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PubMed2004

Bacteremia after plate removal and tooth extraction.

Our aim was to investigate the occurrence of bacteremia associated with removal of a semirigid osteosynthesis plate and an adjacent third molar. Ten patients with fixed mandibular angle fracture were bacteriologically sampled from the second molar's distal gingival pocket, from the third molar's extraction socket and from the osteosynthesis plate. Blood samples from the ante-cubital vein were taken 10 times until 30 min postoperatively. Established culture, isolation and identification methods for the bacterial species were used. Bacteremia was detected in 60% of the subjects, most frequently 1.5 min after removal of the plate (20%) and 1.5 and 5 min after extraction of the tooth (20%), but also 10 min (10%) and 30 min (10%) postoperatively. 13 different bacterial species or groups were isolated, mean 2.5 +/- 1.9 per bacteremia-positive subject. The majority (85%) were anaerobes with Actinomyces, Campylobacter and Lactobacillus species predominating. In all the blood culture-positive cases the corresponding species was also recovered from one or more of the oral samples. These results show that oral surgical procedures are associated with a high frequency of longstanding anaerobic bacteremia, which could be harmful in patients at risk.

Adult↗
PubMed2005

[Enterococcal bacteremia at Nîmes university hospital].

PURPOSE OF THE STUDY: The aim of this study was the description of enterococcal bacteremia and the evaluation of their resistance evolution to antibiotics and the virulence profile of these isolates. PATIENTS AND METHODS: We have studied all the bacteremia caused by Enterococcus spp. from the 1st of July 2003 until the 30th of June 2004 at Nîmes university hospital. For each isolate, population, clinical and microbiological data were collected. Multiplex PCR allowed for the identification of glycoprotein resistant phenotypes and furthermore, to identify the main virulence genes found in the enterococci. RESULTS: Thirty-three strains were identified from 33 patients (60.6% male) with a median age of 68 years (median: 3-96). The vital prognostic was calculated in 63.6% of the cases (MacCabe > or =1); seven patients died during their hospitalization (21.2%). The infections were nosocomial in 60.6% of the cases. No epidemic was observed. The principal comorbidities were cardiovascular and digestive pathologies. In addition, 54.5% of patients had had a surgical intervention. Enterococcus faecalis (87.9%) was the cause of infection in the majority of cases followed by Enterococcus faecium. Most of the infections were monomicrobial (75.8%). E. faecalis was sensitive to amoxicillin and to glycopeptides but was resistant to norfloxacin, erythromycin and pristinamycin. The same observations were made for the E. faecium with the exception of amoxicillin. E. faecalis had the maximum number of virulence genes and E. faecium the least. CONCLUSION: The enterococcal bacteremia had mainly a nosocomial origin. The isolates came from digestive tract flora but also from catheters. The mortality rate was 21.2%. A developing sensitivity to erythromycin and pristinamycin was observed in comparison to the data of the ONERBA (2002-2003). Only one isolate was resistant to glycopeptide. This was the first European E. faecium containing the vanD allele. This isolate proved fatal to the patient. The dark evolution of enterococcal bacteremia and their frequent nosocomial origin induce to promote studies intended for better knowing the risk factors of such infections.

Adolescent↗
PubMed2005

[Methicillin resistant Staphylococcus aureus bacteremia seven years of survey in a French hospital].

In our French general hospital with 1000 hospitalization beds, a specific isolation for multiresistant bacteria colonized or infected patients was set up since 1998. To assess the impact of these recommendations, the rate of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia was calculated for each year since 1998. From 1998 to 2004, 493 cases of Staphylococcus aureus (SA) bacteremia occurred in our hospital: 319 strains were susceptible to methicillin and 174 were MRSA. During the 7 years period of our study, we observed a significant tendency for reduction in the number of bacteremia with MRSA strains (p=0.016). The significant decrease of the MRSA bacteremia between 1998 and 2004 was obtained through the cooperation between staff members, bacteriologists and hospital nosocomial infection committee members.

Bacteremia↗
PubMed2004

Frequency of bacteremia after linear EUS of the upper GI tract with and without FNA.

BACKGROUND: Few data are available concerning the frequency of bacteremia after diagnostic EUS or EUS-guided FNA. This study was undertaken to provide these data and to determine whether present guidelines for prophylactic administration of antibiotics to prevent endocarditis during upper endoscopy are applicable to EUS and EUS-guided FNA. METHODS: A total of 100 patients who were to undergo diagnostic EUS of the upper-GI tract and 50 who were to have upper-GI EUS-guided FNA were enrolled in this prospective study. Blood cultures were obtained before and within 5 minutes after the conclusion of the procedure. In case of bacterial growth, patients were observed for at least 3 days for signs of infection. RESULTS: After diagnostic EUS, significant bacteremia was found in two patients with esophageal carcinoma (2%: 95% CI[0%, 4.8%]) and after EUS-guided FNA in two patients (4%: 95% CI[0%, 9.6%]). The difference was not statistically significant. None of these patients developed clinical signs of infection. Risk factors predisposing to bacteremia could not be identified. CONCLUSION: The frequency of bacteremia after EUS, with and without FNA, is within the range of that for diagnostic upper endoscopy. Therefore, the same recommendations for prophylactic administration of antibiotics to prevent endocarditis may be applied in patients undergoing EUS and EUS-guided FNA. The role of esophageal cancer as a predisposing factor to EUS-associated infection remains uncertain.

Adult↗
PubMed1998

Bacteremia with esophageal dilation.

BACKGROUND: Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered. METHODS: Blood cultures and oral temperatures were obtained before esophageal dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dilation, number of passes, and presence of malignancy. RESULTS: Of 100 procedures in 86 patients undergoing esophageal dilation, 22 (22%) were associated with a positive post-dilation blood culture. Bacteremia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a single dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.007). Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%). CONCLUSION: The rate of bacteremia after esophageal dilation is 22% and is associated with dilation of malignant strictures or passage of multiple dilators. Organisms cultured from the blood are not transmitted from the dilator.

Bacteremia↗
PubMedDate not supplied

Serratia marcescens bacteremia after carotid endarterectomy and coronary artery bypass grafting.

Serratia Marcescens is a common, water-borne hospital colonizer. Respiratory secretions, wounds, and urine are frequently recognized areas of Serratia colonization. Serratia bacteremias usually occur nosocomially and are associated with high mortality and morbidity rates. Serratia bacteremias may be primary or secondary from an identifiable source. Hospital-acquired S marcescens bacteremias have no known source in half of the cases. We present a case of nosocomial primary S marcescens bacteremia in a surgical patient successfully treated with levofloxacin.

Aged↗
PubMed2001

Bacteremia during tonsillectomy.

OBJECTIVE: To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS: Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS: Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION: Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.

Adolescent↗
PubMed2000

Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome.

A prospective study of all patients with clinically significant nosocomial bacteremia at one institution from 1994 to 1997 was performed to: (1) describe the epidemiology and microbiology of nosocomial bacteremias; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. Four hundred four episodes of bacteremia occurred in 322 patients; the crude in-hospital mortality was 31%. Coagulase-negative staphylococci, Staphylococcus aureus, and enterococci were the leading pathogens, and intravascular catheters were the most frequently identified source. The highest mortality occurred in patients with candidemia (67%). Independent predictors of mortality included evidence of shock at the time of infection, acquisition of bacteremia in an intensive care unit, a "Do Not Attempt Resuscitation" order, and the presence of certain comorbid conditions (e.g., malignancy, HIV infection). Because many of these infections may be preventable, education of health care providers and strict adherence to established infection control practices are critical.

Adult↗
PubMedDate not supplied

Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome.

The objectives of this study were to (1) describe the epidemiology and microbiology of community-acquired bacteremia; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. All patients with clinically significant community-acquired bacteremia admitted to a university-affiliated Veterans Affairs medical center from January 1994 through December 1997 were evaluated. During the study period, 387 bacteremic episodes occurred in 334 patients. Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococci were the most commonly isolated organisms; the most frequent sources were the urinary tract and intravascular catheters. Approximately 14% of patients died. Patient characteristics independently associated with increased mortality included shock (OR 3.7, p = 0.02) and renal failure (OR 4.0, p = 0.003). The risk of death was also higher in those whose source was pneumonia (OR 6.3, p = 0.03) or an intra-abdominal site (OR 10.7, p = 0.02), or if multiple sources were identified (OR 13.4, p = 0.003). Community-acquired bacteremia is often device-related and may be preventable. Strategies that have been successful in preventing nosocomial device-related bacteremia should be adapted to the outpatient setting.

Adult↗
PubMed2001

Dental health and viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients.

Viridans streptococci were the most common cause of bacteremia in 61 consecutive myeloablative allogeneic hematopoietic stem cell transplant (HSCT) recipients, occurring in 19 of 31 bacteremic patients (61%) during the period of post-transplant neutropenia. Seven of the 19 had more than one viridans streptococcus in the same blood culture. Twenty isolates from 15 patients were Streptococcus mitis. Most viridans streptococci were resistant to norfloxacin, used routinely for prophylaxis. Comparison of the 19 patients with viridans streptococcal bacteremia with a contemporaneous group of 23 allogeneic HSCT recipients with fever and neutropenia but no identified focus of infection found that patients with viridans streptococcal bacteremia were more likely to have severe intraoral pathology while neutropenic (26% vs 0%) and slightly shorter interval between the last dental procedure and the onset of neutropenia (11 vs 14 days). Poor underlying dental health and the use of norfloxacin thus appear to predispose to viridans streptococcal bacteremia.

Adult↗
PubMed2005

Early vancomycin-resistant enterococcus (VRE) bacteremia after allogeneic bone marrow transplantation is associated with a rapidly deteriorating clinical course.

Vancomycin-resistant enterococcal (VRE) infection is a growing threat. We studied the incidence, risk factors, and clinical course of early-onset VRE bacteremia in allogeneic hematopoietic stem cell transplant recipients. We carried out a chart review of 281 allogeneic hematopoietic stem cell transplant recipients from 1997-2003, including preparative regimen, diagnosis, status of disease, graft-versus-host disease prophylaxis, antimicrobial therapy, and survival. VRE bacteremia developed in 12/281 (4.3%) recipients; 10 (3.6%) were within 21 days of transplant. Diagnoses were acute leukemia (7), NHL (2), and MDS (1). In all, 70% had refractory/relapsed disease; 30% were in remission. In total, 50% had circulating blasts. Nine of 10 had matched unrelated donors (7/9 with CD8+ T-cell depletion). The average time to positive VRE cultures was 15 days; average WBC was 0.05, and 80% had concomitant infections. Despite treatment, all patients died within 73 days of VRE bacteremia. Intra-abdominal complications were common. Causes of death included bacterial or fungal infection, multiorgan failure, VOD, ARDS, and relapse. A total of 60% of patients engrafted neutrophils, but none engrafted platelets. Early VRE bacteremia after allogeneic bone marrow transplant is associated with a rapidly deteriorating clinical course, although not always directly due to VRE. Early VRE may be a marker for the critical condition of these high-risk patients at the time of transplant.

Bacteremia↗
PubMed1999

Early detection of bacteremia in the neonatal intensive care unit using the new BACTEC system.

OBJECTIVE: With the newer techniques of culture analysis such as the BACTEC 9240 fluorometric detection system, detecting bacteremia in the neonate may be possible in a significantly shorter time. We hypothesized that neonatal bacteremia can be detected in less than 48 hours by this method. STUDY DESIGN: Our study included a retrospective review of 613 blood cultures obtained during the period August 1, 1995 to March 18, 1996 taken from 325 infants who had cultures drawn with a sepsis work-up and/or repeat cultures who had initial positive cultures in our Neonatal Intensive Care Unit. Results of blood cultures were studied in conjunction with the variables of body weight, gestational age, organism grown, complete blood count (CBC), and timing of positive cultures. Statistical analyses were performed using Fisher's and two-tailed Student's t tests. RESULTS: The results showed that of 325 infant blood cultures 49 (15%) were positive. Of these, 64% were coagulase-negative staphylococci, 14% viridans streptococci, 8% Escherichia coli, 4% Enterococcus sp., 4% Pseudomonas sp., 2% Enterobacter sp., 2% Klebsiella sp., and 2% Candida albicans. Of the positive blood cultures taken from infants not on antibiotics at the time of culture, 54% were detected positive at 18 hours, 71% at 24 hours, and 100% by 30 hours. Detection time by organism type was as follows: coagulase-negative staphylococci, 21.7 hours; viridans streptococci, 15.6 hours; E. coli, 7.5 hours; Enterococcus sp., 12 hours; Enterobacter sp., 5 hours; Klebsiella sp., 10 hours; and Pseudomonas sp., 12 hours. CONCLUSION: Our results indicate that the BACTEC 9240 fluorometric detection system helps in early identification of neonatal bacteremia (in 24 to 30 hours), with Gram-negative organisms being detected earlier than Gram-positive organisms (p < 0.05) and having significantly higher immature neutrophils in a CBC (I:T ratio of > or = 0.2 (p < 0.001). Early detection of neonatal bacteremia using this method will allow earlier diagnosis and appropriate treatment of the potentially bacteremic and bacteremic infant.

Bacteremia↗
PubMed1998

Improving clinical outcome in bacteremia.

Bacteremia is associated with significant morbidity and mortality. There is wide variation in morbidity and mortality rates according to organism and predisposing conditions. Additionally, prompt administration of appropriate antimicrobial agents is associated with a decrease in mortality. Unfortunately, many bacteremic patients receive inappropriate or no antibiotics. Infectious disease consultation can decrease the number of patients receiving inappropriate initial therapy. 'Quality standard for the treatment of bacteremia' (Gross et al., 1994, Infection Control and Hospital Epidemiology 15, 189-192) is a consensus paper; its purpose is to 'improve the treatment of hospitalized patients with documented bacteremia by ensuring that they receive an antibiotic appropriate in light of the blood-culture susceptibility of the pathogen isolated.' A programme to assess the treatment of bacteremia can improve the quality of care with a modest commitment of additional resources. Many of the activities could be performed by a pharmacist, infection control practitioner, or pathologist. However, physician-to-physician communications are most likely to be successful. This programme should be considered a component of a hospital's quality-improvement programme; either the hospital quality assurance or infection control committee could be responsible for the programme. We encourage adoption of the standard, and recommend prospective monitoring to include the choice of empiric antimicrobial agents.

Anti-Bacterial Agents↗
PubMed2003

Bacteremia due to Stomatococcus mucilaginosus in neutropenic patients in the setting of a cancer institute.

This study reviews the clinical manifestations, causes and frequency of Stomatococcus mucilaginosus bacteremia in neutropenic cancer patients. We analyzed retrospectively all clinical and microbiological records of patients with S. mucilaginosus bacteremia. The incidence was compared with that of other pathogens causing bacteremia during neutropenia for the same period. S. mucilaginosus represented 5.9% of bacteremias in our neutropenic patients. Seven patients with hematologic malignancies and one with breast cancer are described. The common clinical presentation was one of sepsis. All patients presented with damaged mucosal barriers as the probable portal of entry, from either stomatitis or enterocolitis. All patients survived.

Adult↗
PubMed2000

Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies.

BACKGROUND: Tunneled dialysis catheters are often used for temporary vascular access in hemodialysis patients, but are complicated by frequent systemic infections. The treatment of bacteremia associated with infected tunneled catheters requires both antibiotic therapy and catheter replacement. We compared the outcomes of two treatment strategies for catheter-associated bacteremia: exchange of the existing catheter with a new one over a guidewire versus catheter removal with delayed replacement. METHODS: We retrospectively analyzed the outcomes of all cases of tunneled dialysis catheter-associated bacteremia during a two-year period. The infection-free survival time of the subsequent catheter was evaluated in two groups of patients: group A (31 catheters), exchange of the existing infected catheter with a new catheter over a guidewire, and group B (38 catheters), removal of the infected catheter followed by delayed catheter replacement 3 to 10 days later. Patients in both groups received three weeks of systemic antibiotic therapy. Cox proportional hazard models were used to evaluate the factors predictive of infection-free survival time of the replacement catheter. RESULTS: On univariate proportional hazard regression analysis, the infection-free survival time of the replacement catheter was similar for groups A and B (P = 0.72), whereas the hazard of infection was significantly greater for patients with hypoalbuminemia (serum albumin < 3.5 g/dL), as compared with patients with a normal serum albumin (hazard ratio 2.81, 95% CI, 1. 21, 6.53, P = 0.016). The infection-free survival time was not affected by patient age, sex, diabetic status, or type of organism (gram-positive coccus vs. gram-negative rod). CONCLUSIONS: The infection-free survival time associated with the subsequent catheter is similar for the two treatment strategies. However, exchanging the catheter for a new one over a guidewire minimizes the number of separate procedures required by the patient. Hypoalbuminemia is the major risk factor for recurrent bacteremia in the replacement catheter.

Adult↗
PubMed2002

Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution.

BACKGROUND: Tunneled dialysis catheters are complicated by frequent systemic infections. Standard therapy of catheter-associated bacteremia involves both systemic antibiotics and catheter replacement. Recent data suggest that biofilms in the catheter lumen are responsible for the bacteremia, and that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions can eradicate the biofilm. METHODS: We analyzed prospectively the efficacy of an antibiotic lock protocol, in conjunction with systemic antibiotics, for treatment of patients with dialysis catheter-associated bacteremia without catheter removal. Protocol success was defined as resolution of fever and negative surveillance cultures one week following completion of the protocol. Protocol failure was defined as persistence of fever or surveillance cultures positive for any pathogen. In addition, infection-free catheter survival was compared to that observed in institutional historical control patients treated with catheter replacement. RESULTS: Blood cultures were positive in 98 of 129 of episodes (76%) in which patients dialyzing with a catheter had fever or chills. Protocol success occurred in 40 of 79 infected patients (51%) treated with the antibiotic lock. Protocol failure occurred in 39 cases (49%): 7 had persistent fever, 15 had positive surveillance cultures (9 for Candida and 6 for bacteria), and 17 required catheter removal due to malfunction. Each of the pathogens in the surveillance cultures was different from the original pathogen in that patient. Eight of the 9 secondary Candida infections and all 6 secondary bacterial infections resolved after catheter exchange and specific antimicrobial treatment. Overall catheter survival with the antibiotic lock protocol was similar to that observed among patients managed with catheter replacement (median survival, 64 vs. 54 days, P = 0.24). CONCLUSIONS: Use of an antibiotic lock, in conjunction with systemic antibiotic therapy, can eradicate catheter-associated bacteremia while salvaging the catheter in about one half of cases. Moreover, this management approach offers clinical advantages over routine catheter exchange.

Aged↗
PubMed1998

[Bacteremia in intra-arterial angiography, percutaneous transluminal angioplasty and percutaneous transhepatic cholangio-drainage].

PURPOSE: Prospective evaluation of the rate of bacteremia attributed to invasive radiological techniques. METHODS: Aerobic and anerobic blood cultures were obtained in 100 patients (62 men, 38 women; mean age 65 +/- 14 years) undergoing intra-arterial angiography (N = 50), PTA (N = 30) or percutaneous transhepatic biliary drainage (PTCD; N = 20). Samples were taken before the treatment (T0), immediately after puncture of the vessel or bile duct (T2), and 30 min after the termination of the procedure (T3). RESULTS: The overall rate of bacteremia was 18%. During diagnostic angiography a 16% rate of temporary bacteremia (no positive T3 samples) was observed. During PTA the rate was 27% (no clinically significant infectious disease) and during PTCD the rate was 10% (5% cholangitis with septicemia). We isolated staphylococci (S. epidermidis: N = 7, S. species: N = 3, S. aureus: N = 1), streptococci (N = 2), Propionibacterium acnes (N = 5), E. coli (N = 1), Enterococcus faecium (N = 1), Enterobacter species (N = 1), and Clostridium perfringens (N = 1). Apart from the one patient with cholangitis no clinical infectious complication occurred. CONCLUSION: Temporary bacteremia is rather frequent during invasive radiological procedures. Strictly aseptic conditions and antibiotic prophylaxis, specially in case of implantation of a permanent foreign body, is warranted.

Aged↗
PubMed2001

Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding.

BACKGROUND: Cyanoacrylate may form a barrier that prevents bacterial invasion when used in tissue. Because cyanoacrylate polymerizes within seconds on contact with aqueous media, it is used worldwide to arrest gastric variceal bleeding. The aim of this study was to determine the frequency of bacteremia after endoscopic cyanoacrylate injection for gastric variceal bleeding. METHODS: Patients with cirrhosis who underwent endoscopic cyanoacrylate injection for gastric variceal bleeding were included. Patients with cirrhosis who underwent upper endoscopy for nonvariceal upper GI bleeding were recruited as controls. Patients with infection before endoscopy were excluded. Blood was cultured in both groups. Injection needles and endoscope accessory channels were cultured in the cyanoacrylate injection group. RESULTS: More patients injected with cyanoacrylate had positive blood cultures in comparison with the control group (15/47 vs. 1/47, p < 0.0001). In the cyanoacrylate injection group, the volume of blood transfused and Child-Pugh score were factors associated with the occurrence of bacteremia. Most episodes of bacteremia were transient, except for 1 patient who died of sepsis. Most of the microorganisms cultured from blood samples were identical to those cultured from injection needles (65%) and accessory channels (90%). CONCLUSIONS: Endoscopic cyanoacrylate injection for gastric varices does not limit the spread of bacteria. The endoscope accessory channel was the major source of bacteria. Most episodes of bacteremia were transient and uneventful.

Bacteremia↗