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PubMed1987

Staphylococcus aureus bacteremia. Clinical, serologic, and echocardiographic findings in patients with and without endocarditis.

Seventy-two adult patients with Staphylococcus aureus bacteremia were prospectively studied clinically, serologically, and echocardiographically. Multivariate analysis identified four parameters that significantly predicted endocarditis in staphylococcemic patients at time of initial evaluation: absence of a primary site of infection; community acquisition of infection; metastatic sequelae; and valvular vegetations detected by echocardiography. Echocardiography was most predictive of endocarditis in patients with community-acquired S aureus bacteremia from an obvious primary focus. In 11 (69%) of 16 patients with endocarditis and vegetations on two-dimensional echocardiography, this technique also revealed other important findings, including ventricular dilatation, and/or underlying valvular lesions. In 18% of patients with S aureus bacteremia without stigmata of endocarditis, echocardiography provided information that led to a diagnosis of endocarditis and a subsequent change in therapy. Our findings support the routine use of two-dimensional echocardiography in all cases of community-acquired S aureus bacteremia to identify occult endocarditis in patients without classic stigmata of disease, and to provide important prognostic data in clinically apparent endocarditis.

Adult↗
PubMed1984

Polymicrobial bacteremia in pediatric patients.

Of 1,352 positive pediatric blood cultures during a 3.6-year period, two or more microorganisms grew from 72 cultures (5.3%), representing 60 patients. Based on predefined operational criteria for clinical interpretation of blood cultures, these cases were retrospectively classified as polymicrobial bacteremia (each organism, ie, a pathogen, 30%), mixed bacteremia/contaminant (20%), or multiple contaminants (50%). Considered individually, gram-positive organisms were isolated more frequently but were more often judged to be contaminants than the less common gram-negative organisms, which were more often thought to be true pathogens. Although one child did have a combined Streptococcus pneumoniae/Hemophilus influenzae bacteremia, these more common pediatric pathogens were underrepresented in those patients with polymicrobial bacteremia, from whom Enterobacteriaceae, streptococci, staphylococci, and anaerobes were more commonly isolated. Hospitalization for a predisposing illness and/or a focus of infection occurred in 88% of the children with confirmed polymicrobial bacteremia.

Adolescent↗
PubMed1991

Association of interleukin-2 therapy with staphylococcal bacteremia.

The authors prospectively monitored patients undergoing leukapheresis for peripheral stem cell harvesting (PSCH) or lymphokine activated killer (LAK) cell generation for 3 weeks after catheter placement for evidence of local or systemic infections. Over a 1-year period, 16 patients underwent leukapheresis for PSCH in preparation for autologous bone marrow transplantation (ABMT). The original catheters remained in place an average of 20 days without any documented infections. Seventeen patients underwent leukapheresis as part of a low-dose interleukin-2 (IL-2) treatment for LAK cell generation, and their catheters remained in place an average of 20.2 days with three documented episodes of bacteremia (18%). Eight patients treated with high-dose IL-2 also underwent leukapheresis for LAK cell generation and their catheters remained in place an average of 12 days with three documented episodes of bacteremia (38%). In all cases of bacteremia, Staphylococcus species were isolated from the blood. The IL-2 exposure level was associated with the risk of bacteremia (P = 0.01). Other potential risk factors (e.g., number of pheresis procedures, complement level, serum immunoglobulin levels, absolute neutrophil count) were not related to this risk.

Adult↗
PubMed1991

Clostridial bacteremia in cancer patients. A 12-year experience.

Over 12 years, 136 episodes of bacteremia caused by clostridial species were documented. Eighty-three were monomicrobial, and 53 were polymicrobial. Gastrointestinal, genitourinary carcinomas, and acute leukemia were the most common underlying malignancies. Septic shock occurred in 29% of monomicrobial bacteremias and 45% of polymicrobial bacteremias and was associated with a high mortality rate. Acute hemolysis, gas gangrene, and diffuse spreading cellulitis occurred infrequently but were associated with a 100% fatality rate. Many infections caused by Clostridium perfringens and C. septicum were associated with abdominal disease. The most commonly isolated organism was C. perfringens, followed by C. septicum and C. sporogenes. Overall survival was 58%, but it was 66% for monomicrobial episodes and 45% for polymicrobial infections. All of the patients with bacteremia due to an aerobic gram-negative bacillus in addition to the clostridial species died of their infection. The most effective antibiotics were clindamycin, penicillin, metronidazole, and moxalactam. Surgical drainage of abscesses was an important component of therapy.

Adolescent↗
PubMed1990

A model of Staphylococcus aureus bacteremia, septic arthritis, and osteomyelitis in chickens.

We studied the occurrence, magnitude, and kinetics of bacteremia and the resultant osteomyelitis and septic arthritis in an avian model of Staphylococcus aureus infection. Thirty-day-old male broiler chicks were inoculated i.v. with 10(5), 10(6), or 10(7) cfu of strain Duntravis, a beta-hemolytic, coagulase-producing, capsular type 8 isolate from the synovial fluid of a 2-year-old black boy. Bacteremia occurred in 80%, 90%, and 100% of animals inoculated with 10(5), 10(6), or 10(7) cfu, respectively. The magnitude of bacteremia in surviving, bacteremic animals increased for 96 hours after inoculation and then decreased after a plateau phase. Osteomyelitis and septic arthritis occurred only in chicks that were continuously bacteremic. The occurrence of osteomyelitis was uniform among continuously bacteremic animals and developed 1 to 23 hours after inoculation. Chickens are susceptible to systemic infections with S. aureus. Bacteremia, osteomyelitis, and septic arthritis may be induced in healthy chickens without prior manipulations that depress their resistance.

Animals↗
PubMed1990

Bacteremia after injection of esophageal varices.

Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients. The clinical importance of this phenomenon is uncertain. This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia. Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned. In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia. After 4 h, all blood cultures were sterile. No infective complications were identified. Bacteremia appears to be an infrequent and transient event after elective sclerotherapy. Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis.

Adult↗
PubMed1985

Twenty-five year review of Pseudomonas aeruginosa bacteremia in a burn center.

The incidence of Pseudomonas aeruginosa bacteremia was examined in 5,882 burn patients consecutively admitted over a 25-year period to one burn center. The population examined had an average burn size of 33.8% of the body surface and an average age of 26.3 years. Pseudomonas aeruginosa bacteremia occurred in 540 patients. These patients had an average burn size of 54.2% and average age of 28 years. Mortality was 77%. Bacteremia with other organisms occurred during hospitalization of all but 128 of the 540 patients. Comparison of predicted mortality based on burn size and age to observed mortality showed Pseudomonas aeruginosa bacteremia to be associated with a 28% increase in mortality. Examination of mortality as a function of time showed no significant change over the 25-year period. The incidence of Pseudomonas aeruginosa colonization and infection was examined in 400 recently admitted burn patients. Colonization occurred in 107 and 34 infections were recorded in 27 of the colonized patients.

Adult↗
PubMedDate not supplied

Endotoxemia in febrile patients with hematological malignancies. Relationship of type of bacteremia, clinical findings and serum cytokine pattern.

The relation between gram-negative bacteremia, endotoxemia and cytokinemia in patients with hematological malignancies was studied. Serum endotoxin and cytokines (tumor necrosis factor-alpha, interleukin-1 receptor antagonist, interferon-gamma, interleukin-6 and interleukin-10) were determined in 24 patients with hematological malignancies. Patients were included at start of fever (n = 18) or during a temperature peak during continuous fever (n = 6; time = 0). Blood was drawn for cultures at time of inclusion. Additional samples were obtained and grouped in two time intervals (1-5 h and 6-12 h after inclusion). Endotoxin was detected in eight patients. Endotoxemia was more common among patients with bacteremia than among non-bacteremic patients (7/12 versus 1/12; p < 0.05). All studied cytokines showed a tendency to higher mean values at time 0 in patients with endotoxemia than in patients without endotoxemia. Significantly higher mean endotoxin values were seen at time 1-5 h in patients with gram-negative bacteremia (n = 6) than in patients without gram-negative bacteremia, and at time 0 in patients with chills (n = 6) compared to those without chills.

Adult↗
PubMed2001

Group B streptococcal bacteremia in nonpregnant adults with hepatic disease in Korea.

Sixty-seven cases of group B streptococcal bacteremia in adults were retrospectively reviewed during the period 1991-2000. Not one case occurred in pregnant women. The mean age of the patients was 57 years, and 67.2% were men. Of the 67 cases of illness, 25.4% were hospital acquired and 11.9% were polymicrobial. Common predisposing diseases included hepatic disease (55.2%), diabetes mellitus (28.4%), malignancy (20.9%), and cardiovascular diseases (17.9%). Primary bacteremia, peritonitis, bone and joint infections, and skin and soft tissue infections accounted for most presentations. Peritonitis was a more common presentation in patients with hepatic disease (P<0.001), whereas skin and soft tissue infection was more common in patients with non-hepatic disease (P=0.008). More patients with hepatic disease had polymicrobial bacteremia than did patients with nonhepatic disease (P=0.018). Death occurred in 9.8% of cases, and mortality did not differ between patients with hepatic disease and those with nonhepatic disease. Hepatic disease was found to be an important predisposing condition in adults with group B streptococcal bacteremia. However, mortality for patients with hepatic disease was similar to that for patients with nonhepatic disease.

Adult↗
PubMed1977

Pseudomonas aeruginosa bacteremia in a dialysis unit. 11. Relationship to reuse of coils.

Blood for culture was obtained over a six week period from 17 patients undergoing long-term hemodialysis. Bacteremia was detected during 18 of 201 dialyses. Blood drawn during fifteen of these dialyses contained pseudomonas aeruginosa. Ten of the 17 patients (59 per cent) had a Pseudomonas bacteremia some time during the study. Only one patient was symptomatic. The frequency of positive cultures was related to reuse of coils. No cultures were positive until after the fifth use, but by the tenth use, 41 per cent of the dialyses were associated with bacteremia. All coils that were used repeatedly and 32 of 48 of those used only once, grew Ps. aeruginosa when filled with media and incubated. This suggests that the coils were inoculated during dialysis and that benzalkonium chloride, the sterilizing agent, was unable to eradicate this organism. With repeated uses, the number of residual bacteria in the coil became large enough to cause detectable bacteremia during dialysis.

Cross Infection↗
PubMed1979

Clostridium septicum bacteremia. Its clinical significance.

The medical records of 59 patients with Clostridium septicum bacteremia were reviewed; 42 (71 per cent) of these patients had malignancies. One half had hematologic malignancies, and one half had solid tumors. Of the 21 patients with solid tumors, 14 (67 per cent) had cancer of the colon. Among these patients, the cecum was the most frequent site of malignancy. The cecum and distal ileum were the most probable portals of entry for C. septicum bacteremia among the 28 patients examined at autopsy. Patients admitted to the hospital with C. septicum bacteremia usually have fulminating clinical courses and, unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. The results of this study demonstrate the high association of C. septicum bacteremia and malignancy, and the need for early recognition and therapy.

Adolescent↗
PubMed1980

Improved prognosis for granulocytopenic patients with gram-negative bacteremia.

The grave prognosis associated with gram-negative bacteremia occurring in granulocytopenic patients with cancer suggests that granulocyte transfusions are frequently indicated. We have evaluated 67 episodes of gram-negative bacteremia, studied in four consecutive antibiotic trials, in order to correlate prognostic determinants of recovery. These patients had a median absolute granulocyte count of 100/microliter at the time of bacteremia. Empiric antibiotic regimens were begun at the first evidence of suspected infection. Granulocyte transfusions were employed only as clinically indicated by inadequate patient response to antibiotic therapy. Among the 29 patients who had an increase in their granulocyte count of greater than or equal to 100/microliter over the subsequent 14 days, 27 (93 per cent) recovered whereas among 38 patients who had no appreciable increase in their granulocyte count, 21 (55 per cent) improved (p = 0.006). In this latter group of patients with no granulocyte recovery, the susceptibility of the pathogen(s) to the initial empiric antibiotic regimen was of major importance. None of four patients responded when the pathogen was resistant to both antibiotics initially utilized, six of 14 (44 per cent) patients responded when there was susceptibility to one antibiotic, and 15 of 20 (75 per cent) patients responded when there was susceptibility to both antibiotics (p less than 0.025). We conclude that patients with gram-negative bacteremia and persistent granulocytopenia will often respond to antimicrobial therapy alone provided the initial choice of empiric antibiotics is appropriate and that their use is instituted promptly. Granulocyte transfusions need not be added unless clinical evaluation indicates inadequate response.

Agranulocytosis↗
PubMed1984

Clinical importance of "breakthrough" bacteremia.

Fifty-one episodes of bacteremia and a single episode of fungemia occurred during treatment with seemingly adequate doses of appropriate antibiotics. Clinical findings in these "breakthrough" bacteremias and fungemia were compared with those in 448 non-breakthrough episodes. Breakthrough was more likely to be caused by facultative or aerobic gram-negative rods (e.g., Enterobacteriaceae and Pseudomonas species) than by anaerobes. Of the underlying conditions examined, immunosuppressive doses of glucocorticosteroids, diabetes mellitus, and moderate renal failure were significantly more frequent in patients with breakthrough. A significant association was also observed between an intra-abdominal primary focus of infection (abscesses, biliary tract or bowel infections) and the occurrence of breakthrough. Mortality in breakthrough bacteremia was 61 percent compared with 40 percent in non-breakthrough episodes. The phenomenon of breakthrough bacteremia shows the potential limitations of antibiotic therapy alone.

Adult↗
PubMed1975

Bacteremia on an obstetric-gynecologic service.

In a one-year evaluation of the Obstetric-Gynecologic Services of the Los Angeles County University of Southern California Medical Center, bacteremia was confirmed on 144 occasions in 139 patients. This represented an over-all incidence of 7/1,000 admissions with gram-negative bacteremia observed in 3.1/1,000 admissions. There were four deaths in this series. The most frequently recovered aerobes were Escherichia coli, enterococci, and beta hemolytic streptococci, not Group A or D, while the most commonly isolated anaerobes were peptostreptococci, peptococci, and Bacteroides. These patterns of bacterial isolation should be acknowledged in antibiotic strategies for septic patients. There is a positive correlation between the incidence of intrapartum maternal and fetal monitoring and postpartum maternal bacteremia. The oncology patients were the most seriously ill women with bacteremia.

Adolescent↗
PubMed1989

Impaired clearance of Escherichia coli bacteremia in early biliary obstruction.

Adult male rats underwent common bile duct ligation or sham celiotomy. At intervals of 7 and 14 days postoperatively, bacteremia was induced by intravenous injection of 10(9) Escherichia coli or intraperitoneal injection of 10(6) E. coli. Serial quantitative blood cultures and quantitative whole organ cultures were obtained. One week after surgery, clearance of bacteremia was impaired in all of the animals. Clearance of intraperitoneally injected E. coli was less efficient in the duct ligation rats. Fourteen days postoperatively, clearance of bacteremia induced by intravenous or intraperitoneal injection had improved in the sham celiotomy rats but was still significantly impaired in the duct ligation rats. An increased number of viable E. coli were recovered from the lungs of duct ligation rats after intravenous administration. We found that rats with obstructive jaundice do not respond normally to a bacteremia challenge. This impairment in reticuloendothelial function can be noted as early as 1 week after common duct ligation.

Animals↗
PubMed1983

An investigation of enterococcal bacteremia.

Records of all 34 patients with positive blood cultures for enterococcus at Mount Sinai Medical Center of Greater Miami in 1981 were reviewed. Twenty-four true bacteremias were identified from sources including the pelvis/abdomen (9), urinary tract (6), wounds (2), IV catheter (2), contaminated needle (1), endocarditis (1), and primary bacteremia (3). Sixteen of the 24 true bacteremias were hospital acquired, and these infections accounted for 7 of 9 (78%) fatal outcomes. Fourteen of 16 patients with hospital-acquired infection received prior antibiotic therapy. Eight (24%) of the original 34 patients had positive blood cultures for enterococcus as a result of cross-contamination from an automated blood culture analyzer. The rate of cross-contamination per positive blood culture for enterococcus in 1981 was 22%. Two remaining patients in the original series could not be placed in a category of true infection or cross-contaminant. Although there was a real increase in the number of enterococcal bacteremias in 1981, a much larger apparent increase was explained by several episodes of pseudobacteremia.

Anti-Bacterial Agents↗
PubMed1989

Sporadic bacteremia complicating central venous catheter use in a community hospital: a model to predict frequency and aid in decision-making for initiation of investigation.

Sporadic bacteremia complicating single-lumen central venous catheter (CVC) use was prospectively recorded in a community hospital in 1981 and 1982. Sixty-four of 1258 (5.1%) patients had definite bacteremia. A nested case-control study was then undertaken to identify predictive risk factors. Fifteen statistically significant factors found in the 1981 cohort were tested in the 1982 cohort, and four remained significant for both years. Univariate and multiple logistic regression analysis on both years' findings, separately and together, identified two independently associated factors: diagnosed respiratory colonization/infection (p less than 0.0001) and serum albumin level (p less than 0.001). Based on these factors, an equation was developed to express the probability of bacteremia. Solving this equation provides an infection control practitioner with an expected rate of bacteremia that complicates CVC use and provides an aid for decision-making for investigation in the absence of clusters.

Catheterization, Central Venous↗
PubMed1986

Clinical importance of polymicrobial bacteremia.

Ninety-one episodes of polymicrobial bacteremia and fungemia were compared with 407 unimicrobial episodes to assess differences in the microbiological, epidemiological, and clinical features of the two syndromes. Enterobacteriaceae, nongroup A streptococci, anaerobic bacteria, and pseudomonads were disproportionately common in polymicrobial bacteremia. Polymicrobial episodes were significantly more likely to be hospital-acquired, to emanate from bowel or multiple foci, and to occur in patients with nonhematologic malignancies or multiple underlying diseases. Deaths directly related to sepsis were twofold higher in polymicrobial versus unimicrobial bacteremia. Factors associated with increased mortality in polymicrobial sepsis included age greater than 40 yr; absent or diminished febrile response to sepsis; absolute granulocytopenia; inadequate antimicrobial therapy for all microorganisms isolated; and a primary focus of infection in the bowel, the respiratory tract, an abscess, or an occult site. The occurrence and type of polymicrobial bacteremia can suggest a source of sepsis as well as additional diagnostic and therapeutic maneuvers.

Abscess↗