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PubMed2001

Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and neutropenia.

BACKGROUND: Traditionally, children with malignant disease who present with fever and neutropenia are hospitalized for parenteral antibiotics. More recently, outpatient strategies have been proposed for lower risk cohorts of such patients. The authors sought to identify clinical and laboratory parameters that are associated with a low risk of bacteremia in children with malignant disease who presented with febrile neutropenia. METHODS: A multicenter, retrospective cohort of children with malignant disease and fever with neutropenia was established in three pediatric oncology centers over a 5-year period. A total of 1171 episodes of febrile neutropenia (absolute neutrophil count [ANC] < 500 cells per mm(3)) were identified in children with malignant disease age > 1 year. The endpoints examined were 1) bacteremia and 2) intensive care unit admission or death related to bacteremia. The odds ratio was used to determine which of the following admission parameters and cut-off values were associated with the lowest risk for bacteremia: ANC, absolute phagocyte count (APC), absolute monocyte count (AMC), platelet count, and admission temperature. RESULTS: A total of 189 episodes of bacteremia were identified among the 1171 episodes of febrile neutropenia (14% bacteremia). Only 11 of 1171 episodes (0.9%) resulted in intensive care unit admission, and 3 of these patients died. All 11 patients had an AMC < 30 cells per mm(3). The lowest frequency of bacteremia (6.1%) occurred in the children with an admission AMC of > or = 155 cells per mm(3). None of the patients identified as low risk by AMC required an intensive care unit admission or died. No level of ANC, APC, temperature, or platelet count was associated with a statistically significant decrease in the risk for bacteremia in the patient population. CONCLUSIONS: Adverse outcomes due to bacteremia are infrequent in pediatric oncology patients who present with fever and neutropenia are treated with parental antibiotics. Patients with fever and neutropenia and an AMC value of > or = 155 cells per mm(3) have the lowest risk for bacteremia and may be potential candidates for outpatient management.

Adolescent↗
PubMed2000

Predicting bacteremia and bacteremic mortality in liver transplant recipients.

Predictors of bacteremia and mortality in bacteremic liver transplant recipients were prospectively assessed. One hundred eleven consecutive episodes of fever or infections were documented in 59 patients over a 4-year period. Forty-nine percent (29 of 59 patients) of the patients had bacteremia, 39% (23 of 59 patients) had nonbacteremic infections, and 12% (7 of 59 patients) had fever of noninfectious cause. Primary (catheter-related) bacteremia (31%; 9 of 29 patients), pneumonia (24%; 7 of 29 patients), abdominal and/or biliary infections (14%; 4 of 29 patients), and wound infections (10%; 3 of 29 patients) were the predominant sources of bacteremia. Diabetes mellitus (odds ratio, 6.9; P =.03) and serum albumin level less than 3.0 mg/dL (odds ratio, 0.14; P =.02) were independently significant predictors of bacteremia compared with nonbacteremic infections. Mortality at 14 days was 28% (8 of 29 patients) in those with bacteremia compared with 4% (1 of 23 patients) in those with nonbacteremic infections and 0% (0 of 7) in patients with fever of noninfectious cause (P =.03). Intensive care unit stay at the time of bacteremia (100% v 47%; P =.005), absence of chills (0% v 53%; P =.005), lower temperature at the onset of bacteremia (99.2 degrees F v 101.5 degrees F; P =.009), lower maximum temperature during the course of bacteremia (99.3 degrees F v 102 degrees F, P =.008), greater serum bilirubin level (7.6 v 1.5 mg/dL; P =.024), presence of abnormal blood pressure (80% v 16%; P =. 0013), and greater prothrombin time (15.6 v 13.3 seconds; P =.013) were significantly predictive of greater mortality in the bacteremic patients. These data have implications for discerning the likelihood of bacteremia and initiation of empiric antibiotics pending cultures. Lack of febrile response in bacteremic liver transplant recipients portended a poorer outcome.

Antibiotic Prophylaxis↗
PubMed2001

Frequency of transient streptococcal bacteremia following urgent orotracheal intubation in critically ill patients.

OBJECTIVES: To examine whether urgent orotracheal intubation (OI) can induce bacteremia. To find predictive factors for post-intubation bacteremia. DESIGN: Prospective observational study. SETTING: Seventeen-bed medical intensive care unit in a university hospital. PATIENTS: Sixty-eight adult intensive care patients undergoing urgent OI. MEASUREMENTS AND RESULTS: Patients in need of OI could be included if no cardiopulmonary resuscitation was performed. A blood culture was taken immediately before, as soon as possible after, and 60 min after intubation. The indication for intubation, ease of intubation, and the antibiotics used before intubation were registered. Six patients (6/68 or 9%) had streptococcal bacteremia immediately (mean 10.8 min) after intubation. No patient (0/62) had streptococcal bacteremia 60 min after intubation (P = 0.01). Four of the six patients showing streptococcal bacteremia after intubation were intubated by a second doctor because of difficulties during intubation, whereas this was the case in only 9/62 in those without streptococcal bacteremia (P = 0.01). Four of the 13 patients (31%) who needed to be intubated by a second doctor showed transient streptococcal bacteremia. Of the 20 patients not receiving antibiotics at the time of intubation, four (20%) had streptococcal bacteremia compared with 2/47 (4.2%) patients receiving antibiotics (P = 0.06). CONCLUSIONS: Urgent intubation can cause transient bacteremia with streptococci in a significant proportion of intensive care patients. The observed frequency of bacteremia is higher than previously reported after elective intubation. The difficulty of intubation is probably a predisposing factor.

Bacteremia↗
PubMed2002

Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients.

BACKGROUND AND AIMS: Septic complications after hepatectomy remain a difficult problem. Intra-abdominal sources of postoperative infections are well described in the literature. However, no studies have examined the cause and outcome of bacteremia after hepatectomy. This study evaluated the incidence and outcome of bloodstream infections, bacteremia, after hepatectomy and determined the risk factors associated with the development of this serious complication. PATIENTS AND METHODS: Records were retrospectively reviewed of 407 patients who underwent an elective first hepatectomy at Nagoya University Hospital between January 1990 and December 1999. The incidence, cause, outcome, and possible risk factors for bacteremia were examined. RESULTS: A total of 403 blood cultures were performed after hepatectomy in 188 patients (46%), and bacteremia was confirmed in 46 (11%). The incidence was significantly different between patients with obstructive jaundice and those without (24% vs. 4%). Multivariate analysis identified four significant independent variables: operative time, age, obstructive jaundice, and large-scale hepatectomy. The most common bacteria isolated were Staphylococci, followed by Enterococci, Klebsiella pneumoniae, and Enterobacter. A probable source of bacteremia was identified in 21 (46%) of the 46 patients. Patients with bacteremia had higher morbidity and mortality rates than patients without bacteremia, and the incidence of organ failure was five to ten times that of patients without bacteremia; the mortality rate was 43% (20/46). CONCLUSIONS: Postoperative bacteremia is a common complication of hepatectomy to resect biliary tract carcinoma, especially in older patients with obstructive jaundice undergoing major hepatectomy. In addition, for more than half of patients with bacteremia, no clear source of the infection is identified. Thus blood cultures are mandatory in high-risk patients who spike a fever after hepatectomy to identify the correct pathogen and its antibiotic susceptibility.

Aged↗
PubMed2006

Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies.

BACKGROUND: Vancomycin-resistant enterococci (VRE) is an important pathogen in the hospital environment, and a progressive increase in its incidence is a cause of nosocomial infections. Bacteremia is one of the major infections caused by this pathogen. Risk factors for VRE bacteremia were assessed at a university-affiliated hospital. METHODS: Two case-control studies with different control groups were used. In study 1, patients with VRE bacteremia were compared with control patients matched by sex, admission unit, age (+/-10 years), and time of admission (+/-1 year). In study 2, the case group (VRE patients) was compared with vancomycin-susceptible enterococci (VSE) patients. RESULTS: A total of 34 patients with VRE bacteremia and 102 control patients were included in study 1, and 34 patients with VRE bacteremia and 55 patients with VSE bacteremia were included in study 2. In study 1, vancomycin use (OR, 10.19; CI 95%, 3.63-28.57) was associated with VRE bacteremia. In study 2, vancomycin use (OR, 17.58; CI 95%, 5.24-58.96) was also associated with VRE bacteremia. CONCLUSION: Because vancomycin use was the only variable associated with VRE bacteremia in the two studies, we confirmed that vancomycin exposure is the major risk factor for VRE bacteremia.

Bacteremia↗
PubMed2000

Bedside measurement of D-dimer in the identification of bacteremia in the emergency department.

The objective of this pilot study was to determine the clinical utility of the SimpliRed D-dimer bedside assay to identify patients with bacteremia in a university hospital Emergency Department. We tested 265 patients and compared blood culture results with a novel D-dimer semiquantitative whole blood assay. Bacteremia was confirmed in 25/262 patients. Sensitivity of D-dimer assay was 66.7% for Gram-positive bacteremia and 61.5% for Gram-negative bacteremia with negative predictive value of 98% for Gram-positive and 96% for Gram-negative bacteremia patients. Measurement of D-dimer appears to be of value in identifying patients at low risk for bacteremia and can be accomplished rapidly using a whole blood semiquantitative bedside assay. Although increases in D-dimer are not detected in all patients subsequently documented to have bacteremia on a single sampling, the results of this and other earlier studies suggest assay of D-dimer is useful in rapid differentiation of patients with bacteremia from those who have no bacteremia using blood culture positivity as the standard for bacteremia.

Adult↗
PubMed2002

Bacteremias caused by Escherichia coli in cancer patients - analysis of 65 episodes.

OBJECTIVES: The aims of this study were to evaluate risk factors, clinical presentation, outcome and antimicrobial susceptibility in patients with Escherichia coli bacteremia occurring over seven years in a single cancer hospital. METHODS: Sixty five episodes of bacteremia from E. coli appearing over seven years from 12,301 admissions in a single cancer institution were retrospectively analyzed. RESULTS: The proportion of bacteremia caused by E. coli among Gram-negative bacteremia was 20.8% (the second most common organism after Pseudomonas aeruginosa), and infection-associated mortality was 17%. The incidence in 1989-1995 varied from 14.3 to 24.7%. The most common risk factors were: solid tumors as the underlying disease (70.7%); central venous catheter insertion (32.3%); prior surgery (46.2%), and prior chemotherapy within 48 h (44.4%). Neutropenia and urinary catheters did not place patients at high risk in any of the subgroups. When we compared the two subgroups of 61 cases of bacteremia - monomicrobial and polymicrobial (when E. coli was isolated from blood culture with another microorganism) - we found that acute leukemia and breakthrough (recurrence while receiving antibiotics) bacteremia were more frequently associated with polymicrobial E. coli bacteremia. There was also a difference in infection-associated mortality: monomicrobial bacteremia due to E. coli only had a significantly lower mortality in comparison with polymicrobial E. coli bacteremia (8.9 vs 35.0%, respectively; P<0.03). CONCLUSION: The susceptibility of 115 E. coli strains isolated from 65 episodes of bacteremia was stable. Only two episodes caused by quinolone-resistant strains occurred, both in 1995, after six years of using ofloxacin for prophylaxis in neutropenic patients in our hospital. We found that 85.2-91.3% of all strains were susceptible to aminoglycosides, 97.8% to quinolones, and 90-100% to third generation cephalosporins and imipenems. The patients most commonly infected had solid tumors and the mortality was only 17%.

Anti-Bacterial Agents↗
PubMed2000

Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis.

We examined the risk of bacteremia in patients with liver cirrhosis (compared with the risk for all Danish citizens >20 years of age who were living in North Jutland County, Denmark), as well as the type of bacteremia and the 30-day case-fatality rate. We used the Danish National Registry of Patients to identify 1339 patients with liver cirrhosis, and we used the North Jutland County Bacteremia Database to identify episodes of bacteremia. We observed 117 cases of bacteremia in patients with liver cirrhosis (11.0 cases were expected), which yielded a standardized incidence ratio of 10.5 (95% confidence interval [CI], 8.8-12.7). Sixty-two cases of bacteremia were nosocomial infections. There were 53 cases of gram-positive bacteremia, 55 cases of gram-negative bacteremia, and 8 cases of polymicrobial bacteremia (1 case of candidemia was excluded from the analysis). The most common cause of death was bleeding from gastroesophageal varices; the second most common cause of death was infection in the respiratory system. The 30-day case-fatality rate was 0.53 (95% CI, 0.39-0.73). Patients with liver cirrhosis had an increased risk of bacteremia and a poor prognosis.

Adult↗
PubMed2006

Staphylococcus aureus bacteremia in older adults: predictors of 7-day mortality and infection with a methicillin-resistant strain.

OBJECTIVES: To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA). DESIGN: Retrospective cohort study from January 2003 until December 2004. SETTING: Two tertiary care, university-affiliated hospitals. METHODS: One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia. RESULTS: Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P=.03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P=.04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P=.001). Multivariate analysis identified previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P=.02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P=.003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P=.02) to be independently associated with the presence of MRSA. CONCLUSIONS: The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.

Aged↗
PubMed1998

Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality?

BACKGROUND: The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS. PURPOSE: To review the literature concerning the epidemiology of CNS bacteremia in the United States and Europe with reference to the multiple definitions of infection versus contamination, considering the effect of potential biases influencing the validity of the reported results. METHODS: Literature search of the MEDLINE database from January 1980 to February 1998. Studies with fewer than 500 episodes of bloodstream infections or fewer than 100 episodes of CNS bacteremia were not included in the pooled analysis. RESULTS: (1) CNS remain the most frequent contaminants (58%-83% of positive blood cultures); (2) the proportion of all bloodstream infections caused by CNS is increasing (R=.51); (3) the overall incidence of true CNS bacteremia is increasing (R=.54, P=.0014); (4) comparing the United States to Europe, there is an increasing trend in the incidence of nosocomial bacteremia due to CNS in the United States (R=.82, P=.0006), but no trend is seen in European studies; (5) the mortality associated with true CNS bacteremia varies between 4.9% and 28%. DISCUSSION: This review confirms the increasing importance of CNS bacteremias, measured both as a proportion and as an incidence of bloodstream infections. The contributions of several possible explanations for the incidence increase and the difference between the United States and Europe need further evaluation: (1) increased recognition and awareness of CNS infections among clinicians; (2) a gradual change in the definition of true bacteremia from an obligatory two positive blood cultures to one positive blood culture associated with a clinical picture compatible with infection; (3) a change in blood culture practices and techniques; (4) an increase in the numbers of blood cultures performed, which is reported both in the United States and in Europe; (5) a shift toward more elderly patients with increasingly severe underlying illnesses; and (6) increasing use of intravascular devices. CONCLUSIONS: The apparent trend of increasing CNS bacteremia seems to be valid. Whether there is a real difference between the United States and Europe concerning the increase of CNS bacteremia is difficult to establish due to the large number of confounding factors. Few studies take into account the number of blood cultures performed or the use of intravascular devices to adjust for the observed trends. Further on-site surveillance studies are needed to investigate the phenomenon more extensively.

Bacteremia↗
PubMed1997

Treatment of penicillin-resistant pneumococcal bacteremia in neutropenic patients with cancer.

We identified 17 cases of pneumococcal bacteremia among 340 neutropenic cancer patients with bacteremia. Pneumonia was more frequent in patients with pneumococcal bacteremia than in those with bacteremia due to other organisms: 12 (71%) of 17 patients with pneumococcal bacteremia had pneumonia, whereas only 23 (7%) of 323 patients with nonpneumococcal bacteremia had pneumonia (P < .001). Eight (47%) of the 17 episodes of pneumococcal bacteremia were caused by penicillin-resistant strains (MICs ranged from 0.12 microg/mL to 4 microg/mL); these penicillin-resistant pneumococci showed varying degrees of diminished susceptibility to all beta-lactams studied, especially ceftazidime (MICs of this drug ranged from 1 microg/mL to 64 microg/mL). Imipenem was the beta-lactam agent most active against these organisms (MICs ranged from 0.03 microg/mL to 0.25 microg/mL). Patients with penicillin-resistant pneumococcal bacteremia received inappropriate empirical antibiotic therapy more often than did patients with bacteremia due to susceptible strains (i.e., 4 (50%) of 8 patients vs. 0 of 9, respectively; P < .05). Eight (47%) of the 17 patients with pneumococcal bacteremia died. In areas where penicillin-resistant pneumococci are highly endemic, these findings should be considered in selecting empirical antibiotic therapy for neutropenic patients with cancer who are suspected of having pneumonia.

Adolescent↗
PubMed2006

The clinical impact of bacteremia in complicated acute pyelonephritis.

BACKGROUND: Bacteremia has been considered as a surrogate marker of severe infection in several infectious diseases. However, it remains uncertain whether the presence of bacteremia correlates with severe infection in patients with complicated acute pyelonephritis (APN). METHODS: We performed a retrospective study to investigate the relationship between the presence of bacteremia and disease severity in complicated APN. To do this, we reviewed medical records from 128 patients diagnosed with complicated APN admitted to Kaohsiung Veterans General Hospital, Taiwan between January, 2003 and December, 2003. In our analysis, we compared clinical presentation, treatment response, and outcome in patients with and without bacteremia. RESULTS: Fifty-four of 128 patients (42%) were bacteremic. This group of patients presented more frequently with severe sepsis or septic shock (P < 0.001), compared with nonbacteremic patients. Other factors that correlated with the presence of bacteremia were older age, diabetes mellitus, more band forms in neutrophil cell counts, impaired renal function, and a lower level of serum albumin. Using a multivariate logistic regression analysis, we show that lower levels of serum albumin (odds ratio, 0.18; 95% CI, 0.05-0.65; P = 0.008) and presence of severe sepsis (odds ratio, 4.76; 95% CI, 1.43-15.84; P = 0.011) were independent factors associated with bacteremia. Following treatment, the bacteremic group took a longer time to become defervescent than the nonbacteremic group (5.1 +/- 2.3 vs. 4.2 +/- 1.6 days, P = 0.023). Also, the bacteremic group had a greater mean duration of intravenous antibiotics administration and longer hospital stays (P < 0.001). Multiple logistic regression analysis shows that non-Escherichia coli bacteremia, presence of urolithiasis or hydronephrosis, shorter duration of antibiotics administration, and being male were significantly associated with recurrence of urinary tract infection within 6 months. CONCLUSION: Bacteremia in cases of complicated APN indicates a severe disease, which is more likely to recur in patients with non-E coli bacteremia. Our study showed that bacteremia is indeed a useful clinical indicator of severe disease and, if found, should influence patient management. Therefore, we recommend that blood culture samples should be taken in all patients with complicated APN.

Acute Disease↗
PubMed1998

Enterococcal bacteremia in children: a review of seventy-five episodes in a pediatric hospital.

BACKGROUND: Enterococcal bacteremia is being increasingly reported. Although there have been a number of recent studies of enterococcal bacteremia in adults, there are few studies involving children. We carried out a prospective study to determine the epidemiologic, clinical and laboratory characteristics of such bacteremia in children. METHODS: Clinical and microbiologic data were recorded prospectively for all episodes of enterococcal bacteremia occurring during a 3-year period between January 1, 1995, and December 31, 1997. RESULTS: Seventy-five episodes of enterococcal bacteremia occurring in children at our institution during a 3-year period were prospectively analyzed. Serious underlying disease was present in 67 (89.3%) episodes, and in 48 (64.%) episodes patients had received antibiotics during the 2 weeks preceding enterococcal bacteremia. Forty-seven (62.7%) episodes were nosocomial in origin and 26 (34.7%) were polymicrobial. Fifty (66.7%) episodes occurred in children 1 year old or less. A source of bacteremia was identified in 33 (44%) episodes, intravascular device being the most common identifiable source. Of the 73 isolates identified to species level, there were 36 Enterococcus faecium, 36 Enterococcus faecalis and one Enterococcus avium. In 60 (80%) episodes appropriate anti-enterococcal therapy was given. The overall mortality rate was 7.5%. Four clinical patterns of infection were identified: self-limited bacteremia, 16.0%; low grade sepsis with a favorable outcome after specific therapy, 65.3%; severe and prolonged infection associated with a high mortality rate, 14.7%; and fulminant neonatal sepsis in previously healthy babies, 4.0%. CONCLUSION: Enterococcal bacteremia in children comprises a heterogeneous group. Bacteremias that are mild and self-limited and respond promptly to antibiotic therapy appear to be more common in children.

Adolescent↗
PubMed1999

Increasing incidence of gram-negative rod bacteremia in a newborn intensive care unit.

OBJECTIVES: To determine whether there has been an increase in the incidence or a change in the epidemiology of gram-negative rod (GNR) bacteremia in patients in a newborn special care unit. METHODS: Retrospective review of GNR bacteremia in patients hospitalized in the NBSCU at Yale-New Haven Hospital during a 10-year period. RESULTS: There were 120 isolates from 113 episodes of GNR bacteremia during the study period. The incidence of GNR bacteremia increased from a mean of 10.2 to 25.5 (P = 0.017) episodes of GNR bacteremia per 1000 admissions per year between the time periods 1988 to 1994 and 1995 to 1997, respectively, paralleling an increase in the overall incidence of bacteremia. The increase in GNR bacteremia in these two groups was not related to changes in the patient population, the number of admissions or duration of hospitalization. Stepwise multivariate analysis identified two independent variables associated with infants who had GNR bacteremia during the period 1995 to 1997 as compared with 1988 to 1994, maternal intrapartum antibiotics (odds ratio, 4.9; 95% confidence interval, 1.9 to 12.6) and the presence of a percutaneous central venous catheter (odds ratio, 4.6; 95% confidence interval, 1.8 to 11.8). CONCLUSIONS: We observed changes in clinical obstetric and neonatal care that paralleled the increase in GNR bacteremia at our institution. A prospective study is needed to elucidate the impact of these changes on the incidence of GNR bacteremia in this population.

Bacteremia↗
PubMed1999

Non-typhi Salmonella bacteremia in children.

BACKGROUND: Non-typhi Salmonella (NTS) infections are a frequent cause of self-limited diarrheal illness in healthy children. Bacteremia is a known complication of NTS infection, but the management of children with bacteremia has been based on limited data. OBJECTIVE: To study the outcomes of pediatric patients with NTS bacteremia. METHODS: Retrospective review of patients with NTS bacteremia covering a 16-year period at an urban pediatric hospital. Clinical data from the initial visits and any follow-up visits or hospitalizations were abstracted from the medical record. RESULTS: We studied 144 patients. Median age was 10.5 months. Fifty-four patients were hospitalized at the initial visit including all the patients with immunodeficiency (n = 12). Of the 90 patients initially managed as outpatients, 79 were subsequently admitted; only 1 of these patients developed a focal complication. Persistent bacteremia was found in 51 (41%) patients. Among nonimmunocompromised patients, persistent bacteremia was noted in 34% [95% confidence interval (CI), 20 to 52%] of those initially treated with oral antibiotics, 52% (CI 30 to 74%) of those initially treated with a parenteral dose of antibiotics and in 31% (CI 22 to 43%) of those who were not initially given antibiotics. No laboratory or clinical factors predicted persistent bacteremia. Twelve patients developed focal infections: 3 of 119 previously healthy children (2.5%, CI 0.5 to 7%); and 9 of 25 children with underlying medical conditions (36%, CI 19 to 57%). Focal infections included meningitis (3), osteomyelitis (4), septic arthritis (2), pneumonia (2) and cholangitis (1). CONCLUSIONS: NTS bacteremia occurs in otherwise healthy children, although the risk of focal infections is small. Patients with NTS bacteremia frequently have persistent bacteremia at follow-up regardless of initial antibiotic treatment.

Bacteremia↗
PubMed2002

Predictors of bacteremia in febrile children with sickle cell disease.

PURPOSE: Bacteremia is an important cause of death and complications in children with sickle cell disease (SCD), yet predictors of bacteremia in these patients have not been well identified. The purpose of this study was to test whether clinical and hematologic variables commonly used to predict bacteremia in normal young children with fever could accurately predict bacteremia in febrile children with SCD. PATIENTS AND METHODS: The authors reviewed the medical records of all patients with SCD younger than 18 years of age over a 10-year period at a single institution for febrile events. They tested the univariate associations of age, height of fever, white blood cell count (WBC), absolute neutrophil count (ANC), and absolute band count (ABC) with bacteremia. Three separate multivariate analyses were performed using the predictor variables age, temperature, and one of three hematologic variables (ANC, WBC, or ABC) with the outcome bacteremia. RESULTS: There were 175 evaluable febrile events, of which 8 (4.6%) were associated with bacteremia. In the multivariate analyses, all hematologic variables, but not age or height of fever, retained significant associations with bacteremia. CONCLUSIONS: In febrile children with SCD, WBC, ANC, and ABC are all independently associated with bacteremia when adjusting for height of fever and age. Hematologic variables may be useful in developing prediction algorithms to identify febrile patients with SCD at higher risk of bacteremia. These data emphasize the need for a national trial to develop a predictive model with defined thresholds.

Age Factors↗
PubMedDate not supplied

Bacteremia in veterans administration nursing home patients.

The objective of this study was to identify differences between nursing home (NH) and nonnursing home (non-NH) patients with bacteremia regarding host risk factors, exposures, microbiology, and outcome. Between October 1995 and February 1998, 134 episodes of true bacteremia were identified at the North Chicago Veterans Administration Medical Center (NCVAMC). Seventy-eight episodes of bacteremia occurred in NH patients who stayed for at least 3 months in the NH at the NCVAMC and developed bacteremia there or 48 hours after admission to the acute care hospital (ACH). Fifty-six episodes occurred in the non-NH patients who developed bacteremia in the community or 48 hours after admission to the ACH. NH patients were more likely to be older than 65 years (88% vs. 71%, P = 0.0334) and to have pressure sores (25% vs. 5%, P = 0.005), urinary incontinence (42% vs. 27%, P = 0.0471), and mental illness (62% vs. 29%, P = 0.0001) than non-NH patients. Coagulase-negative Staphylococcus and Escherichia coli were the most common causes of bacteremia occurring as frequently in both groups. Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and enterococcal bacteremia were comparable, whereas vancomycin-resistant enterococci, ceftazidime-resistant E. coli, Klebsiella pneumoniae, and Enterobacter were rarely isolated. Twelve (15%) NH patients died within 2 weeks of acquiring bacteremia compared with 4 (7%) non-NH patients (P = 0.1176). For ACH-acquired cases, 20 NH patients were similar to 26 non-NH patients with regard to hospital stay; exposure to antibiotics, steroids, intensive care setting, surgery, tube feeding, and urinary and vascular catheters prior to bacteremia. Although NH and non-NH patients with bacteremia have different host characteristics, they have similar in-hospital exposures, distribution of infecting organisms, and outcome.

Aged↗
PubMed1995

Bacteremia at a Danish university hospital during a twenty-five-year period (1968-1992).

In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. Enterobacteriaceae dominated as causative agents (57%), following by Gram-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia was found in 8% of the episodes. The incidence of Enterobacteriaceae bacteremia culminated in the middle (1978-82) of the period (4.7/1,000 admissions) and decreased during the last decade. Gram-positive bacteremia increased throughout the period (from 1.8 to 2.9; p < 0.001), due mainly to increasing incidences of bacteremia caused by non-hemolytic streptococci, Streptococcus pneumoniae and coagulase-negative staphylococci. Bacteroides fragilis accounted for a rising incidence of anaerobic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were available for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with indwelling catheters, mainly bladder catheters (28%) and i.v. lines (7%). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently malignancies (20%) and diabetes mellitus (7%). The mortality rate related to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the first 2 days after the first positive blood culture was obtained. Logistic regression analysis defined 7 variables that independently influenced the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antibiotic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗