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PubMed1987

The incidence of bacteremia during skin surgery.

The development of transient bacteremia during simple surgical excision of cutaneous neoplasms was studied. Of 35 patients undergoing surgery on eroded, but not clinically infected, cutaneous tumors, one developed a transient bacteremia, whereas none of 15 patients developed bacteremia during surgery on cutaneous neoplasms with intact skin surfaces. The low incidence of bacteremia associated with surgery on eroded skin neoplasms suggests that, for this commonly performed surgery, prophylactic antibiotics be administered perioperatively only to patients with prosthetic heart valves and not to other patients at risk for endocarditis. This recommendation would be in keeping with the American Heart Association guidelines for prophylaxis for other surgical procedures associated with low incidences of transient bacteremia.

Anti-Bacterial Agents↗
PubMed1985

Routine quantitative blood cultures in children with Haemophilus influenzae or Streptococcus pneumoniae bacteremia.

The potential clinical value of quantitative blood cultures determined by a commercially available lysis-direct plating method was studied in 50 children with either Haemophilus influenzae or Streptococcus pneumoniae bacteremia. The magnitude of bacteremia correlated with the severity of the infection; patients with greater than or equal to 100 colony-forming units per milliliter were significantly more likely to have meningitis (P less than .01, chi 2 = 7.5). On the other hand, all patients with S. pneumoniae bacteremia with colony counts lower than 15 colony-forming units per milliliter had "occult bacteremia" with no focus of infection. The data suggest that patients with higher levels of bacteremia have more severe disease. Quantitative blood culture results may be helpful in identifying which children are at risk for invasive disease.

Colony-Forming Units Assay↗
PubMed1985

Does bacteremia occur during flexible sigmoidoscopy?

Up to 10% of patients may have bacteremia after rigid sigmoidoscopy. The aim of our study was to determine the frequency of bacteremia accompanying flexible sigmoidoscopy. Blood samples for aerobic and anaerobic cultures were obtained before, during, and after flexible sigmoidoscopy in 100 patients who were examined a mean distance of 49.5 cm, range 15-60 cm, after a bowel preparation of two Fleet enemas. In one patient, a transient bacteremia with Streptococcus intermedius was documented and was attended by no associated clinical manifestations. This organism has been previously isolated from patients with endocarditis, peritonitis, emphysema, and hepatic and appendiceal abscesses. There was no association in our study with bacteremia and such factors as length of bowel examined and duration of procedure, the presence of bowel pathology, performance of endoscopic biopsies, liver disease, and portal hypertension or poor bowel preparation. We conclude that the extremely low incidence of significant bacteremia with flexible sigmoidoscopy may be related to the smaller diameter of the instrument and provides further support for the routine use of flexible rather than rigid sigmoidoscopy.

Adult↗
PubMedDate not supplied

Transient bacteremia due to suction abortion: implications for SBE antibiotic prophylaxis.

The incidence and character of the bacteremia associated with elective suction abortion was investigated in volunteer subjects aged 19 to 35 years who were to undergo first trimester abortion by suction curettage. One hundred and forty-four blood cultures were obtained from thirteen pregnant and four non-pregnant (control) subjects matched for age. Transient bacteremia occurred during or soon after suction abortion in 11 of 13 (84.7%) study subjects. Four of these patients were bacteremic after bimanual pelvic examination, just prior to initiation of the abortion procedure. Seven others developed bacteremia temporally related to cervical dilatation and suction abortion. The bacteremia was intermittent in some, persistent in others, existed as long as one hour after the procedure, and was transient in all patients. Microorganisms isolated from the blood were all normal genital tract flora and were predominantly anaerobes, although alpha hemolytic streptococci were also recovered. Mixed bacteremia occurred in six patients. In contrast, blood cultures from four non-pregnant women were sterile. This study indicates that the systemic circulation-uterine cavity barrier is significantly disrupted during abortion by suction curettage permitting endogenous genital tract microorganisms to gain access into the bloodstream. These observations also suggest that there may be some risk of developing endocarditis during suction abortion in patients with cardiac deformities, and lend some support to the current practice of giving antibiotic prophylaxis to abortion patients with cardiac lesions which predispose them to endocarditis.

Abortion, Induced↗
PubMed1983

Infection and T lymphocyte subpopulations: changes associated with bacteremia and the acquired immunodeficiency syndrome.

Patients with bacteremia, bacterial endocarditis, or acquired immunodeficiency syndrome (AIDS) were prospectively studied using monoclonal antibody reagents to assess alterations in T-lymphocyte subpopulations. Patients with endocarditis had significantly higher ratios of T-helper (OKT4+) to T-suppressor-cytotoxic (OKT8+) cells than did patients with bacteremia alone. Staphylococcus aureus endocarditis patients had a mean ratio of 8.49 (range 4.73-22.36) while S aureus bacteremia had a mean ratio of 2.75 (range 2.15 to 3.21). Similar results were found with Staphylococcus epidermidis endocarditis (mean 1.62) and bacteremia (mean 1.23). Klebsiella pneumoniae endocarditis (5.10) and sepsis (4.32), and E coli bacteremia (2.15). Nine male patients with AIDS had markedly depressed ratios (mean 0.25, range 0.04 to 0.67) while eight male homosexuals with unexplained lymphadenopathy ("pre-AIDS") had normal or increased ratios. Bacteremic infections are associated with an increased OKT4+/OKT8+ ratio with the degree of increase dependent upon virulence, location, and duration of infection. The immunomodulating effects of infection are manifested in changes in T-cell subsets, and these measurements can be useful in clinical management.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Staphylococcus epidermidis bacteremia in neonates: further observations and the occurrence of focal infection.

The frequency and clinical significance of Staphylococcus epidermidis isolates from blood cultures of neonates collected during a 17-month period in The New York Hospital neonatal intensive care unit (NICU) were reviewed. Twenty-three episodes of clinically significant S epidermidis bacteremia were detected using the criteria of isolation from 3/3 blood culture bottles from a single culture, or isolation from two or more blood cultures taken at different times, or simultaneous isolation from blood and fluid, pus or vascular catheter. Of these 23 episodes of S epidermidis bacteremia, ten were associated with colonized vascular catheters, and four episodes occurred in infants with necrotizing enterocolitis. Focal S epidermidis infection occurred in ten episodes, and persistent bacteremia occurred frequently in this setting. S epidermidis was the most frequent cause of bacteremia in the Neonatal Intensive Care Unit during the period reviewed. Of the isolates determined to be clinically significant, 74% were resistant to methicillin and cephalothin and 91% were resistant to gentamicin. All isolates were sensitive to vancomycin. In addition to removing vascular catheters suspected of being colonized and searching for potential sites of focal infection, an antibiotic regimen that includes vancomycin should be initiated once significant S epidermidis bacteremia has been recognized in the neonate.

Catheters, Indwelling↗
PubMed1982

Complications of Staphylococcus aureus bacteremia. Occurrence in patients undergoing long-term hemodialysis.

Since staphylococcus aureus bacteremia continues to be a common occurrence in patients with arteriovenous fistulas who are undergoing long-term hemodialysis, the complications and outcome of 37 episodes of bacteremia were examined. Systemic complications included pulmonary emboli, empyema, persistent bacteremia, and endocarditis. Such events were rarely life threatening--three of the 34 episodes involving patients without severe concurrent medical problems resulted in death. Local complications at the fistula site were common; however, thrombosis, hemorrhage, impending rupture, and persistent bacteremia caused loss of fistula in 13 of the 22 episodes seen with fistula inflammation. Results of this study demonstrate that, although loss of vascular access was an important problem, particularly in patients with prosthetic grafts, patients with S aureus bacteremia who were undergoing long-term hemodialysis had a favorable prognosis for survival, particularly when they were compared with other patients not undergoing hemodialysis.

Adolescent↗
PubMed1978

Hospital costs and mortality attributed to nosocomial bacteremias.

Hospital patients with nosocomial bacteremia and matched hospital control patients without this infection were used to determine the excess hospital costs and mortality attributed to nosocomial bacteremias. Mortality was 14 times greater in patients with nosocomial bacteremia than in matched members of the control group with the same primary diagnoses. An itemized cost analysis, based on 81 case-control pairs, showed an average excess of approximately $3,600 in direct hospital costs for patients who had nosocomial bacteremias. It is estimated that only 24% of the total excess costs to these hospital patients are preventable. Patients with nosocomial bacteremia had an average hospitalization period that was 14 days longer than the average hospital stay for members of the control group.

Costs and Cost Analysis↗
PubMed1995

[Pneumococcal bacteremia: what is new?].

85 patients who displayed Streptococcus pneumoniae (S. pneumoniae) bacteremia during hospitalization at the CHUV between January 1990 and December 1991 are reviewed retrospectively to reassess the importance of this pathology after the introduction in Switzerland of antipneumococcal vaccination. The data were compared with those obtained from a similar study at Lausanne between 1974 and 1978. Epidemiology, underlying diseases (present in 82% of patients), clinical findings (78% pneumonia, 8% meningitis, 14% bacteremia without detected primary focus) and mortality (31%) were comparable in the two series. There were, however, points of difference. First, the incidence of pneumococcal bacteremia increased between 20 and 40 years, affecting HIV positive patients in particular, with high mortality. Second, nosocomial pneumococcal bacteremia was relatively frequent (7%) and particularly severe, with very high mortality. Third, 17% of strains proved resistant to one or more antibiotics. Finally, use of the antipneumococcal vaccine is not widespread since only one of the 85 patients had been vaccinated whereas 82% presented a recognized indication for the vaccine. In conclusion, pneumococcal bacteremia remains frequent, involves major mortality and is more often due to resistant strains. These are important arguments in favour of vaccinating patients at risk.

AIDS-Related Opportunistic Infections↗
PubMed1977

Bacteremia in a community hospital: spectrum and mortality.

The problem of bacteremia was studied at our 500-bed community hospital during 1974-1975. All patients with positive blood cultures for clinically significant organisms were analyzed with respect to age, sex, host factors, type, dose, and time of institution of therapy with antibiotics, and mortality. Of 142 episodes of bacteremia, outcome according to underlying host factors showed that 12/15 died in the rapidly, fatal group, 12/24 died in the ultimately fatal group, and in the nonfatal group 25/103 died. Mortality for Gram-positive bacteremia was 37% (7/54) for Gram-negative bacteremia in the nonfatal group. In addition to underlying host factors, inappropriate antibiotic therapy also contributed to higher mortality in patients with gram-negative bacteremia.

Adolescent↗
PubMed2006

Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.

BACKGROUND: Alternative therapies for Staphylococcus aureus bacteremia and endocarditis are needed. METHODS: We randomly assigned 124 patients with S. aureus bacteremia with or without endocarditis to receive 6 mg of daptomycin intravenously per kilogram of body weight daily and 122 to receive initial low-dose gentamicin plus either an antistaphylococcal penicillin or vancomycin. The primary efficacy end point was treatment success 42 days after the end of therapy. RESULTS: Forty-two days after the end of therapy in the modified intention-to-treat analysis, a successful outcome was documented for 53 of 120 patients who received daptomycin as compared with 48 of 115 patients who received standard therapy (44.2 percent vs. 41.7 percent; absolute difference, 2.4 percent; 95 percent confidence interval, -10.2 to 15.1 percent). Our results met prespecified criteria for the noninferiority of daptomycin. The success rates were similar in subgroups of patients with complicated bacteremia, right-sided endocarditis, and methicillin-resistant S. aureus. Daptomycin therapy was associated with a higher rate of microbiologic failure than was standard therapy (19 vs. 11 patients, P=0.17). In 6 of the 19 patients with microbiologic failure in the daptomycin group, isolates with reduced susceptibility to daptomycin emerged; similarly, a reduced susceptibility to vancomycin was noted in isolates from patients treated with vancomycin. As compared with daptomycin therapy, standard therapy was associated with a nonsignificantly higher rate of adverse events that led to treatment failure due to the discontinuation of therapy (17 vs. 8, P=0.06). Clinically significant renal dysfunction occurred in 11.0 percent of patients who received daptomycin and in 26.3 percent of patients who received standard therapy (P=0.004). CONCLUSIONS: Daptomycin (6 mg per kilogram daily) is not inferior to standard therapy for S. aureus bacteremia and right-sided endocarditis. (ClinicalTrials.gov number, NCT00093067 [ClinicalTrials.gov].).

Adult↗
PubMed2002

Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection.

BACKGROUND: Although several epidemiological surveys of Klebsiella clinical isolates have been performed, few studies have correlated the clinical isolate with disease. OBJECTIVE: To compare the clinical and bacteriological characteristics of Klebsiella pneumoniae bacteremia acquired as community or nosocomial infections. METHODS: We prospectively enrolled 158 consecutively hospitalized patients with K pneumoniae bacteremia. Clinical data were reviewed. Antimicrobial susceptibility testing and capsular serotyping were performed. We used the chi(2) test, the Fisher exact test, or the t test for statistic analysis. RESULTS: Underlying diabetes mellitus was more common in community-acquired than in nosocomial infection (46/94 [49%] vs. 8/64 [12%]; P<.001). On the other hand, neoplastic disease (34/64 [53%] vs. 13/94 [14%]; P<.001) and antibiotic resistance (P<.01) were more frequent in patients with nosocomial compared with community-acquired infections. Klebsiella pneumoniae liver abscesses, which were all community acquired, accounted for the source of 22 (23%) of 94 community-acquired K pneumoniae infections. No attributable source of infection was found for 37 (58%) of the 64 nosocomial infections vs. 15 (16%) of the 94 community-acquired infections. Only 58 isolates (36.7%) could be serotyped; of these, capsular serotypes K1, K2, and K28 accounted for 37 (23.4%), 8 (5.1%), and 6 (3.8%), respectively, of all strains. However, typeable isolates were significantly more common among community-acquired than nosocomial isolates (42/94 [45%] vs. 16/64 [25%]; P =.01), especially for serotype K1 (28/94 [30%] vs. 9/64 [14%]; P =.02). Significant risk factors for mortality included nosocomial infection, lung infection, thrombocytopenia, leukopenia, ceftazidime resistance, inappropriate antimicrobial therapy, and septic shock. CONCLUSIONS: Significant differences were identified between community-acquired and nosocomial K pneumoniae bacteremia. Ceftazidime resistance in nosocomial K pneumoniae bacteremia carried a high risk for mortality, and serotype K1 in K pneumoniae was more prevalent in community-acquired infection, suggesting more virulence.

Bacteremia↗
PubMedDate not supplied

Influence of blood culture results on antibiotic choice in the treatment of bacteremia.

BACKGROUND: It is unclear how often blood culture results influence empiric antibiotic regimens. METHODS: To assess the frequency of antibiotic modification and the rates of proper documentation of blood culture results by house staff physicians, we prospectively evaluated 226 episodes of bacteremia in 199 patients. RESULTS: Antibiotics were changed in 49.6% of episodes of true bacteremias. Physicians were more likely to change therapy if gram-negative rods (odds ratio [OR], 3.19) or Staphylococcus aureus (OR, 3.12) were isolated, if the blood culture was obtained in the first 7 days of hospitalization (OR, 1.9), or if house staff physicians properly documented the culture results in the medical chart (OR, 3.8) (all P values, < .05). Documentation of positive blood culture results by house staff physicians was absent in 26% of patients, and it was observed less often in patients on the surgical service (OR, 0.35; P = .004) or if a contaminant was recovered (OR, 0.24; P < .001). Eighty-three percent of "true-positive" blood cultures, as compared with 55% of "contaminated" blood cultures, were documented with a note in the medical records (P < .0001). Rates of documentation were higher for gram-negative rods, for patients who were already receiving antibiotic therapy, and for those who had a change of therapy after the culture results became available (all P values, < .05). A multivariate logistic regression model showed that documentation of the blood culture result (OR, 1.78; P = .006) or a positive culture within 7 days of hospitalization (OR, 1.49; P = .01) was independently associated with a change in therapy. CONCLUSIONS: In a significant proportion of patients with bacteremia, the blood culture result may not be the most important factor that determines antibiotic choice. Bacteremia is not adequately documented by house staff physicians in up to a quarter of patients.

Anti-Infective Agents↗
PubMed2000

Resource utilization and contaminated blood cultures in children at risk for occult bacteremia.

OBJECTIVE: To measure the increases in resource utilization and hospital charges associated with the evaluation of contaminated blood cultures obtained from emergency department patients at risk for occult bacteremia. DESIGN: Retrospective medical record review. SETTING: Emergency department of an urban, university-affiliated pediatric referral center. PATIENTS: Children aged 3 to 36 months with blood cultures positive for bacterial growth obtained between January 1994 and October 1996. MAIN OUTCOME MEASURES: Increased resource utilization related to contaminated blood culture follow-up, including telephone contact, return emergency department visits, additional diagnostic tests and therapies performed at reevaluation, and hospital admissions. Hospital charges for these additional services were tabulated. RESULTS: Of 8,306 children who had blood cultures drawn, 491 (5.9%) had positive findings. Four hundred eighty-five (98.8%) of these were available for review. Two hundred seventy-six (57%) of 485 were excluded from final analysis. Of the remaining 209 patients at risk for occult bacteremia, 85 (41%) had cultures that grew contaminants only. Follow-up of these 85 patients generated 106 telephone calls, 49 return visits to the emergency department, 102 additional diagnostic tests, 18 doses of parenteral antibiotics, and 12 hospital admissions with a combined length of stay of 24 days. This resulted in additional charges of $78,904, or an additional $642 per true pathogen recovered. CONCLUSIONS: Contaminated blood cultures obtained from children at risk for occult bacteremia lead to substantial increases in resource utilization and hospital charges. These untoward effects should be accounted for in formal decision analyses regarding the management of occult bacteremia.

Bacteremia↗
PubMed1997

Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis.

OBJECTIVE: To compare the risks for bacteremia and urinary tract injections (UTI) in young febrile children with and without bronchiolitis. DESIGN: A prospective cohort study. SETTING: The emergency departments of 3 pediatric referral hospitals. PATIENTS: A convenience sample of 432 previously healthy febrile patients aged 24 months or younger. Patients were divided into groups, based on the presence (n = 163, bronchiolitis group) or absence (n = 269, control group) of wheezing and/or retractions on examination. Blood cultures were obtained from all patients, and urine cultures were obtained from female patients, and male patients aged 6 months or younger. Chest radiographs were obtained on patients with lower respiratory tract signs, and those with lobar pneumonias were excluded (7 wheezing and 8 nonwheezing patients), leaving 156 patients with bronchiolitis and 261 control patients. OUTCOME MEASURES: Growth of any bacterial pathogens from the blood or 10(4) colony-forming units per milliliter or more from the urine. RESULTS: None of the 156 patients with bronchiolitis had bacteremia (95% confidence interval, 0%-1.9%) vs 2.7% of the 261 controls (95% confidence interval, 1.1%-5.4%; P = .049); 1.9% of the patients with bronchiolitis had UTI vs 13.6% of the controls (odds ratio, 0.12; 95% confidence interval, 0.02-0.55; P = .001). None of the subset of patients with bronchiolitis aged 2 months or younger (n = 36) had bacteremia or UTI; however, there were not enough of these younger patients to make statistically conclusive comparisons. CONCLUSIONS: Previously healthy febrile children aged 24 months or younger with bronchiolitis are unlikely to have bacteremia or UTI. Therefore, routine cultures of the blood and urine in these patients are unnecessary. More data are needed regarding the subset of febrile infants aged 2 months or younger with bronchiolitis.

Bacteremia↗
PubMed1992

Postinjury shock and early bacteremia. A lethal combination.

Gut bacteria translocation has been invoked as a prime cause of early postinjury death. To examine this hypothesis, we obtained emergency department blood cultures in 132 acutely injured patients requiring urgent laparotomy for trauma. In the latter half of these patients, mesenteric lymph node and liver biopsy cultures were also performed. The incidence of early bacteremia was 11% (10/94) in the patients without shock compared with 32% (12/38) in the group with shock. The majority (73%) were gram-positive bacteremias. Most notably, Staphylococcus was isolated in 13% (5/38) of the patients with shock, but these isolates were of no apparent clinical significance. In contrast, 18% (7/38) of the patients with shock had enteric bacteremias, and all of these patients died. Cultures were positive in 11% of the liver samples and 15% of the mesenteric lymph nodes. With the exception of two patients with concurrent enteric bacteremias, these hepatic and mesenteric lymph node bacteria were of no clinical significance. In conclusion, bacterial translocation occurs infrequently, and virtually all enteric bacteria were found in dying patients; the cause or effect remains to be defined.

Adult↗
PubMed2000

Pneumococcal pneumonia and bacteremia model in mice for the analysis of protective antibodies.

Pneumococci cause infection by colonizing the nasopharynx and invading the mucosal surfaces. Infection models in mice, where the natural route of infection is mimicked, may be useful to study antibody mediated protection against pneumococcal pneumonia and bacteremia. We have established a pneumococcal pneumonia and bacteremia model in mice and investigated the protective capacity of human antibodies. Intranasal challenge with serotypes 1, 3, 6A and 8 caused lung infection and bacteremia which was lethal. Serotype 6B caused low, but detectable, infection and other serotypes tested were not virulent. Passive immunization with a human IgG preparation i.p. protected mice in a dose dependent manner against bacteremia caused by the virulent serotypes (except serotype 3) and partially or completely cleared pneumococci from the lungs of mice infected with serotypes 1, 6A and 8. Adsorption of antibodies with homologous capsular polysaccharides eliminated protection against disease but adsorption with cell wall polysaccharides (CWPS) did not. Furthermore, a good correlation was observed between protection of sera in vivo and opsonic activity in vitro. The results indicate that the model may be useful to analyse the levels, isotypes, specificity and other characteristics of human antibodies which protect against pneumococcal infection and to evaluate the protective potential of pneumococcal vaccine candidates.

Animals↗
PubMed1993

Anaerobic bacteremia in a cancer center.

Seventy-five episodes of clinically relevant anaerobic bacterial bacteremia observed in cancer patients were reviewed. Gastrointestinal (22.7%), hematological (22.7%) and female genital tract (18.6%) cancers were the most common underlying malignant diseases. Among 84 strains of strict anaerobic bacteria recovered in the 75 patients, gram-negative rods were isolated in 49 patients (58.3%), gram-positive rods in 29 patients (34.5%) and gram-positive cocci in 6 patients (8%). Bacteroides spp. and Clostridium spp. were the most frequent pathogens (85.7%). Twenty-one episodes of bacteremia were polymicrobial, aerobic gram-positive cocci being the most frequently associated pathogens. When identified, the primary sites were the gastrointestinal tract (40%), the female genital tract (17.3%), skin and soft tissue (14.6%), the oropharynx (12%) and the lower respiratory tract (6.7%). The source remained unknown in 7 cases (9.3%). The overall survival (evaluated 10 days after the occurrence of bacteremia) was 82.5%. There was no difference in mortality between patients with monomicrobial and polymicrobial bacteremia. Pulmonary complications were more frequent in patients with fatal outcome in comparison to patients who survived. The mortality rate of the patients adequately treated was 10.3% compared to 41% for the patients not treated or treated inadequately (P = 0.016, chi 2).

Adult↗