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PubMedDate not supplied

[Bacteremia and pseudobacteremia caused by coagulase-negative Staphylococcus in children].

OBJECTIVE: To compare patients with Coagulase Negative Staphylococcus bacteremia (CoNS-B) and pseudobacteremia (CoNS-PB) in a pediatric hospital. METHODS: Descriptive and comparative study between children diagnosed with CoNS-B and CoNS-PB. RESULTS: A total of 159 children with CoNS positive blood cultures were evaluated. 66 children were classified as CoNS-B (41.5%) and 93 as CoNS-PE3 (58.5%). On the average CoNS was isolated on day 21 among children with bacteremia (B) and on day 2 in those with PB (p < 0.01). Excluding newborns, patients with B and PB had on average 2.6 and 1.1 positive cultures respectively. Most children with bacteremia were at the intensive care unit (67.2%), while patients with PB were mostly detected at the emergency room. Using logistic regression analysis, we found four factors independently associated with CoNS bacteremia: total parenteral nutrition (OR 5.4; 95% CI 2.2-12.9), low birth weight (OR 2.6; 95% CI 1.1-5.9), catheters placed by cut-down technique (OR 1.9; 95% CI 1.1-3.8), and inmuno-compromised patients (OR 2.7; 95% CI 1.1-6.7). Resistance to oxacilin was reported in 71.7% of the CoNS isolated. The overall mortality associated to CoNS-B was 6%. Among children with CoNS-PB, 10% received antibiotics, half of them vancomycin. CONCLUSIONS: These results show that CoNS-B occurs mainly as a nosocomial episode. CoNS-PB more likely resulted from specimen contamination at collection, being responsible for almost 60% of all positive blood cultures. The false-positive results caused unnecessary administration of antibiotics in a significant proportion of CoNS-PB events and have a potential impact upon the emergence of resistant pathogens.

Adolescent↗
PubMed2001

Mycobacterium tuberculosis bacteremia in a university hospital.

SETTING: Patients with blood cultures positive for Mycobacterium tuberculosis between 1988 and 1999. OBJECTIVE: To study the clinical and microbiological characteristics of patients with tuberculous bacteremia, including data about evolution and management. DESIGN: Retrospective review of the clinical charts and microbiological records of patients with culture-proven tuberculous bacteremia between 1988-1999. RESULTS: During the study period, 19 patients with culture-proven M. tuberculosis bacteremia were detected (1.42 isolates/patient, 4.7% of all patients with blood cultures for mycobacteria). Four patients were non-infected with the human immunodeficiency virus and 15 were HIV-infected. In four patients blood was the only positive sample. Five patients were diagnosed simultaneously with tuberculosis and HIV infection. Only 13 had a temperature higher than 37.5 degrees C. Most patients had symptoms or signs of respiratory tract involvement, and 11 patients died (10 from tuberculosis). The average time for detection of positive blood cultures was 33.25 days for lysis-centrifugation cultures and 26.46 days for BACTEC cultures. The incidence of M. tuberculosis bacteremia remained stable during the study period. CONCLUSIONS: Although blood cultures are useful for definitive diagnosis of disseminated tuberculosis, the long incubation times made them of limited usefulness in the clinical management of patients. Mortality remains high in these patients.

Adult↗
PubMed2001

The significance of asymptomatic bacteremia for the newborn.

BACKGROUND: So far, there has been no systematic detection of asymptomatic bacteremia in pregnant women. Consequently, its possible effects on newborn infants have not been discussed. The aim of this study was to determine the incidence of asymptomatic bacteremia in pregnant and parturient women and neonates as well as to assess its influence on the health condition of newborn infants during the first three months of life. METHODS: A total of 626 blood cultures were taken from 353 pregnant women (with single-fetus pregnancy)and their newborns: 156 during pregnancy, and immediately after delivery from 235 mothers and their 235 newborns. Blood culture results were clinically and statistically analyzed along with data on the development of the newborns. RESULTS: Positive blood culture was found in 12% of pregnant women, in 19% of parturient women and 25% of the newborns. The most often isolated bacteria were: Staphylococcus epidermidis in 36 cases (18%), Escherichia coli in 35 cases (17.5%) and Enterococcus in 20 cases (10%). Asymptomatic bacteremia was found to be in a statistically significant correlation with signs and symptoms of life-threatening conditions (p<0.01), early-onset and late-onset infections and other disorders occurring in newborn infants (p<0.05), mostly of the female sex. CONCLUSION: It seems that asymptomatic bacteremia cannot be considered harmless but appears to influence the health of newborns.

Bacteremia↗
PubMed2001

Characteristics of group A streptococcal bacteremia with comparison between children and adults.

This retrospective study aimed to compare the characteristics of group A streptococcal bacteremia in children and adults. A total of 76 (12 children and 64 adults) patients with group A streptococcal bacteremia treated from October 1995 through September 2000 at the Linko Chang Gung Memorial Hospital were included. The mean age was 47.6 years (range, 12 days-90 years). Forty-four (57.9%) patients had predisposing medical conditions. Malignant cancer (23.7%) and diabetes (22.4%) were the 2 most common conditions, which occurred only in adults. Two (16.7%) children had chickenpox associated with secondary group A streptococcal bacteremia. Skin and soft tissue infection (60.5%) was the most common clinical manifestation. The mortality rate related to group A streptococcal bacteremia was 25%. Twelve patients met the criteria of streptococcal toxic shock syndrome and 6 (50%) were children (p<0.05). Despite immediate and aggressive treatment, mortality due to streptococcal toxic shock syndrome was 66.7%. The incidence of streptococcal toxic shock syndrome was much higher in children (50%) than in adults (9.4%). Early diagnosis of invasive group A streptococcal infections and streptococcal toxic shock syndrome requires awareness of the presentations and a high level of suspicion. For fulminant group A streptococcal infection, a combination of a beta-lactam antibiotic plus clindamycin and/or adjuvant therapy with intravenous immunoglobulin is recommended.

Adolescent↗
PubMed2001

Eleven-year study of recurrent pneumococcal bacteremia.

In order to describe the epidemiology and the clinical and microbiological manifestations of recurrent pneumococcal bacteremia, a long-term study was conducted. Between January 1988 and December 1998, a total of 344 episodes of bacteremia caused by pneumococci was detected in 331 patients. Thirteen (3.9%) of these patients experienced recurrent episodes of pneumococcal bacteremia, and all of them had underlying diseases. In 12 of these patients the recurrence was considered to be a reinfection, and in one patient it was considered to be a relapse. Three patients were found to harbor identical strains in both bacteremic episodes, as determined by pulsed-field techniques. Only hematological neoplasia appeared to be a predisposing factor for recurrent pneumococcal bacteremia.

Adult↗
PubMed2001

[Value of an antibiotic lock for the prevention of bacteremia recurrence from central catheters in chronic hemodialysis].

Prospectively since 11/1997, all central venous catheter related bacteremias in our dialysis center (n = 60) was recorded. We systematically tested antibiotic lock technique using pure heparin (1 ml = 5000 Ul) mixed with antibiotic matched to isolated micro-organism after 15 days of systemic antibiotherapy. During 39 months of study, 27 bacteremias were documented from 23 patients. Seventeen locks in 15 patients were performed after each dialysis sessions during one month. Associated tunnel infection did not allow to stop the lock in 3 cases. In the 12 remaining patients, we observed 4 recurrences for 3 patients after the stop of the lock with the same micro-organism in 3 times/4 without modifications of antibiotics sensibility. No septic metastases were notified and the patency of all catheters were respected. The incidence of bacteremias was 4.6 per 1000 catheters days before the lock and 0.88 after, during a mean observation period of 15 months per patients. Sterilisation of infected catheters seems possible and the incidence of bacteremias is reduce by the lock technique without coming out of septic complications or selected micro-organisms.

Anti-Bacterial Agents↗
PubMed2002

Clinical features and antimicrobial susceptibility trends in Citrobacter freundii bacteremia.

This retrospective study investigated the clinical characteristics and antimicrobial susceptibilities of 36 cases of Citrobacter freundii bacteremia treated at the Taipei Veterans General Hospital from 1996 through 1999. The results showed that the predominant infection site was the intraabdominal region and the mortality was 22%. The resistance of C. freundii to most third-generation cephalosporins and broad-spectrum penicillins increased in both nosocomial and community-acquired C. freundii bacteremia during the study period, and the strategy of using a combination of antimicrobial agents to treat C. freundii infection was effective. This study also demonstrated the importance of appropriate antimicrobial therapy to the successful outcome of C. freundii bacteremia. The guidelines of the National Nosocomial Infections Surveillance System were followed to determine trends of resistance of C. freundii to various antimicrobial agents. The resistance of C. freundii to antibiotics in 1999 (n = 10), compared with the period from 1996 through 1998 (n = 26), increased 66% for ciprofloxacin, 36% for ticarcillin/clavulanate, 70% for piperacillin/tazobactam, and 62.8% for piperacillin, but remained uniformly susceptible to imipenem/cilastatin and the new fluoroquinolone (levofloxacin). This increase in resistance was attributable to the use of third-generation cephalosporin instead of first-generation cephalosporins. These findings indicate the need for new measures to facilitate the appropriate choice of antimicrobial agents for patients with C. freundii bacteremia.

Adult↗
PubMed1992

Bacteremia and bacterial infections in highly febrile children without apparent focus.

To find the incidence of bacteremia and serious bacterial infections in febrile children without an apparent focus of infection, we prospectively studied 100 febrile children aged 1 month-3 years with a rectal temperature > or = 39 degrees C. Ten children had a blood culture positive bacteremia and nine had serology positive for bacteremia; 6 had urinary tract infection, 5 otitis media and 8 meningitis. A diagnosis of non bacterial illness was made in 62 patients. Staphylococcus aureus was the most common bacteriologic isolate on blood culture (five) and by serology (eight). TLC > or = 15,000/cu mm m-ESR > or = 25 mm and temperature > or = 39 degrees C had high specificity (95-100%) but low sensitivity for diagnosis of bacteremia.

Bacteremia↗
PubMedDate not supplied

[Epidemiology of bacteremias at a university hospital].

The epidemiological aspects of bacteremias were determined in a university hospital, according to service, age, sex and place of acquisition (nosocomial or community-acquired). From August 1985 through July 1986 the incidence rate of bacteremias at the Sao Paulo Hospital was 21.7/1000 admissions. Such a high rate is probably related to the characteristics of the patients admitted to the hospital. The incidence was higher in the extremes of age and was similar in either sex. Approximately 60% of the bacteremias were nosocomial including 9.1% that were present at admission in patients transferred from other hospitals. The most frequent isolated pathogen was S. aureus. The most important source of bacteremia was the respiratory tract followed by the gastrointestinal and urinary tracts.

Adolescent↗
PubMed1992

[The surveillance of nosocomial bacteremia in the Intensive Care Unit of the Hospital Pediátrico Docente Centro Habana].

A prospective study was carried out in order to assess nosocomial bacteremia in the Intensive Care Unit of the Centrohabana Teaching Pediatric Hospital, from January to May 1988. 66.7% of the bacteremia episodes diagnosed were of a nosocomial origin, mostly secondary. Nosocomial bacteremia rate was 15.5 per 100 admissions, with predominance in the age group under 1 year of age. Risk factors for acquiring nosocomial bacteremia were hospital stay longer than 72 hours, age under 1 year, tracheal intubation, deep venous catheterization and urinary catheterization. The most frequently associated microorganisms were Staphylococcus epidermis, Escherichia coli and Pseudomonas aeruginosa.

Bacteremia↗
PubMed2003

Bacteremia in hematological and oncological children with febrile neutropenia: experience in a tertiary medical center in Taiwan.

A retrospective study of bacteremia in children with febrile neutropenia admitted to a medical center in Taiwan from January 1999 to December 1999 was performed. There were 190 episodes of febrile neutropenia during this period and 46 pathogens were isolated from blood specimens in 38 bacteremic episodes (7 mixed infections). Pseudomonas aeruginosa (17.4%), Staphylococcus aureus (10.9%), Klebsiella pneumoniae (10.9%), and Enterobacter cloacae (10.9%) were the most common isolates. Three of the 5 isolates of S. aureus were resistant to methicillin. Twenty-three episodes of bacteremia (four mixed infections) were associated with recent antibiotic use. Of the 23 bacteremic episodes with recent antibiotic use, P. aeruginosa (20%), methicillin-resistant S. aureus (10%), K. pneumoniae (10%), Escherichia coli (10%), and E. cloacae (10%) were isolated most often. Relapsed leukemia (odds ratio 3, 95% confidence interval 1.4-6.5) and recent antibiotic therapy (odds ratio 3.4, 95% confidence interval 1.7-7.7) were the independent risk factors of bacteremia. There were 9 mortality cases in patients with bacteremia, including 4 cases with mixed infections, and 5 cases with P. aeruginosa, E. coli, Klebsiella oxytoca, S. aureus, and Streptococcus mitis, respectively. Broad-spectrum antibiotics were necessary in febrile neutropenic children because of the high percentage of mixed infection.

Academic Medical Centers↗
PubMed2003

Viridans streptococcus bacteremia in children on chemotherapy for cancer: an underestimated problem.

The authors discuss the morbidity associated with viridans streptococcus bacteremia, and its implications on the choice of antibiotics used as prophylaxis and treatment. They retrospectively studied the case notes of 38 children who were being treated for various malignant conditions in their unit and developed 40 episodes of bacteremia with viridans streptococci between October 1995 and January 1999. Viridans streptococci were the third commonest blood culture isolate during this period, after coagulase-negative staphylococci and Staphylococcus aureus. The majority of the isolates were Streptococcus mitis (55%). Others were S. sanguis (25%), S. oralis (12.5%), S. salivarius (5%), and S. acidominimus (2.5%). Twenty-five percent of the patients had been treated with regimens that included cytosine arabinoside, 60% were receiving prophylactic co-trimoxazole, and 87.5% were neutropenic. Thirty percent of patients had abnormal chest X-rays, and 15% were hypotensive; 2 patients required admission to the intensive care unit. Initial antibiotic therapy was changed because of failure of clinical response in 60% of cases, despite the infecting organism being sensitive in vitro. This study confirms the importance of viridans streptococci as a cause of bacteremia in pediatric hematology and oncology patients, leading to significant morbidity. Further work is required to establish the optimal treatment for viridans streptococcus bacteremia.

Adolescent↗
PubMed1992

Streptococcal bacteremia in neutropenic adult patients.

In order to define the circumstances of occurrence, clinical presentation and prognostic factors of streptococcal bacteremia in neutropenic patients, we retrospectively reviewed 60 cases of streptococcal bacteremia following intensive chemotherapy for acute myeloblastic leukemia (AML), acute lymphoblastic leukemia (ALL) or allogeneic bone marrow transplantation. Causative streptococcal species included streptococcus viridans (42 cases), streptococcus faecalis (12), streptococcus pneumoniae (4) and other streptococci (2). All patients were febrile and 32% presented diffuse pneumopathy with frequent isolation of streptococci from bronchoalveolar washing fluids. There were no statistical differences in presentation between the bacteremia caused by different streptococcal species. Death occurred in 22% of the patients and factors favoring poor prognosis included pneumopathy (p less than 0.001), more than 2 positive blood cultures (p less than 0.01) and initial chemotherapy for AML (p less than 0.01). Pneumopathy occurred more frequently after chemotherapy for AML. It is concluded that streptococcal bacteremia is to be prevented in patients undergoing intensive chemotherapy, particularly if cytarabine is used.

Adolescent↗
PubMed1992

An endemic strain of Staphylococcus haemolyticus colonizing and causing bacteremia in neonatal intensive care unit patients.

Coagulase-negative staphylococci are now the major cause of bacteremia in neonatal intensive care units. To date, coagulase-negative staphylococci causing neonatal infections have been found to be distinct when typed by standard techniques. To determine whether or not an endemic strain could be identified using more discriminatory techniques, we characterized coagulase-negative staphylococci isolates obtained from a prospective study of coagulase-negative staphylococci bacteremia in a neonatal intensive care unit during 1984 through 1985, by standard techniques supplemented with DNA-DNA hybridization and restriction endonuclease analysis. We typed 58 strains that were isolated from 52 episodes of bacteremia in 38 neonates. There were 46 isolates of Staphylococcus epidermidis. Three pairs of strains were identical, and each strain was from a different patient. There were 12 isolates of Staphylococcus haemolyticus. Ten were identical, referred to as strain TOR-35, and had been isolated from eight different infants. Characterization of strains obtained in 1986 from a prospective study of coagulase-negative staphylococci-colonizing neonates admitted to the same neonatal intensive care unit found the TOR-35 strain had colonized 6 of 17 neonates by day seven. A point prevalence survey of all neonates in the same neonatal intensive care unit in 1990 found 5 of 30 neonates to be colonized with the TOR-35 strain. Therefore, we were able to identify an endemic strain of S haemolyticus that caused multiple episodes of bacteremia during a 6-month period and remained present in the same environment for a 5-year period.

Anti-Bacterial Agents↗
PubMed2004

Clinical experiences of bacteremia caused by metallo-beta-lactamase-producing gram-negative organisms.

The emergence of acquired metallo-beta-lactamase (MBL) in gram-negative bacilli is regarded as a therapeutic challenge since such enzymes are capable of hydrolyzing all beta-lactams in vitro except the monobactams. The clinical characteristics and outcome of 8 episodes of gram-negative bacteremia caused by MBL-producing isolates from January 1997 through December 2000 (Klebsiella pneumoniae, 6 isolates; Pseudomonas stutzeri, 4; Pseudomonas aeruginosa, 1; and Pseudomonas putida, 1) were analyzed. The median age of the patients was 61 years (range, 2-95 years). Most patients (n = 6, 75%) had more than 1 comorbid illness or condition and 6 patients acquired bacteremia in the intensive care unit. The median time from admission to the first positive culture was 34.5 days (range, 1-99 days). Pneumonia was the most common site of infection. Five patients (62.5%) received a carbapenem to treat bacteremia. The median time to defervescence was 6 days (range, 2-12 days). No bacteriologic failure was noted during or after antimicrobial therapy. The overall mortality rate from bacteremia caused by gram-negative, MBL-producing organisms was nil at 14 or 28 days.

Adolescent↗
PubMed2005

Characteristics of Achromobacter xylosoxidans bacteremia in northern Taiwan.

There were 40 cases of Achromobacter xylosoxidans bacteremia during a 6-year period in a medical center in northern Taiwan. Males outnumbered females (72.5% vs 27.5%). Common underlying diseases and conditions in these 40 bacteremic patients were malignancies (57.5%), central venous catheter implants (55%), surgery (35%), neutropenia (30%) and use of steroids (25%). Recurrent bacteremia occurred in 4 patients (10%), all of whom had a central venous catheter implant which was considered the most probable source of infection. More than one-quarter (27.5%) of the cases were community acquired. The mortality rate due to A. xylosoxidans bacteremia was 47.5%. Risk factors significantly associated with mortality were nosocomial acquisition and polymicrobial bacteremia. Disk susceptibility testing showed that these isolates were resistant to aminoglycosides and most cephalosporins but were susceptible to piperacillin, imipenem, ceftazidime and trimethoprim-sulfamethoxazole.

Achromobacter denitrificans↗
PubMed2005

Community-acquired anaerobic bacteremia in adults: one-year experience in a medical center.

A prospective observational study was conducted to evaluate the clinical characteristics and outcome of community-acquired anaerobic bacteremia. From June 1 2001 through May 31 2002, 52 patients with community-acquired anaerobic bacteremia were enrolled at the emergency department in a teaching hospital. There were 19 patients (34%) with polymicrobial bacteremia and Escherichia coli was the most common copathogen (n = 6). Of 62 anaerobic isolates, species of the Bacteroides fragilis group were the most common isolates (n = 28, 45%), followed by Clostridium spp. (n = 11, 18%). Among the 52 patients enrolled, up to 27% had underlying malignancy and the gastrointestinal tract accounted for 48% of the sources of infection. Clinical manifestations suggesting anaerobic infections were common and three-quarters (n = 39) of 52 patients received adequate empirical antimicrobial treatment. Documentation of anaerobic bacteremia seldom influenced antimicrobial treatment. The 30-day mortality was 25%. Although univariate analysis revealed that underlying malignancy (p=0.003), leukopenia (p=0.044) and absence of fever (p=0.047) were associated with mortality, only malignancy (p=0.007) was an independent risk factor in the multivariate analysis.

Academic Medical Centers↗
PubMedDate not supplied

Bacteremia during open septorhinoplasty.

BACKGROUND: In this study, we aimed at determining the incidence of bacteremia during septoplasty and open septorhinoplasty. METHODS: The study included 60 patients (30 septoplasties and 30 open septorhinoplasties). Preoperative nasal cultures from the nasal cavity and vestibule were taken by using swabs, and blood cultures were obtained from peripheral veins preoperatively, intraoperatively, and postoperatively. Blood cultures were evaluated by using the BACTEC method. RESULTS: Neither the blood cultures taken preoperatively nor those obtained postoperatively was positive for any organisms. On the other hand, although the bacterial growth was observed in only one of the blood cultures (3.3%) taken intraoperatively during septoplasty, it was observed in four blood cultures (13.3%) obtained intraoperatively during open septorhinoplasty. CONCLUSION: Our data indicate that a transient bacteremia occurs during open septorhinoplasty. Although this bacteremia is transient and it has not led to any clinical manifestations in our patients, the possibility of bacteremia during this surgery should be kept in mind and necessary precautions should be taken preoperatively in patients with a high risk of cardiovascular infection.

Bacteremia↗