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PubMed1982

Detection of fungemia obscured by concomitant bacteremia: in vitro and in vivo studies.

Our recent clinical experience suggested that bacteremia may interfere with the detection of concomitant fungemia when standard blood culture methods are used. To determine the extent to which bacteria may interfere with fungal isolation from blood cultures, an in vitro model simulating blood cultures taken during concomitant fungemia and bacteremia was created. Each of six bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus faecalis, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) was combined with each of three pathogenic yeasts (Candida albicans, Candida tropicalis, and Torulopsis glabrata) in vented blood culture bottles containing enriched brain heart infusion broth and fresh normal human blood. Blood culture bottles were analyzed at 1, 2, and 7 days of incubation. Gram strains and subcultures onto chocolate and MacConkey agars failed to detect fungi in 37.0, 66.7, and 100% of samples, respectively. However, subcultures onto Sabouraud dextrose agar failed in only 13% of the samples (occurring only with P. aeruginosa). In a rabbit model of concomitant fungemia with C. albicans and bacteremia with P. aeruginosa, no yeasts were recovered from blood cultures despite 100% detection of P. aeruginosa. Therefore, the usual microbiological techniques may be inadequate to detect fungemia when concomitant bacteremia is present.

Animals↗
PubMed1987

Clinical features and therapeutic interventions in 17 cases of Bacillus bacteremia in an immunosuppressed patient population.

We retrospectively examined episodes of Bacillus bacteremia at a hospital with a large proportion of immunosuppressed patients. Seventeen episodes in 9.5 years met our case definition: two of two bottles of one blood culture or one of two bottles of two or more separately obtained blood cultures drawn on the same date. During the same period, there were 59 additional episodes in which a single blood culture had only one of two bottles positive for Bacillus species. Only 2 of 59 such episodes resulted in recurrent bacteremia (3%), as compared with 5 of 17 episodes meeting our case definition (29%) (P = 0.004). In four of five episodes complicated by recurrent bacteremia and in which appropriate antibiotics were used, a Hickman-Broviac catheter was in place and was not removed. We suggest that our case definition permits the differentiation of infection from contamination based on outcome and that patients with Bacillus bacteremia have chronic venous catheters removed as well as receive antibiotic treatment.

Adolescent↗
PubMed1976

Polymicrobic bacteriuria: significant association with bacteremia.

Current clinical practice states that a urine culture yielding three or more isolates must be considered a contaminated specimen and discarded. The validity of this practice was tested by reviewing all patients at the West Haven Veterans Administration Hospital with positive blood cultures for 1 year to determine how many were associated with polymicrobic bacteriuria (two or more urine isolates each present at greater than 10(5) colonies/ml). During 1973 there were 18 patients who had bacteremia associated with a urinary tract infection in which the same organism with the identical antibiogram was found in both the blood and the urine of these 18 patients with monomicrobic bacteremia 11(61%) had polymicrobic bacteriuria, with a mean of an additional 1.75 urinary pathogens present in significant quantities. In these patients with polymicrobic bacteriuria, an indwelling bladder catheter was present for a mean period of 4.4 months before the episode of bacteremia. Only 5 of the 11 patients with polymicrobic bacteriuria had temporally associated urinary tract manipulation. Monomicrobic bacteriuria occurred in seven patients (39%). The mean indwelling bladder catheter time was 0.9 days, and urinary tract manipulation near the time of bacteremia occurred in all seven patients. Prospectively, nine other patients with polymicrobic bacteriuria were recultured by one of us to be certain that appropriate collection and transportation methods were used; the presence of polymicrobic bacteriuria was repeatedly demonstrated in 7(78%). This study illustrates the clinical importance of polymicrobic bacteriuria.

Aged↗
PubMed1988

Pulmonary and peripheral lymph protein clearance during bacteremia after surgery.

An increase in pulmonary transvascular protein clearance is seen in sheep following postoperative bacteremia. We evaluated whether this increased protein clearance is specific for the lung by comparing in sheep the effect of postoperative bacteremia on both pulmonary and prefemoral lymph protein clearance. Fibronectin, implicated as a factor influencing vascular permeability, was also measured. After intravenous infusion of a sublethal dose of 5 x 10(8) live Pseudomonas aeruginosa (n = 10), pulmonary lymph flow (QL) increased 146% (P less than 0.01), and the lung lymph-to-plasma (L/P) total protein concentration ratio increased 21% (P less than 0.05). This resulted in a 208% elevation (P less than 0.01) in lung protein clearance (LPC = QL x L/P). In contrast, peripheral lymph flow and peripheral protein clearance were not altered. After intravenous infusion of a lethal dose of 5 x 10(9) live Pseudomonas (n = 7), QL rose 243-348% (P less than 0.025), whereas the lung L/P remained at base line, resulting in a 240-358% increase in LPC (P less than 0.025). Again, peripheral lymph flow and protein clearance did not increase. Plasma fibronectin declined slightly after low-dose bacterial challenge but decreased (P less than 0.001) 40% by 4-5 h after high-dose bacterial challenge. After both low- and high-dose bacterial challenge, fibronectin in pulmonary lymph increased (P less than 0.05) relative to total protein. In contrast, no change in peripheral lymph fibronectin was seen. Thus, while postoperative bacteremia increased lung protein clearance, it did not increase peripheral protein clearance, suggesting specificity with regard to the microvascular response to bacteremia.

Animals↗
PubMed1990

Prostaglandins mediate skeletal muscle arteriole dilation in hyperdynamic bacteremia.

Live Escherichia coli bacteremia during the high cardiac output (hyperdynamic) phase of sepsis causes constriction of large arterioles but dilation of small arterioles in skeletal muscle. This study examines the role of dilator prostaglandins, serotonin, and histamine in these differential microvascular responses in the decerebrate rat that avoids the effects of drug anesthesia. Topical application of meclofenamate, a prostaglandin synthesis inhibitor, to the cremaster muscle 60 min after induction of E. coli bacteremia enhanced the constriction of large arterioles from 20 +/- 8 to 46 +/- 9% less than baseline and blunted the dilation of small arterioles from 39 +/- 9 to 17 +/- 7% above baseline values in the cremaster microcirculation. Induction of E. coli bacteremia after pretreatment of the cremaster with meclofenamate constricted large arterioles to 40 +/- 4% less than baseline and small arterioles to 31 +/- 4% less than baseline. This indicates that prostaglandins initiate small arteriole dilation in response to E. coli, but some other dilator factor is activated by prostaglandins to maintain small arteriole dilation during E. coli bacteremia. Topical application of cyproheptadine, an antagonist of both histamine and serotonin receptors, to the cremaster muscle did not alter the E. coli-induced constriction of large arterioles or the dilation of small arterioles in the cremaster microcirculation.

Animals↗
PubMed1990

Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center.

During the period from April 4, 1988, to April 20, 1988, nine pyrogenic reactions and five gram-negative bacteremias occurred in 11 patients undergoing dialysis. All pyrogenic reactions and gram-negative bacteremias occurred among patients in whom a reprocessed dialyzer was used. The rate of pyrogenic reactions or bacteremias per 100 sessions using a reprocessed dialyzer was higher than in sessions during which a new dialyzer was used (4.5 vs. 0; p = 0.03). Dialyzers were manually reprocessed with 2.5% Renalin germicide. The Renalin concentrations varied widely in 12 dialyzers stored after manual reprocessing during the epidemic period (0.9-4.2%); the median endotoxin concentrations varied from 0 to 246 ng/ml and were higher in dialyzers with Renalin concentrations less than or equal to 1.0% than in dialyzers with higher concentrations (p = 0.01). Experiments using a dilution technique described by a technician resulted in Renalin concentrations ranging from 1.4% at the surface to 3.5% at the bottom of the preparation container. These findings suggest that failure to adequately admix Renalin during dilution may be associated with low levels of disinfectant, high levels of bacteria and endotoxins in dialyzers, and outbreaks of pyrogenic reactions and gram-negative bacteremias in dialysis patients.

Acetic Acid↗
PubMed1978

Anaerobic bacteremia as observed in a children's hospital. Clinically this may signify true anaerobic sepsis.

To ascertain the significance of anaerobic bacteremia in a children's hospital, the records of all patients whose blood cultures grew anaerobes during a 24-month period were reviewed. Anaerobes were isolated from 144 out of 1,126 blood cultures yielding bacteria. Anaerobic diphtheroid grew in 122 out of 143 anaerobic cultures, but only 4 out of 122 were isolated from patients with anaerobic sepsis. Nine per cent of the total episodes of anaerobic bacteremia occurred in 13 children who met out criteria for anaerobic sepsis; two oor more blood cultures obtained within a three-day period growing anaerobic bacteria, or an aerobe and an anaerobe, in a febrile child or one with an apparent infectious focus. Bacteroides accounted for 7 out of 13 (64 per cent) of the relevant isolates, while anaerobic diphtheroids 4 out of 13 (26 per cent) and anaerobic gram-positive cocci accounted for the remainder 2 out of 13 (18 per cent). Only one infant, with polymicrobial bacteremia, died, suggesting that anaerobic bacteremia is associated with less mortality in children than in adults. Anaerobic sepsis occurred in children who have had recent abdominal surgery, or who are immunosuppressed.

Adolescent↗
PubMed1980

Bacteremia in patients with cystic fibrosis.

Bacteremia in patients with cystic fibrosis (CF) has not been previously reported, a fact probably attributable to activated systemic immunity in the presence of chronic bronchopulmonary infection. We have observed two CF patients under a year of age with documented bacteremia, and a teen-aged patient with autopsy evidence of premortem bacteremia. Organisms were Staphylococcus aureus, Serratia marcescens, and Pseudomonas aeruginosa, having presumably spread from the lower respiratory tract in both patients. None of the patients had historical or laboratory evidence of immunodeficiency. The true incidence of bacteremia in CF patients is unknown, and the circumstances under which it occurs have not yet been defined.

Adolescent↗
PubMed1982

Occult bacteremia in toxic-appearing, febrile infants. A prospective clinical study in an office setting.

The prevalence of occult bacteremia was evaluated prospectively in two groups of infants: those with a toxic appearance and temperature greater than 38.8 C and a comparison group with similar fever but without a toxic appearance. All patients were diagnosed by one physician employed in a suburban, middle-class, private ambulatory pediatric practice. Toxicity scores were assigned based on the results of history and physical examination. Peripheral white blood cell (WBC) counts and blood cultures were obtained for every child. Of 52 toxic infants involved in the study, an infectious source, commonly otitis media, was found in 26 (50%). Eighteen patients (35%) had WBC counts above 15,000. Bacteremia was documented in six patients (12%), due to Streptococcus pneumoniae in five and to group C Streptococcus in one. Five bacteremic infants had toxic, febrile illnesses for which no overt focus could be identified. None of 31 febrile infants without a toxic appearance had bacteremia. We conclude that highly febrile, toxic-appearing infants are at risk for occult bacteremia even when they are seen in the pediatrician's office. Toxicity diagnosed on the basis of clinical findings in a febrile infant warrants obtaining a white blood cell count and a blood culture.

Ambulatory Care↗
PubMed1991

Enterobacter cloacae bacteremia in children: a review of 30 cases in 12 years.

A review was performed of the 30 cases of pediatric Enterobacter cloacae (EBC) bacteremia which occurred at our institution during a 12-year period. These 30 cases represented 88% of all cases in which EBC was isolated by blood culture (four other instances were considered contaminants); the rate of isolation of this organism relative to all positive blood cultures was 0.6%. There were 14 patients less than 12 months of age, with 10 less than 2 months of age. Infection was nosocomially-acquired in 17 cases. At the time the positive blood culture was obtained, 5 patients were afebrile, and 8 patients (five immunocompromised) had been receiving parenteral antibiotic therapy to which the organism exhibited in-vitro sensitivity for at least 24 hours. EBC was a constituent of polymicrobial bacteremia in 6 cases; in 5 instances the associated organisms were also gram-negative bacteria. There were a total of 33 underlying medical conditions or foci of infection associated with EBC bacteremia identified in 27 patients, the most common of which were immune-deficiency state (17) and gastrointestinal tract lesions (6). There were 3 patients who died. EBC bacteremia is a relatively rare pediatric infection. It is commonly nosocomially-acquired, and afflicts children who are younger-aged or compromised by underlying medical problems.

Anti-Bacterial Agents↗
PubMedDate not supplied

Availability, wishful thinking, and physicians' diagnostic judgments for patients with suspected bacteremia.

A prospective cohort study was done to assess the effects of value bias and the inappropriate use of the availability heuristic on physicians' judgments of the probability of bacteremia. Subjects of the study were 227 medical inpatients in a university hospital who had blood cultures done. Estimates of the probabilities that individual patients would have positive blood cultures were collected from the house officers who ordered the cultures. Clinical data and culture results were also obtained. Based on the data the authors calculated "value variables," reflecting doctors' assessments of the risks that individual patients would die in the hospital if they were to have bacteremia. "Recalled experience variables" reflected the doctors' recollections of recent experiences with patients with bacteremia. The physicians significantly overestimated the likelihood of bacteremia for most of their patients. Their ROC curve for this diagnosis showed moderate discriminating ability (area = 0.687, SE = 0.073). Two recalled experience variables were significantly associated with the physicians' probability estimates. The value variables were significantly inversely associated with them. These relationships were independent of several clinical variables and measures of disease severity. The physicians' intuitive diagnostic judgments were thus influenced by the availability heuristic and by wishful thinking, a form of the value bias. The availability heuristic may mislead physicians by causing them to believe that random variations in the prevalence of a nonepidemic disease represent real trends. Wishful thinking may lead physicians to underestimate the likelihood of a disease for patients most at risk for its consequences. Teaching physicians to develop better judgmental strategies may improve the quality of their judgments and hence their patient care.

Anti-Bacterial Agents↗
PubMed2003

Endotoxemia and Gram-negative bacteremia as predictors of outcome in sepsis: a meta-analysis using ROC curves.

The prognostic value of the detection of endotoxin in plasma of patients with suspected Gram-negative sepsis is unclear despite numerous studies. Sixteen studies have reported endotoxemia detection and blood culture results with outcome data for 1937 patients with suspected Gram-negative sepsis. Comparisons of the fatality rates for the subgroups of patients with, respectively, either endotoxemia (group 3), or Gram-negative bacteremia (group 2), or both detected (group 1), versus the fatality rate for the subgroup of patients with these factors absent (group 4), were made based on summary odds ratios (and 95% CI). Summary odds ratios for the comparison of group 2 versus group 4 and group 3 versus group 4 were non-significant (2.2; 0.9-5.8 and 2.0; 0.8-4.8, respectively). The summary odds ratio was significant for group 1 versus group 4 (3.6; 2.1-6.3), and more so among studies in which non-Enterobacteriaceae were common among the Gram-negative blood culture isolates (4.8; 2.1-10.7). Endotoxemia, like Gram-negative bacteremia, is a weak prognostic indicator. Endotoxemia appears to have most prognostic significance when it is detected in the co-presence of Gram-negative bacteremia. The differing interpretations among published studies could be attributed to the variability in types of Gram-negative bacteremia observed.

Endotoxemia↗
PubMed1978

Bacteremia during barium enema study.

The occurrence of bacteremia was studied in patients undergoing barium enema. Blood cultures were done on 34 patients before, during, and after the procedure using two schedules. Cultures were obtained once during the procedure in the first schedule and four times in the second. None of the cultures were positive by the first schedule, while 23% of patients studied by the second schedule had one or more positive cultures. Organisms isolated were anaerobes. The bacteremia was transient and self-limited, without serious clinical sequelae. The incidence of bacteremia during barium enema examination was statistically indistinguishable from bacteremia previously reported during colonscopy. It is concluded that antibiotic prophylaxis is not indicated in most patients undergoing colonic diagnostic procedures. Prophylaxis in selected high-risk patients requires further study.

Adult↗
PubMed1986

Bacteremia following transurethral instrumentation. The predictive value of a serum bactericidal activity test.

The bacteremic rate following transurethral instrumentation and the possibility of a serum bactericidal activity test to predict which patients that were at an increased risk of developing bacteremia was evaluated. Of 33 investigated patients, all elderly men, 14 underwent transurethral prostatic resection, 14 cystoscopy and 5 urethrotomy. None of the patients received prophylactic antibiotic treatment. The majority (97%) of the patients had bacteria isolated from the urinary tract before the instrumentation. Gram-positive cocci accounted for about two thirds (64%) and Gram-negative rods for about one third (31%) of all isolates. The most frequent species isolated were coagulase negative staphylococci (29%), Streptococcus faecalis (19%) and Klebsiella pneumoniae (12%). The bacteremic rate was 21%. None of the patients developed septicemia. Forty-four per cent of the patients with greater than or equal to 10(5) colony forming units/ml (cfu/ml) in urine developed bacteremia compared with 8% in patients with a sterile urine or less than 10(5) cfu/ml in urine (p less than 0.05). The urethral/prostatic flora was the source of bacteremia in at least one patient. Eighty-one per cent of the isolated strains were serum resistant. About half (54%) of the Gram-negative rods were more or less sensitive against actual, fresh patient serum. All Gram-positive cocci were resistant. There was no difference in the serum sensitivity between bacteria isolated from bacteremic patients and non-bacteremic patients. In conclusion, this study confirmed the relative high risk of developing bacteremia following transurethral instrumentation, especially if the urine is infected.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1975

Bacteremia: the significance of outside versus inside hospital origin.

168 patients with bacteremia seen in 1965-1969 were studied with regard to mortality rate, age and sex distribution, sources of infection, predisposing factors and infecting organisms. Special attention was drawn to outside hospital originating bacteremia vis-a-vis hospital-acquired bacteremia. In general, the results obtained were essentially in agreement with earlier experiences elsewhere. The most striking observations were, firstly, the grave prognosis associated with hospital-acquired bacteremia and, secondly, the dominant role played by gram-negative bacilli.

Adolescent↗
PubMed1985

Recurrent Salmonella typhimurium bacteremia associated with the acquired immunodeficiency syndrome.

Seven Haitian and one white patient with the acquired immunodeficiency syndrome and Salmonella typhimurium bacteremia were identified over a 28-month period. In three patients bacteremia developed concurrently with an opportunistic infection associated with the acquired immunodeficiency syndrome. The remaining five patients had their initial episodes of bacteremia 3 to 11 months before the diagnosis of the acquired immunodeficiency syndrome. These five patients had signs suggestive of the syndrome, plus evidence of disordered cellular immune function (lymphopenia, anergy, decreased T-helper cells, decreased proliferative responses, and a deficiency in mononuclear-cell alpha interferon production). Salmonella typhimurium bacteremia in the appropriate clinical setting may be an opportunistic pathogen associated with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1975

Bacteremia with upper gastrointestinal endoscopy.

Fifty patients undergoing upper gastrointestinal fiberoptic endoscopy were studied prospectively for the development of bacteremia by aerobic and anerobic blood cultures obtained before, during, and at 5 and 30 minutes after the procedure. Forty-six patients were culture negative; four had positive cultures at 5 or 30 minutes after the procedure, or at both times. The level of bacteremia as estimated by pour plates was very low. Bacteremia did not correlate with the performance of biopsy or the type of mucosal abnormality found. It is concluded that only very high-risk patients should receive antimicrobial prophylaxis before this procedure. The minor risk of this low-level bacteremia should not be considered a contraindication to the performance of upper gastrointestinal endoscopy.

Duodenal Diseases↗
PubMed1999

[Excess length of stay attributable to nosocomial bacteremia: usefulness of the Hospitalization Appropriateness Protocol].

BACKGROUND: To evaluate the usefulness of the Appropriateness Evaluation Protocol (AEP) for assessing the extra length of stay attributable to nosocomial bacteremia. PATIENTS AND METHODS: Retrospective review of the medical records (1989, 1990 and 1991) of all patients, who developed Staphylococcus aureus nosocomial bacteremia. Evaluation of hospital stay was performed using the AEP. Calculation of the kappa index and intraclass correlation coefficient. RESULTS: A total of 158 patients were included S. aureus nosocomial bacteremia is responsible for a mean excess length of stay of 4.3 days per patient. Kappa index for the method used was 76%, and intraclass correlation coefficient was 61%. CONCLUSIONS: The AEP has been shown to be a reliable tool for assessing the extra days of stay attributable to nosocomial bacteremia in the Spanish National Health System. The use of AEP should be extended to assess the extra stay attributable to other types of nosocomial infections.

Adult↗