract infection, 1 (4%) had intra-abdominal infection, and 1 (4%) had skin and soft-tissue infection. Nosocomial isolates are often resistant to many antibiotics. Amikacin and the beta-lactamase-stable (third generation) cephalosporins are superior to gentamicin in the treatment of nosocomial S. marcescens bacteremia. We here emphasize that the awareness and treatment of S. marcescens bacteremia in daily clinical practice is unequivocally critical.

Adult↗
PubMed1991

[Bacteremia in febrile children].

Bacteremia in children under 2 years of age is not uncommon. Several studies indicated that a small proportion of young children with fever who do not appear to be seriously ill may have bacteremia, and a small proportion of this subgroup may go on to develop serious illness such as meningitis. The rationale for this study was to assess both the incidence of bacteremia in febrile children in Taipei area and the predictive value of the white blood cell count and degree of body temperature for bacteremia. Three hundred febrile children (B. T. greater than or equal to 39 degrees C), without underlying disease or readily recognizable viral illness, who visited the emergency service of Chang Gung Memorial Hospital, were enrolled. Blood cultures and complete blood counts were obtained. Clinically important pathogens were identified in 6 of 300 cases (2%). The incidence and pathogens of various age group were: (1) Neonate, 2/15 (13%), one each of Group D streptococcus & streptococcus viridans; (2) 1 month to 1 year old, 3/66 (5%), 2 Escherichia coli and 1 Salmonella Group D; (3) 1 to 2 years old, 0/49; (4) 2 to 5 years old, 0/72; (5) 5 to 10 years old, 0/67; (6) 10 to 15 years old, 1/26 (4%), Salmonella typhosa. Neither the white blood cell count, the absolute segmented or band neutrophil count, nor the degree of body temperature had predictive value for bacteremia.

Adolescent↗
PubMed1991

Enterobacter bacteremia in the community hospital.

BACKGROUND: The purpose of this study was to examine the epidemiological and clinical characteristics of Enterobacter bacteremia in the community hospital, where nosocomial infections are not commonly studied. METHODS: The blood culture records of five community hospitals in the Dayton, Ohio, area were reviewed to find cases of Enterobacter bacteremia. The respective hospital charts were then reviewed. RESULTS: Seventy-five episodes of Enterobacter bacteremia were reviewed. Eighty percent (60) of the organisms were nosocomially acquired, and 20% (15) were community acquired. The median age of the patients was 64 years. In 39% (29) of the episodes, fever was not the primary manifestation. The mortality rate was 29% (22). In 30% of the cases, the portal of entry for the bacteremia was unknown. The most common known portals of entry were genitourinary, gastrointestinal or biliary, and peritoneal. The most common underlying disorders were malignancy, postoperative states, and diabetes mellitus. In 9% of the cases, no underlying disorder was detected. The organisms showed high sensitivity to chloramphenicol, aminoglycosides, piperacillin sodium, and cefotaxime sodium. High degrees of resistance were shown to ampicillin, first-generation cephalosporins, and cefoxitin. Eighty-four percent (46) of the patients treated appropriately survived, and 55% (11) of the patients treated inappropriately died. CONCLUSIONS: Enterobacter bacteremia is most commonly nosocomially acquired and appears to be a problem in the community hospital. Appropriate therapy improves rates of patient survival.

Adolescent↗
PubMed1990

Polymicrobial bacteremia in the late 1980s: predictors of outcome and review of the literature.

Although polymicrobial bacteremia has been described in several previous series, there has been no recent study of patients using rigorous statistical analysis. Our objective was to characterize a present-day patient population with polymicrobial bacteremia and to define factors prognostic of survival. Polymicrobial bacteremia accounted for 6% of all positive blood cultures at a university hospital and a Veterans Administration hospital over a 2 1/2 year period in the late 1980s. The majority of these patients were elderly with significant underlying diseases, notably malignancies, and 56% of all episodes were nosocomially acquired. Enterobacteriaceae have remained the most common organisms, though the frequency of gram-positive cocci isolated has increased compared to older studies. Gastrointestinal, genitourinary, and skin and soft-tissue sources were the most common, although the incidence of infections due to central venous catheters appeared to be increasing. The source of 25% of bacteremia was not identified despite newer diagnostic techniques. By univariate analysis, mortality, which was 36% overall, correlated with thrombocytopenia, respiratory failure, disseminated intravascular coagulation, encephalopathy, severity of underlying disease, hemolysis, adult respiratory distress syndrome, use of steroids, renal insufficiency, institution, presence of central lines, and nosocomial acquisition. Using stepwise logistic regression analysis, mortality was predicted by respiratory failure, severity of underlying disease, and hemolysis. We conclude that polymicrobial bacteremia remains an important entity in the present-day hospitalized population, with an increasing frequency of gram-positive organisms and catheter sources, and a large proportion of undiagnosed etiologies.

Humans↗
PubMedDate not supplied

[Bacteremia caused by Bacteroides. An analysis of 50 episodes].

During the 32 months between October 1984 and May 1987 there were 72,800 admissions in our center; 31,523 blood cultures were undertaken and in 3,831 of them (11.5%) at least one significant organism was recovered; 6.7% of blood cultures yielded anaerobic bacteria, and 3.1% Bacteroides spp. In the 1,478 instances of bacteremia recorded during that period, the relative frequencies of bacteremia by anaerobic bacteria and by Bacteroides were 8.6% and 3.9%, respectively. In overall 50 Bacteroides bacteremias (47 due to Bacteroides fragilis and 3 to Bacteroides spp), 32 (64%) were hospital acquired and 14 (28%) postsurgical. Their most common source was the abdominal cavity (25, 50%), followed by the skin and soft tissues (7, 14%), feminine pelvis (4, 8%), miscellaneous (8, 16%), and unknown (7, 14%). Fifteen bacteremias (30%) were polymicrobial, 20 (40%) were associated with septic shock, and 15 (30%) with renal failure. Overall mortality rate was 52%, and that directly attributable to bacteremia was 32%. Poor prognostic predictors included the source from a perforated viscus, septic shock, renal failure or gastrointestinal hemorrhage, and the absence of adequate antimicrobial therapy.

Adolescent↗
PubMed1989

Klebsiella pneumoniae bacteremia in the community hospital.

The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.

Adult↗
PubMed1988

Anaerobic bacteremia in a neonatal intensive care unit: an eighteen-year experience.

A review of anaerobic bacteremia in the Neonatal Intensive Care Unit identified 29 episodes of clinically significant bacteremia occurring over the past 18 years. This experience suggested that certain clinical settings were associated with specific anaerobic infections. Although Gram-positive and Gram-negative anaerobes were isolated with similar frequency, 8 of 12 infants bacteremic within the first 48 hours of life were infected with Gram-positive, penicillin G-susceptible organisms whereas 11 of 17 infants older than 2 days were bacteremic with Gram-negative, penicillin G-resistant anaerobes. Eleven of 17 infants with anaerobic bacteremia associated with necrotizing enterocolitis were bacteremic with Gram-negative anaerobes. Five of 6 infants with anaerobic bacteremia associated with chorioamnionitis were bacteremic with Gram-positive anaerobes. These observations should be considered in making decisions regarding empiric therapy for the newborn at highest risk for anaerobic bacteremia.

Anti-Bacterial Agents↗
PubMed1979

A comparison of immunologic profiles and their influence on bacteremia in surgical patients with a high risk of infection.

Prospective sequential studies of the antibacterial function of neutrophils, lymphocyte responsiveness, opsonic capacity of serum and serum levels of C3(B), properdin, factor B, IgG, and albumin were made in 32 patients with severe burn injury (greater than or equal to 45%), 21 patients with severe multisystem traumatic injury, 20 high-risk, infected patients, and 22 renal transplant patients. Fifty-five episodes of bacteremia occurred in 37 of the 95 patients. Abnormal neutrophil function was clearly associated as a predisposing factor to these episodes, whereas there was no association between bacteremia and low serum levels of C3, IgG, factor B, or properdin. C3, factor B, and IgG usually rose following bacteremia as acute phase proteins, but there was evidence of a consumptive opsoninopathy in 11% of episodes. Defective opsonization was associated with a high risk of bacteremia only when there was a coexisting abnormality of neutrophil function (88% of such patients became bacteremic). None of 27 nonburned patients tested with delayed hypersensitivity antigens responded normally, and there was regularly depression of lymphocyte responsiveness to phytohemagglutinin-A and concanavalin-A in a whole blood assay related to serum immunosuppressive factors, but poor responsiveness was not associated with bacteremia.

Adolescent↗