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PubMed1994

Pre-emptive administration of corticosteroids prevents the development of ARDS associated with Streptococcus mitis bacteremia following chemotherapy with high-dose cytarabine.

Adult respiratory distress syndrome (ARDS) complicating Streptococcus mitis bacteremia is a major cause of mortality in patients undergoing therapy for leukemia. In order to try to prevent the development of ARDS in 11 patients with S. mitis bacteremia following chemotherapy including cytarabine, high doses of corticosteroids were administered pre-emptively. None of these patients developed ARDS. In a historical control group of 21 comparable patients who had not been given corticosteroids, the incidence of ARDS was high (38%), with a death rate of 14%. Preemptive administration of high-dose corticosteroids appeared to be highly effective in suppressing the mechanisms that induce ARDS in patients with S. mitis bacteremia after cytarabine treatment. The results suggest that ARDS complicating S. mitis bacteremia is not merely a microbiological problem but may, at least in part, represent an immunologically mediated phenomenon.

Adolescent↗
PubMed1994

Nosocomial bacteremia in a medical-surgical intensive care unit: epidemiologic characteristics and factors influencing mortality in 111 episodes.

OBJECTIVE: To analyze the epidemiology and factors influencing mortality of ICU-acquired bacteremia. DESIGN: Prospective clinical study. SETTING: A medical-surgical ICU in an university hospital. PATIENTS: We recorded variables from 111 consecutive ICU-acquired episodes for a 3-year period. RESULTS: The attack rate was 1.9 episodes per 100 patient-days. The commonest isolates were coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Intravascular catheters were the most frequent source of infection. Overall mortality was 31.5%, and 65.7% of all deaths were directly attributable to infection. Bacteremia from intra-abdominal, lower respiratory tract or unknown origin were associated with a poor prognosis. A logistic regression analysis defined intraabdominal origin (p = 0.01, OR = 15.7) and presence of shock (p = 0.04, OR = 3.3) as independently influencing the risk of death. No significant differences were found for the remaining variables studied. CONCLUSIONS: Epidemiology and etiology of ICU-acquired bacteremia does not differ seriously in respect to nosocomial bacteremia among unselected populations, although it is associated with a greater incidence and overall mortality. Presence of shock is the most important modificable variable affecting the outcome.

Bacteremia↗
PubMed1997

Risk factors, clinical features and outcome of Acinetobacter bacteremia in adults.

The medical records of 39 patients with Acinetobacter bacteremia identified in the period between 1985 and 1995 were reviewed. In 24 cases (62%) the bacteremia was considered to have been clinically significant. Most of the infections (79%) were nosocomial, and the majority of these were acquired in an intensive care unit. Ten (42%) patients developed septic shock complicating the bacteremia and 13 (54%) died. In most of these cases (85%), Acinetobacter bacteremia was thought to have caused or contributed to death. The following variables were associated with a greater risk of mortality: age > 65 years (OR = 16; p = 0.01); development of septic shock (OR = 22; p = 0.004); and the presence of coagulopathy (OR = 20; p = 0.03).

Acinetobacter↗
PubMed1996

Staphylococcal bacteremia in cancer patients: risk factors and outcome in 134 episodes prior to and after introduction of quinolones into infection prevention in neutropenia.

A total of 134 episodes of staphylococcal bacteremia (SBE) appearing among 9987 admissions, and 979 episodes of bacteremia in cancer patients within 5 years, were analyzed for risk factors, clinical course and outcome; 64 were monomicrobial and 70 polymicrobial. The most frequent risk factors were acute leukemia, catheter insertion, long-lasting neutropenia, and prior prophylaxis with quinolones. There was no significant difference between polymicrobial and monomicrobial SBE in risk factors. The two groups differed only in the source of bacteremia (gastrointestinal and respiratory-tract infections were more common in monomicrobial SBE) and etiology-Staphylococcus aureus appeared more frequently in monomicrobial than in polymicrobial bacteremia (20.3% compared to 4.3%, P < 0.05). More complications (14.3%) such as abscesses, endocarditis, etc. appeared in the group of polymicrobial SBE (P < 0.05). No difference was observed in clinical course and outcome between monomicrobial and polymicrobial SBE. The incidence of SBE has increased since 1991, when quinolones were first used in prophylaxis in afebrile neutropenia at our center; however, the infection-associated mortality in monomicrobial SBE was low (4.3%).

Adult↗
PubMed1991

Leuconostoc species as a cause of bacteremia: two case reports and a literature review.

Two new cases of significant bacteremia caused by Leuconostoc spp. are reported and five others described in the literature are reviewed. Four of the seven patients were under one year old and presented with prolonged diarrhea related to gastrointestinal disorders. The remaining three patients were over 50 years of age and being treated in intensive care units. Six patients had nosocomially acquired catheter-related bacteremia. Leuconostoc spp. are naturally resistant to vancomycin, and five patients had received this antibiotic for prior bacteremia caused by methicillin-resistant staphylococci. The majority of patients presented with fever without severe complications. Penicillin is the treatment of choice and there is no report of any death directly attributable to infection by these microorganisms. Infection with Leuconostoc spp. should be suspected if "vancomycin-resistant streptococci" are isolated from the blood, and recorded as a potential cause of bacteremia in patients with indwelling intravenous catheters.

Age Factors↗
PubMed2000

Factors predicting occult bacteremia in young children.

A febrile child without a definite localizing sign of infection may be in initial phase of bacteremia which unless treated would result in systemic complication. These instances are referred to as "Occult bacteremia". The common pathogens isolated in these children are Streptococcus pneumoniae, Hemophilus influenzae and Neisseria meningitidis. A hundred consecutive children in the age group of 3-36 months attending pediatric outpatient department and casualty were clinically evaluated using AIOS (acute illness observation scale) score and were subjected to complete blood counts, smear for malarial parasites, ESR and blood culture. In the 19-month study period, 4 instances of occult bacteremia were identified. Streptococcus pneumoniae was cultured in 3 cases and H. influenzae in one. A febrile and toxic child in the age group of 3-36 months has a high risk of occult bacteremia. High fever of temperature > or = 102 degrees F, ESR > or = 15 mm/hour, and total leukocyte count > or = 15,000/mm3, in a child with AIOS score of > or = 10 may be considered for more detailed investigations and early intervention with antimicrobial therapy.

Bacteremia↗
PubMed2000

Neonatal gram-negative bacteremia.

A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the predominant isolates were Pseudomonas aeruginosa (38.3%), Klebsiella pneumoniae (30.4%), Escherichia coli (15.6%) and Acinetobacter sp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases. Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures were the most commonly identified sources of septicemia. Prematurity and low birth weight were the main underlying conditions in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with neutropenia, nosocomial infection and inappropriate antibiotic therapy. Resistance was increasingly noted against many antibiotics. The isolates were predominantly resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%). The commonest microorganisms causing gram-negative bacteremia were Pseudomonas aeruginosa followed by Klebsiella pneumoniae. The community-acquired bacteremia was mainly due to E. coli. The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbactam with amikacin or ampicillin + sulbactam with ciprofloxacin is most effective.

Bacteremia↗
PubMedDate not supplied

Bioelectrical impedance analysis predicts outcome in patients with suspected bacteremia.

Fluid shifts from intracellular to extracellular water (ICW to ECW) are a feature of sepsis, caused by increased vascular permeability and cell catabolism. Changes in ECW and total body water (TBW) were assessed in a prospective observational study of patients with bacteremia by a bedside technique, and its prognostic impact determined. In 78 hospital patients with fever, the resistance ratio (Rinf/RO) and estimated ECW/TBW ratio from multifrequency bioelectrical impedance analysis, and f1p4m albumin concentration were measured. Rinf/RO and ECW/TBW ratios decreased from day 0 to 2 in patients with significant bacteremia (n = 31), but not in patients with doubtful or negative blood cultures (n = 22 and 25). Increased Rinf/RO at baseline, and further increase of ECW/TBW from day 0 to 2, were associated with lower rate of recovery after 1 week and with higher mortality. Baseline Rinf/RO above the median (0.75) had positive and negative predictive values of 0.31 and 0.95 for death. This prognostic effect was independent of underlying disease and blood culture result in a multivariate model. Hypoalbuminemia at baseline was predictive of outcome, but changes in albumin from day 0 to 2 were unrelated to blood culture results or outcome. In patients with bacteremia, fluid shifts from intracellular to extracellular water occur early, are rapidly reversible by antibiotic treatment but are associated with adverse prognosis. Bioelectrical impedance deserves further study as a tool for bedside monitoring of patients with bacteremia.

Adult↗
PubMed2006

Aeromonas bacteremia in an elderly immunocompetent patient.

We report the case of an elderly immunocompetent patient with Aeromonas hydrophila bacteremia without evidence of portal of entry. Despite several risk factors for a poor outcome, such as impaired renal function, two positive blood cultures, and community-acquired infections, the patient survived. Antimicrobial susceptibility was normal. Unknown polycystic liver disease was discovered and misdiagnosed as a hepatic abscess at the time of the bacteremia which was confirmed by repeated CT scans. Because of the absence of other risk factors for Aeromonas bacteremia, hepatic polycystic disease may take part in the onset of Aeromonas sp bacteremia as well as immunosenescence.

Aeromonas↗
PubMed2002

Clinical impact of nosocomial Klebsiella bacteremia in critically ill patients.

In order to determine the clinical impact of Klebsiella bacteremia on critically ill patients, a matched cohort study was conducted between January 1992 and December 2000. During the study period, all intensive care unit (ICU) patients with nosocomial Klebsiella bacteremia were defined as cases (n=52), but two of these patients were excluded from the matched cohort due to incomplete medical records. The remaining 50 patients were matched at a ratio of 1:2 with control patients (n=100) on the basis of the APACHE II severity of disease classification system. Patients with Klebsiella bacteremia experienced acute renal failure and hemodynamic instability more often than controls. They also had a longer ICU stay and longer ventilator dependence. In-hospital mortality rates for cases and controls were nearly equal (36% vs. 37%, respectively; P=0.905). In conclusion, after adjusting accurately for severity of underlying disease and acute illness, no difference in mortality was found between ICU patients with Klebsiella bacteremia and their matched control subjects.

Adult↗
PubMed2000

Clinical significance of polymicrobial versus monomicrobial bacteremia involving Pseudomonas aeruginosa.

The objective of this study was to examine the clinical significance of polymicrobial bacteremia involving Pseudomonas aeruginosa. Two hundred forty-eight episodes of Pseudomonas aeruginosa bacteremia, 43 of which were polymicrobic, were studied prospectively over a 6-year period. Three sets of blood cultures were obtained for each patient. Positive results for all three blood cultures were found more frequently in patients with polymicrobial infection, who were older than those with monomicrobial infection. Patients with polymicrobial bacteremia also were worse clinically and developed shock more frequently. Crude mortality was higher in patients with polymicrobial infection. A multivariate analysis revealed three variables significantly and independently associated with polymicrobial Pseudomonas aeruginosa bacteremia: higher age, poor clinical status of the patient, and positive results for all blood cultures obtained.

Adult↗
PubMed2003

Analysis of prognostic factors in 95 patients with Acinetobacter baumannii bacteremia.

BACKGROUND: Because Acinetobacter baumannii bacteremia is a global problem, we were motivated to characterize this disease in Taiwan. PATIENTS AND METHODS: We analyzed findings in 95 patients with documented A. baumannii bacteremia between January 1, 1998 and December 31, 2000 (47 men, 48 women; mean age 58.8 years). RESULTS: The mean length of stay in the hospital was 44.0 days. Clinically, 76 patients had fever and 35 patients developed shock. Fifty patients had respiratory tract infections; 24, urinary tract infections; 11, intra-abdominal infections; three, CNS infections; and two, catheter-related infections. Five patients had primary bacteremia. Empirical antibiotic therapy was initiated at the onset of the clinical signs of infection. Antimicrobial susceptibility test results were variable. 47 patients died and 48 survived; the mortality rate for A. baumannii bacteremia was 45.3% (43/95). CONCLUSION: Physicians should pay attention to this infection because the early identification of high-risk patients could facilitate prophylaxis and potentially reduce associated problems.

Acinetobacter Infections↗
PubMed2006

Enterobacter bacteremia: Clinical features, risk factors for multiresistance and mortality in a Chinese University Hospital.

BACKGROUND: This study was performed to characterize the clinical features and to identify the risk factors for multiresistance and mortality in patients with Enterobacter bacteremia. PATIENTS AND METHODS: A number of 126 patients with Enterobacter bacteremia in 1995-2004 at the Medical university-affiliated Hospital of Anhui, China were retrospectively analyzed. RESULTS: Of the 126 cases of bacteremia, 81 (64.3%) patients were identified as nosocomial infection. The overall multiresistance rate was 45.2% (57/126). Multiresistance was associated with nosocomial infection, recent invasive procedure, previous third-generation cephalosporins therapy, prolonged perioperative prophylaxis, the species of Enterobacter (E. cloacae) and polymicrobial bacteremia in univariate analysis. In multivariate analysis, previous third-generation cephalosporins therapy (OR = 13.6, p = 0.007) and prolonged perioperative prophylaxis (OR = 6.4, p = 0.029) were the strong, independent risk factors for the multiresistance. The crude 30-day mortality rate was 39.7% (50/126). Mortality directly attributed to Enterobacter spp. was 32.5% (41/126), which was significantly associated with multiresistance, nosocomial infection, recent invasive procedure, and inadequately empirical therapy in univariate analysis. Multivariate analysis revealed that only nosocomial infection (OR = 3.292, p = 0.049) was independently associated with mortality. The survival curve showed that the inappropriate initial therapy group had a lower probability of survival than the appropriate therapy group in infection-related mortality (Log Rank, p = 0.0142). CONCLUSION: Enterobacter is becoming increasingly important nosocomial pathogens. Nosocomial infection is a clinical risk factor tightly associated with multiresistance and worse outcome. More judicious use of third-generation cephalosporins may decrease the incidence of nosocomial multiresistant Enterobacter spp. in China.

Adolescent↗
PubMed1992

Anaerobic bacteremia: incidence, patient characteristics, and clinical significance.

PURPOSE: In the 1970s, blood culture for obligate anaerobic bacteria became routine in most United States hospitals. Since then, various authorities have reported isolation of obligate anaerobes in 5% to 25% of blood cultures. Our experience suggests a much lower frequency; therefore, we retrospectively assessed the occurrence and significance of these cultures at our institutions. PATIENTS AND METHODS: Sixty-six patients at the University of Michigan Hospitals (UMH) and nine patients at the Ann Arbor Veteran's Administration Medical Center (AAVAMC) had one or more blood cultures positive for an obligate anaerobe between July 1, 1987, and December 31, 1988. Their medical records were reviewed retrospectively. RESULTS: The proportion of positive blood cultures yielding obligate anaerobes was 3.2% at the UMH and 1.8% at the AAVAMC. The incidences of clinically significant anaerobic bacteremia at the two hospitals were 0.68 and 0.54 cases per 1,000 patient admissions. Among the 40 patients from whom significant isolates were obtained, 15 (38%) had a fatal outcome. Bacteroides and Clostridium species accounted for 90% of the isolates and all of the fatal cases. The source for anaerobic bacteremia was usually obvious; 30 of the 40 patients were given empiric antibiotic therapy for anaerobes. The gastrointestinal tract was the source in two thirds of the cases and was clearly implicated as the source of 80% of the fatal bacteremias. CONCLUSIONS: The frequency of anaerobic bacteremia in our hospitals is much lower than was suggested in several large studies during the 1970s, probably reflecting a real decline in the incidence. The clinical features of our cases are similar to those of previous studies, and the mortality is still high despite the use of antibiotics effective against anaerobes. Since most patients were thought to have anaerobic infections at the time that cultures were obtained, they were usually treated empirically. Subsequent blood cultures positive for anaerobes infrequently influenced clinical management.

Adolescent↗
PubMed1993

A cluster of coagulase-negative staphylococcal bacteremias associated with peripheral vascular catheter colonization in a neonatal intensive care unit.

BACKGROUND: A cluster of six neonatal cases of coagulase-negative staphylococcal bacteremias occurred in a Los Angeles County neonatal intensive care unit in March 1989. METHODS: A retrospective cohort study assessed the impact of host-and delivery-related variables, length of hospitalization, duration of antibiotic treatment, performance or duration of invasive procedures, and staffing variables on risk of coagulase-negative staphylococcal bacteremia. RESULTS: Unstratified analyses yielded eight risk factors with risk ratios greater than 2. After stratification by gestational age (less than 29 weeks) and low birth weight (less than 1500 gm), frequency of blood transfusions, duration of respiratory therapy, heparin lock and central vascular line placement, and hyperalimentation remained associated with elevated risk. Two species were identified, arguing against a common source of infection. Of four cohort months with more than 15 very low birth weight infants in the neonatal intensive care unit, an elevation of coagulase-negative staphylococcus-positive blood cultures and diagnosed bacteremias occurred in only two. CONCLUSIONS: This cluster of coagulase-negative staphylococcal bacteremia was probably caused by frequent manipulation of catheters in neonates who were at heightened risk because of low birth weight and prematurity.

Bacteremia↗
PubMed1994

Epidemic gram-negative bacteremia in a neonatal intensive care unit in Guatemala.

BACKGROUND: Nosocomial bloodstream infection is an important cause of morbidity and mortality among neonates. From September 1 through December 5, 1990 (epidemic period), gram-negative bacteremia developed in 26 neonates after their admission to the neonatal intensive care unit (NICU) of Hospital General, a 1000-bed public teaching hospital in Guatemala with a 16-bed NICU. Twenty-three of the 26 patients (88%) died. METHODS: To determine risk factors for and modes of transmission of gram-negative bacteremia in the NICU, we conducted a cohort study of NICU patients who had at least one blood culture drawn at least 24 hours after admission to the NICU and performed a microbiologic investigation in the NICU. RESULTS: The rate of gram-negative bacteremia was significantly higher among patients born at Hospital General, delivered by cesarian section, and exposed to selected intravenous medications and invasive procedures in the NICU during the 3 days before the referent blood culture was obtained. During the epidemic period, the hospital's chlorinated well-water system malfunctioned; chlorine levels were undetectable and tap water samples contained elevated microbial levels, including total and fecal coliform bacteria. Serratia marcescens was identified in 81% of case-patient blood cultures (13/16) available for testing and from 57% of NICU personnel handwashings (4/7). Most S. marcescens blood isolates were serotype O3:H12 (46%) or O14:H12 (31%) and were resistant to ampicillin (100%) and gentamicin (77%), the antimicrobials used routinely in the NICU. CONCLUSIONS: We hypothesize that gram-negative bacteremia occurred after invasive procedures were performed on neonates whose skin became colonized through bathing or from hands of NICU personnel.

Bacteremia↗
PubMed2006

Procalcitonin test in the diagnosis of bacteremia: a meta-analysis.

STUDY OBJECTIVE: We seek to evaluate the diagnostic performance of the procalcitonin test for the diagnosis of bacteremia in the emergency department (ED) population. METHODS: We conducted a search of MEDLINE, bibliographies of previous systemic reviews, and pertinent national meeting research abstracts. We included studies that assessed the diagnostic accuracy of procalcitonin for bacteremia, with blood culture as the reference standard. We included prospective investigations of adults and children with suspected infection studied in the ED or at admission. Two authors independently extracted data and assessed study quality; consensus was reached by conference. The analysis was based on the I2 statistic for heterogeneity, unweighted summary receiver-operating characteristic curve, and random-effects pooled sensitivity and specificity across studies using the same test threshold. RESULTS: The search yielded 348 publications and 1 unpublished study. Seventeen studies met the inclusion criteria and provided a sample of 2,008 subjects. There was a substantial degree of inconsistency (I2=64%). The unweighted summary receiver-operating characteristic curve provided the best overall estimate of test performance, with an area under the curve of 0.84 (95% confidence interval [CI] 0.75 to 0.90). Sensitivity analysis based on study quality did not significantly change the results. Subgroup analysis including only studies that used a test threshold of 0.5 or 0.4 ng/mL yielded pooled estimates for sensitivity and specificity of 76% (95% CI 0.66 to 0.84) and 70% (95% CI 0.60 to 0.79), respectively. CONCLUSION: We found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate. Future research designed to determine the utility of the procalcitonin test as a diagnostic tool used in isolation for detecting bacteremia in ambulatory patients is needed before widespread clinical use.

Adult↗
PubMedDate not supplied

Pacemaker-induced Staphylococcus aureus mitral valve acute bacterial endocarditis complicated by persistent bacteremia from a coronary stent: Cure with prolonged/high-dose daptomycin without toxicity.

Continuous high-grade Staphylococcus aureus bacteremia suggests acute bacterial endocarditis (ABE), a protected focus, ie, an abscess, or a device-related infection. Daptomycin was curative of S. aureus ABE and coronary stent-related bacteremia. Prolonged high-dose daptomycin therapy (12 mg/kg per day for 41 days) is not associated with any toxicity. Persistent S. aureus bacteremia in ABE should suggest myocardial or perivalvular abscess. If intracardiac abscess can be ruled out and there is no extracardiac source of the S. aureus bacteremia, then a device-related infection should be considered.

Aged↗