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PubMed1995

Clinical evaluation of catheter-related fungemia and bacteremia.

Forty-four patients with catheter-related infection admitted to Hokusho Central Hospital between 1985 and 1991 were studied retrospectively. The rate of catheter-related fungemia or bacteremia to all corresponding cases of fungemia and bacteremia increased from 7.7% in 1985 to 28.8% in 1991. The isolated pathogens were Candida parapsilosis (8 strains), Candida tropicalis (6 strains), methicillin-resistant Staphylococcus aureus (MRSA) (6 strains), methicillin-sensitive S. aureus (MSSA) (5 strains) and Streptococcus epidermidis (3 strains). Bacteremia occurred after catheterization of the femoral vein for a mean duration of 37 days. The period was significantly shorter than that after catheterization of the subclavian vein (56 days). The major isolates from the subclavian vein were Candida spp. (14/17, 82.4%), followed by MRSA (1/17, 5.9%) and MSSA (1/17, 5.9%), while isolates from the femoral vein were Candida spp. (6/16, 37.5%), MRSA (5/16, 31.3%) and MSSA (3/16, 20.8%). Catheter removal alone did not improve the clinical condition, particularly in MRSA bacteremia; the combination of antimicrobial therapy and removal of the catheter was necessary for a better prognosis.

Aged↗
PubMed2005

Risk factors for hospital-acquired bacteremia.

OBJECTIVE: Bacteremia is one of the most serious health problems associated with high morbidity and mortality. The aim of this study was to identify risk factors for bacteremia in daily medical care to facilitate rapid and accurate clinical decisions about treatment. PATIENTS AND METHODS: We studied 306 inpatients retrospectively. Age, peripheral neutrophil count, C-reactive protein (CRP), platelets, serum total cholesterol, total protein, albumin and cholinesterase were compared in patients with positive- and negative-blood cultures. The associations between blood culture positivity and glucose tolerance, bedridden state, presence of a central venous catheter (CVC) or urinary catheter were examined. On October 14, 2002, strategies for prevention of catheter-related infection were altered in our hospital. We studied the impact of these changes on the risk of bacteremia. RESULTS: Sixty-seven patients had positive and 239 had negative blood cultures. Age, neutrophil, platelets, total protein, albumin, and cholinesterase were significantly different between the culture-positive patients and the culture-negative patients. Multivariate analysis showed albumin and platelets as independent predictors. The bedridden state and catheter-inserted states (central venous or urinary) conferred significantly higher positive blood culture rates. Multivariate analysis showed using urinary catheters and indwelling femoral CVCs as independent risk factors. There was no significant difference in the blood culture-positive rate before and after the change in prevention strategies; before the change, 6 of 9 catheter-inserted blood culture-positive cases yielded MRSA, while 4 of 12 cultures yielded Staphylococcus epidermidis after the change. CONCLUSION: Our study highlights the risk factors of bacteremia in vulnerable patients.

Adolescent↗
PubMed1991

Klebsiella bacteremia: a review of 196 episodes during a decade (1980-1989).

This report reviews 196 episodes of klebsiella bacteremia in 194 patients during a 10-year period (1980-1989) in a community teaching hospital in the USA. The median age of patients was 70 years with a mode of 84 years. The prevalence was 0.76 episodes/1000 admissions. Nosocomial acquisition of bacteremia occurred in 43% of episodes and 16% of patients were from nursing homes. Klebsiella pneumoniae accounted for 86% and K. oxytoca for 13% of episodes. Most isolates were resistant to ampicillin and carbenicillin but susceptible to other antimicrobial agents tested. 55 episodes (28%) were polymicrobial; Escherichia coli and enterococci were the most common co-isolates. The major portals of entry were the respiratory tract and urinary tract. The majority of patients had major underlying conditions. The overall mortality was 37%. Factors that adversely influenced the mortality rate were nosocomial bacteremia, polymicrobial bacteremia, respiratory tract as the portal of entry, rapidly fatal and ultimately fatal underlying conditions, septic shock, severe leukopenia, increases in total serum bilirubin level or serum creatinine level and inappropriate antimicrobial therapy.

Age Factors↗
PubMed1995

Mortality rate and magnitude of Staphylococcus aureus bacteremia as assessed by a semiquantitative blood culture system.

A 4-year retrospective study ascertained the relation between the magnitude of Staphylococcus aureus bacteremia and mortality. 253 episodes of S. aureus bacteremia diagnosed in a Danish regional Department of Clinical Microbiology were included. Blood cultures were routinely done by inoculation of aseptically drawn blood into multiple tubes of bacteriological media. The rate of positive tubes was assumed to distinguish high- from low-grade bacteremia without providing an absolute count of colony forming units. The median number of tubes inoculated was 18 (range 6-48) with approximately 0.5-1 ml of blood per tube. The rate of positive tubes was related neither to the source of infection, i.e. whether the S. aureus infection was nosocomially or community-acquired, nor to the portal of entry. However, mortality increased with increasing rate: it was 18% for rates < 0.30, 23% for 0.30-0.69, 30% for 0.70-0.99, and 37% for a rate of 1.0. Thus, for S. aureus infections the magnitude of bacteremia seems to be a prognostic factor with possible bearings on clinical and therapeutic decisions.

Adolescent↗
PubMed1995

A survey of Campylobacter bacteremia in three Danish counties, 1989 to 1994.

Over a 5-year period (April 1989 to March 1994) bacteremia caused by Campylobacter species was diagnosed in 15 patients in a population of 1.3 million in three counties in Jutland province, Denmark. The incidence was 0.2/100,000/year and the ratio of blood to fecal isolates, was 0.008. Campylobacter coli and Campylobacter jejuni accounted for 6 cases each, Campylobacter fetus for 2, and in 1 case the species diagnosis was uncertain. Seven patients were males and 8 females; median age was 42 (range 15-90) years. 11 patients had underlying disorders, including immunological, neoplastic and vascular disease. In a 67-year-old man a Starr-Edwards prosthesis of the aortic valve was probably infected by C. fetus, as recurrent bacteremia resolved following valve replacement. Eight patients had pyrexia and diarrhea, whereas 7 had pyrexia with only slight intestinal discomfort or none at all. In 4 patients the bacteremia was associated with cutaneous cellulitis or vasculitis. 14 of 15 patients survived. Campylobacter bacteremia seems to be more common in Denmark than hitherto thought.

Adolescent↗
PubMed1995

Protracted and recurrent methicillin-resistant Staphylococcus aureus bacteremia despite defervescence with vancomycin therapy.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia persisted for 46 days in a 63-year-old patient and recurred over 98 days in a 79-year-old patient, despite vancomycin therapy. Although the fever resolved, patient 1 developed a spinal epidural abscess 38 days after beginning therapy and patient 2 sustained multiple relapses. A time-kill study demonstrated a reduced vancomycin killing rate in both isolates when compared to the killing rate of a control MRSA strain. The bacteremia persisted after increasing the vancomycin dose to achieve trough levels of 15-20 micrograms; it cleared after adding gentamicin. These cases illustrate that MRSA bacteremia may persist during vancomycin therapy despite resolution of fever and may lead to delayed complications, and that adding gentamicin may be necessary for ultimate clearance of the bacteremia.

Aged↗
PubMed1995

Staphylococcus aureus bacteremia: a 14-year nationwide study in hematological patients with malignant disease or agranulocytosis.

This retrospective nationwide study of 756 cases of S. aureus bacteremia in hematological patients, between 1977-1990, confirms that S. aureus bacteremia is disproportionately prevalent among, and a major cause of morbidity and mortality in, hematological patients. The case mortality rate attributable to S. aureus bacteremia (44%) was significantly higher than the rate (29%) found in patients without hematological disease. A decreasing mortality was, however, observed from the first to the last part of the study period (53 and 37% respectively). A logistic regression analysis showed that mortality was further dependent on age, the type of hematological disease and origin of infection/primary focus of infection. Analysis of clinical features confirmed that in comparison with other patients, S. aureus bacteremia in hematological patients more often was hospital-acquired, acquired without known portal of infection/primary focus of infection and much less frequently resulted in osteomyelitis or endocarditis. From phage typing and antibiotic susceptibility patterns no specific types of S. aureus were associated with hematological patients.

Adolescent↗
PubMedDate not supplied

Bacteremia and bacterial translocation in the naturally occurring canine gastric dilatation-volvulus patient.

This prospective study was performed to determine the prevalence of bacteremia in the naturally occurring gastric dilatation-volvulus (GDV) patient, the possible relationship between bacteremia and survival, and whether bacteremia was a result of translocation from the stomach. Blood cultures were collected from each patient. Bacterial cultures were collected from the liver, mesenteric lymph node, and stomach. Forty-three percent of the GDV cases and 40% of the controls developed positive blood cultures. Gram-negative rods were the most frequently isolated organisms. Evidence of bacterial translocation from the stomach could not be demonstrated in GDV patients, and survival was not affected by the presence of bacteremia.

Animals↗
PubMed2004

International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections.

BACKGROUND: Commonly encountered nosocomially acquired gram-negative bacteria, especially Klebsiella pneumoniae, produce extended-spectrum beta-lactamases (ESBLs) as an antibiotic resistance mechanism. OBJECTIVE: To determine whether microbiology laboratories should report the presence of ESBLs and to establish the infection-control implications of ESBL-producing organisms. DESIGN: Prospective observational study. SETTING: 12 hospitals in South Africa, Taiwan, Australia, Argentina, the United States, Belgium, and Turkey. PATIENTS: 440 patients with 455 consecutive episodes of K. pneumoniae bacteremia between 1 January 1996 and 31 December 1997; of these, 253 episodes were nosocomially acquired. MEASUREMENTS: The K. pneumoniae isolates were examined for the presence of ESBLs. Pulsed-field gel electrophoresis was used to analyze the molecular epidemiology of nosocomial bacteremia with ESBL-producing K. pneumoniae. RESULTS: Overall, 30.8% (78 of 253) episodes of nosocomial bacteremia and 43.5% (30 of 69) episodes acquired in intensive care units were due to ESBL-producing organisms. After adjustment for potentially confounding variables, previous administration of beta-lactam antibiotics containing an oxyimino group (cefuroxime, cefotaxime, ceftriaxone, ceftazidime, or aztreonam) was associated with bacteremia due to ESBL-producing strains (risk ratio, 3.9 [95% CI, 1.1 to 13.8]). In 7 of 10 hospitals with more than 1 ESBL-producing isolate, multiple strains with the same genotypic pattern were observed, indicating patient-to-patient spread of the organism. CONCLUSIONS: Production of ESBLs by Klebsiella pneumoniae is a widespread nosocomial problem. Appropriate infection control and antibiotic management strategies are needed to stem the spread of this emerging form of resistance.

Bacteremia↗
PubMedDate not supplied

Gingival degerming by povidone-iodine irrigation: bacteremia reduction in extraction procedures.

The purpose of this study was to find out whether or not a certain mouth wash, i.e. povidone-iodine, will reduce the incidence of bacteremia following tooth extraction. The sample was composed of twenty-six patients who were given gingival sulcus irrigation and rinsing prior to tooth extraction. Thirteen patients used povidone-iodine mouthwash and the other 13 patients with an identically matched placebo. Prior to irrigation and rinse, first blood sample is drawn and first gingival sulcus sample is taken. To complete the whole procedure, the patient rinsed with 10-20 ml of assigned coded mouthwash for 30 seconds and then repeated the rinsing after 2 minutes followed by 60 second irrigation with 10-20 ml of the same coded mouthwash, administered in the gingival sulcus and surrounding mucosa of the tooth to be extracted. A second gingival sulcus sample is taken then extraction is performed. A second blood sample is drawn within 3 minutes of extraction. Growth and reduction in bacteremia were determined before, during and after extraction procedure. Results indicated significant reduction in incidence of post-operative bacteremia with povidone-iodine as compared with placebo (P = .01558) and significant reduction in growth of gingival cultures with povidone iodine as compared with placebo (= .65337). Povidone-iodine mouthwash used as a rinse and gingival sulcus irrigant reduced the growth of gingival cultures and the incidence of post-operative bacteremia in more specimen compared to the placebo.

Anti-Infective Agents, Local↗
PubMed1999

[Predictive factors of the presence of bacteremia in males with urinary infection].

UNLABELLED: BACKGROUND AND PATIENTS AND METHODS: Possible predictive factors of the presence of bacteremia in 135 males with parenchymatous urinary tract infection (PUI) are studied by means of univariate and multivariate analysis. RESULTS: Thirty percent of the patients had bacteremia. In the multivariate analysis the following factors were significative: duration of symptoms > 5 days, a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days. CONCLUSIONS: One third of the males with community acquired PUI have bacteremia. The best predictors of the presence of bacteremia are a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days.

Acute Disease↗
PubMed1998

Acinetobacter calcoaceticus-baumannii complex bacteremia: analysis of 82 cases.

Eighty-two cases of Acinetobacter calcoaceticus-baumannii complex bacteremia were identified during a 33-month period, from November 1993 to July 1996, at the Veterans General Hospital, Taipei. All cases were due to hospital-acquired infections, with 28 cases of polymicrobial bacteremia. Most patients had severe debilitating conditions: 26 had malignancies, 40 required stay in Intensive Care Unit and 17 had undergone major operations. The main predisposing factors included central venous catheterization, endotracheal intubation or tracheostomy, prior antibiotic therapy and prolonged hospitalization. Amikacin, tobramycin, and ceftazidime were the most effective agents in vitro against A. calcoaceticus-baumannii complex. 32 patients (39 %) died during hospitalization, 19 of the cases (23 %) directly attributed to septicemia. Factors that adversely influenced mortality included polymicrobial bacteremia, inappropriate antimicrobial therapy and prior antibiotic treatment. Of particular interest is the fact that none of the patients who did not receive appropriate antimicrobial therapy survived. Early diagnosis and appropriate antibiotic therapy are critical for improving the prognosis of A. calcoaceticus-baumannii complex bacteremia.

Acinetobacter Infections↗
PubMed1999

[Factors affecting the clinical course of bacteremia. Prospective study at a university hospital].

BACKGROUND: The aim of this study was to identify the risk factors mainly influencing the mortality of a series of bacteremic patients. METHODS: A prospective study of the clinically significant bacteremias detected in the Hospital Clínico Universitario in Malaga (Spain) over the period from June 1994 to May 1995 was performed. Univariate analysis of the results was carried out with the chi 2 test and multivariate analysis was undertaken by logistic regression (Stepwise backward). RESULTS: The incidence of bacteremia was of 19.5 cases/1,000 admissions and the mortality was of 21.9%. According to the univariate analysis, 11 variables were significantly associated with greater risk death: age > 60 years, stay in the intensive care unit, respiratory diseases as the main diagnosis, etiology by Pseudomonas aeruginosa, absence of fever, septic shock, presence of chronic renal insufficiency, cirrhosis or heart disease with underlying diseases, performance of invasive procedures prior to and hospital stay of less than 10 days. Logistic regression analysis determined the factors which mainly influenced in the prognosis of bacteremia: septic shock (p < 0.0001, odds ratio [OR]: 17.97), cardiovascular diseases (p = 0.004, OR: 9.86), AIDS (p = 0.03; OR: 1.02). CONCLUSIONS: Although the prognosis of bacteremia is strongly influenced by determined conditions of the patient, it may be improved, overall through the control of possible hemodynamic complications of the patients and to a lesser extent by antibiotic treatment.

Aged↗
PubMedDate not supplied

[Evaluation of the reincubation of positive blood cultures for detection in the BACT-ALERT system for the detection of polymicrobial bacteremia].

Between February and September 1997, 6588 blood cultures at the Instituto de Cardiología y Cirugía Cardiovascular and Hospital de Niños Ricardo Gutiérrez were studied by using the Bact-Alert system (Organon Teknika) 341 contaminants and 294 episodes of bacteremia (600 samples) were analyzed. From these samples, 280 (95.3%) were monomicrobial episodes and 14 (4.7%) polymicrobial episodes. Positive blood cultures detected by the Bact-Alert system were processed and then reincubated during 7 days, when they were Gram stained and subcultured in blood agar, chocolate agar (both in 5-10% CO2), laked blood agar supplemented with hemin and vitamin K in anaerobic atmosphere (only anaerobic bottles) and CLDE (aerobic conditions). Following reincubation, 3 out of 14 polymicrobial bacteremias were detected, rising the level of detection from 3.7% to 4.7%. Taking into account the total number of bacteremias, only in 3 out of 294 (1%), a second microorganism was detected. Otherwise, in blood cultures where a contaminating microorganism was initially isolated, no further isolates representing a true bacteremia were recovered. Reincubation and terminal subculture of initially positive blood cultures did not provide relevant data in order to change therapeutic measures in the studied population. Due to the increase in costs and labor we consider that this methodology is not routinely advised.

Bacteremia↗
PubMed2000

Fatal outcome of Erysipelothrix rhusiopathiae bacteremia in a patient with oropharyngeal cancer.

Bacteremia due to Erysipelothrix rhusiopathiae is rare; the most common presentation reported in the literature is endocarditis. We report a 32-year-old man with oropharyngeal cancer who developed aspiration pneumonia and E. rhusiopathiae bacteremia, and presented with fever, chills, dyspnea, and productive cough with purulent sputum. Despite treatment with amoxicillin/clavulanate and nutritional support for 9 days, he died of respiratory failure. He had no clinical evidence of endocarditis. He had no history of animal or occupational exposure, and might have been colonized with E. rhusiopathiae in the oral cavity, followed by aspiration pneumonia and bacteremia. A fatal outcome in a patient with bacteremia due to E. rhusiopathiae without endocarditis is rare.

Adult↗
PubMed2000

Bacteremia due to Campylobacter species: high rate of resistance to macrolide and quinolone antibiotics.

BACKGROUND AND PURPOSE: Although the rate of isolation of Campylobacter from stool specimens in Taiwan is similar to those in other developed countries, Campylobacter bacteremia has rarely been reported in Taiwan, and the patterns of antimicrobial susceptibility of blood isolates to various antimicrobial agents remain unknown in the Taiwanese population. The purpose of this study was to determine the clinical characteristics of patients with Campylobacter infection in a university hospital in Taiwan and the antimicrobial susceptibility patterns of the Campylobacter isolates. METHODS: We retrospectively reviewed medical records of all patients with Campylobacter bacteremia treated in a university hospital between January 1991 and March 1999. Minimum inhibitory concentrations of 13 antimicrobial agents to 10 stored blood isolates were determined using the E-test. RESULTS: Approximately half (52%) of the 21 patients had chronic liver disease and one-quarter had hepatobiliary or gastrointestinal malignancies. Thirteen (62%) patients had conditions that were associated with gastroenteritis. Other clinical manifestations associated with Campylobacter infection included cellulitis, perinatal sepsis, peritonitis, vascular catheter-related infection, and primary bacteremia. The duration of illness was generally short: approximately half (52%) of the 21 patients had fever lasting for only 1 day. Antimicrobial susceptibility testing of the 10 isolates revealed that most of the blood isolates were resistant to erythromycin and nalidixic acid (100% and 90%, respectively), while the rate of cross-resistance between erythromycin and azithromycin was 70%, and that between nalidixic acid and ciprofloxacin was 67%. CONCLUSIONS: Our observations suggest that Campylobacter bacteremia should be included in the differential diagnosis of patients with chronic liver disease or malignancies involving the hepatobiliary system or gastrointestinal tract who present with fever and gastroenteritis. Clinicians in Taiwan should be alert to the high rate of resistance of Campylobacter isolates to macrolide and quinolone antibiotics.

Adolescent↗
PubMed2000

Erysipelas-like cellulitis with Pasteurella multocida bacteremia after a cat bite.

A 73-year-old female patient presented with Pasteurella multocida erysipelas-like cellulitis, bacteremia, and shock. The onset of the disease occurred 24 h after a cat bit her to the right lower leg. Initially, the picture of bacteremia and shock developed, with minimal local cellulitis. Pasteurella multocida grew in blood culture. A combination of amoxicillin and clavulanic acid was therapeutically successful in respect that the signs of bacteremia and shock disappeared. However, extensive erysipelas-like cellulitis developed on the bitten leg within the next 2 days. The disease was efficiently treated with penicillin G combined with netilmicin and administered for 10 days. This report documents the first case of Pasteurella multocida erysipelas-like cellulitis with bacteremia and shock.

Aged↗
PubMed2000

Nosocomial coagulase negative Staphylococci bacteremia: five year prospective data collection.

UNLABELLED: Coagulase-negative Staphylococcus (CoNS) species, as a group, constitute a major component of the normal microflora of the human skin and mucous membranes. Over the last 20 years, there has been an increase in the documentation of infections due to CoNS, especially with S. epidermidis species, the most common cause of nosocomial primary bloodstream infections. OBJECTIVE: To determine the frequency of CoNS isolates in blood cultures, to evaluate the meaning of this isolation (contaminant or pathogen), and to determine their epidemiologic and susceptibility patterns (oxacillin, ciprofloxacin, vancomycin, clindamycin and teicoplanin). METHODS: All strains of CoNS isolated from blood cultures collected from adults and children during 1993 to 1998, were classified as contaminant or pathogenic according to NNISS criteria (1988). Infections were classified as primary or secondary bacteremia, from clinical or surgical patients, and divided by sex and age. Susceptibility patterns were also studied in both groups. RESULTS: From 1993 to 1998, 1,702 positive blood cultures were recorded. CoNS were isolated from 546 samples (32%), with 306 (56%) classified as contaminant and 240 (44%) as true bacteremia. The presence of an intravenous catheter was an important risk factor. Endocarditis (47%) ans pneumonia (32%) were the most common sites leading to secondary bacteremia. CONCLUSION: The results confirm the increasing importance of true CoNS bacteremia and confirm their association with prosthetic valve endocarditis. We emphasize the need for care at the time of blood collection, as well as the need for care in the processing of the material, so that contamination can be reduced. This will allow a more precise description of the infections caused by coagulase-negative Staphylococcus.

Adult↗