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PubMed2000

A case-referent study on fetal bacteremia and late fetal death of unknown etiology in Lithuania.

BACKGROUND: The objectives were to test the hypothesis that certain strains of microorganisms are present in fetal blood in a significant proportion of parturient women suffering unexplained third trimester fetal death, and to examine the correlation between fetal bacteremia and histologic chorioamnionitis and vasculitis. METHODS: A case-referent study was carried out on 58 pregnant women with fetal death of unknown etiology (cases) and 116 pregnant women at term (referents) with live fetuses. Cultures from maternal endocervix, amniotic fluid, placental homogenate, external ear and blood of newborns were performed in both groups. Histological examination of placentas and fetal membranes was carried out in order to identify chorioamnionitis and chorionic vasculitis. RESULTS: Intrauterine fetal bacteremia was observed in 36% of cases and in 0% of referents (p= 0.001). Escherichia coli was the most common strain, isolated in 21% of fetal blood samples in cases. Extensive histologic chorioamnionitis was observed in 50% of cases with the presence of Escherichia coli in blood of stillborns. Chorionic vasculitis was found in 67% of such cases. Positive significant correlations between isolation of the Escherichia coli from maternal endocervix, amniotic fluid, placenta, fetal ear and blood in stillborns and histological chorioamnionitis and chorionic vasculitis were observed. CONCLUSIONS: Escherichia coli bacteremia was detected in a significant proportion of stillborns suffering a third trimester prelabor death. Fetal bacteremia significantly correlated with histologic signs of inflammation in placenta and membranes. Ascending subclinical intrauterine infection may play an important role in the etiology of otherwise unexplained late prelabor fetal death.

Adult↗
PubMed1975

Sustained bacteremia and transvenous cardiac pacemakers.

Five patients with transvenous cardiac pacemakers had sustained staphylococcal bacteremia (defined as bacteremia for at least 12 hours) two weeks to ten months after pacemaker insertion. Three of the five patients had no evidence of an extravascular focus of infection at the time of stphylococcal bacteremia. An additional patient had a petechial rash, which is unusual in staphylococcal bacteremia, unless endocarditis is present. All patients were treated with antibiotics and drainage of the pacemaker packet when it was infected, removal of the pacemaker generator, or removal of the catheter electrode. One patient without evidence of pocket infection was treated successfully with antibiotic therapy alone.

Acute Disease↗
PubMed1976

Absence of bacteremia after insertion or removal of intrauterine devices.

A prospective study of the risk of bacteremia in 84 women having insertion and in 16 women having removal of intrauterine devices was performed. Bacteremia was not found in any of these 100 women at 1 to 3, 15, or 30 minutes after the procedure or in any of 57 women studied again 1.5 hours later. Because of the remote risk of bacteremia, the presence of congenital or valvular heart disease need not be an absolute contraindication to the use of an intrauterine device for contraception in an otherwise healthy young woman. Prophylactic antimicrobial therapy during insertion or removal of an intrauterine device appears to be unnecessary in the absence of evident pelvic infections. The risk of bacteremia during removal of an intrauterine device from an infected uterus cannot be determined from this study.

Female↗
PubMed1990

Short-course treatment of bacteremia with ceftriaxone monotherapy.

The efficacy of short-course ceftriaxone monotherapy in treatment of bacteremia was evaluated in an open protocol. Patients with laboratory-proven bacteremia were randomly treated with one of three dosing schedules for a duration of 5 to 7 days. Fifty-seven (62%) out of the 92 evaluable infections had successful results. Successful responses were seen in 20 (59%) out of 34 infections given 4 g every 24 hours, 15 (54%) out of 28 given 2 g every 12 hours, and 22 out (73%) of 30 given 2 g every 24 hours. The results showed no significant differences. The cases evaluated as failures were largely due to infections with resistant organisms or inadequate drainage of the primary infectious foci. Forty-nine (94%) of the 52 infections had successful results with one of the short-course treatment regimens, provided that they had no factors indicative of a poor prognosis. We stress the importance of anti-microbial susceptibility and adequate removal of the primary foci in the treatment of bacteremia. Our experience indicates that once-daily administrations of 2 g ceftriaxone as monotherapy is preferred for short-course treatment of bacteremia since it is equally effective, but more economical than higher dose regimens.

Adult↗
PubMed1990

Klebsiella pneumoniae bacteremia: analysis of 100 episodes.

In 1985, 100 episodes of klebsiella pneumoniae bacteremia in 98 patients were treated at the Veterans General Hospital--Taipei. The disease was community acquired in 58% and nosocomially acquired in 42%; unimicrobial in 86% and part of a polymicrobial bacteremia in 14%. Medical records of 90 episodes were available and were analyzed. Portals of entry, in decreasing order of frequency, were hepatobiliary (24%), respiratory (20%), and urinary tract (19%). Diabetes mellitus, which was found in 25 (28%) patients, was the most common underlying disease, followed by malignancies in 13 (14%), biliary tract abnormalities in 9 (10%), and cirrhosis of the liver in 8 (9%). The most frequent clinical findings were fever (89%) and leukocytosis (60%), followed by thrombocytopenia (27%), jaundice secondary to bacteremia (22%) and shock (21%). The course of one (1%) patient, who was diabetic and had a liver abscess, was complicated by metastatic septic endophthalmitis and meningitis. Overall case fatality was 46%. Poor prognostic factors included inappropriate antibiotic therapy, respiratory tract as a portal of entry and the presence of shock. Cephalosporins and aminoglycosides were the most active antibiotics. The use of one or more antibiotics, which included at least one cephalosporin, with in vitro activity against the corresponding isolate, with adequate dosage and an appropriate route of administration significantly reduced deaths directly attributed to K. pneumoniae septicemia, 32% (18/57), compared with 88% (21/24) in patients who were not treated appropriately (p less than 0.001). Combination therapy with a cephalosporin and aminoglycoside in conjunction with surgery in selected cases is the treatment of choice for K. pneumoniae bacteremia.

Adolescent↗
PubMed1991

Temperature and total white blood cell count as indicators of bacteremia.

This study was designed to quantify more precisely the accuracy of magnitude of rectal temperature and total white blood cell (WBC) count as indicators of bacteremia in children with an obvious focal bacterial infection. A total of 955 children, aged 3 to 36 months, who had rectal temperature greater than or equal to 39.0 degrees C and were seeking care at either of two urban pediatric emergency departments had blood drawn for culture; 885 had blood drawn for WBC count. Twenty-seven had bacteremia. Various combinations of temperature and WBC count were selected to construct receiver-operating-characteristic curves by plotting sensitivity vs false-positive rate (1 - specificity). The receiver-operating-characteristic curve of WBC count provided significantly better diagnostic information than the curve for temperature increments above 39.0 degrees C. Each increment of 0.5 degrees C led to large decrements in sensitivity and false-positive rates. At a WBC count cutoff of 10,000/mm3, the sensitivity was 92% while the false-positive rate was 57%. Using this cutoff point, the clinician could have avoided performing 368 of 955 blood cultures and missed only 2 of 26 children with bacteremia. Receiver-operating-characteristic curves combining WBC count and temperature increments above 39.0 degrees C provided no better diagnostic information than that of WBC count at a temperature cutoff of 39.0 degrees C. It is concluded that increments in temperature above 39.0 degrees C provided additional diagnostic specificity for bacteremia only at the expense of unacceptable decreases in sensitivity. Total WBC count provided better information. A WBC count cutoff of 10,000/mm3 increased specificity with minimal decrease in sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1991

[Prospective study of routine screening for cirrhosis and colonic tumors associated with Streptococcus bovis bacteremia].

Between 1987 and 1990, seven patients hospitalized in our hospital had bacteremia caused by Streptococcus bovis. Complete gastrointestinal evaluation was routinely carried out for digestive portal of entry and liver disease screening. In four cases (2 bacteremia, 2 endocarditis), a colonic growth was detected: sigmoid adenoma (n = 1) and rectosigmoid carcinoma (n = 4); in one case (endocarditis), several rectosigmoid carcinomas were associated with alcoholic cirrhosis; in one case (bacteremia), alcoholic cirrhosis was diagnosed; in one case (endocarditis), no gastrointestinal or hepatic portal of entry was found. These cases emphasize the need for simultaneous detection of endocarditis and gastrointestinal portal of entry such as colonic tumor and/or cirrhosis, in case of Streptococcus bovis bacteremia.

Adenocarcinoma↗
PubMed1990

[Clinical importance of bacteremias caused by Acinetobacter calcoaceticus].

Clinical data from patients with Acinetobacter calcoaceticus bacteremia observed during a period of 10 years were retrospectively reviewed. These bacteremias represent the 0.66% of the total number of positive blood cultures observed during the same period of time. The type anitratus was the most common (79.4%) although there were no significant differences in epidemiology, sensitivity, or clinical significance between both types. Only in 55.8% of the cases bacteremia was considered of clinical relevance. Multiple intravenous catheters represented the most important risk factor for bacteremia and site of infection origin (42%). Mortality in this series was about 30% of the cases. Contributions to the high mortality rate were the impossibility to establish an appropriate antimicrobial treatment in most of the cases and the existence of severe underlying diseases. The presence of immunosuppressive therapy or the existence of polymicrobial sepsis did not alter the prognosis. We conclude that once the presence of a blood culture positive to A. calcoaceticus is detected, antimicrobial treatment should be immediately established and investigation on the origin sites should be directed to the existing intravascular catheters.

Acinetobacter Infections↗
PubMed1990

[Bacteremia in the patient with liver cirrhosis. Prospective study of 61 episodes].

We prospectively evaluated 61 episodes of bacteremia in 54 patients with hepatic cirrhosis, representing 9% of the overall number of bacteremic episodes in adult patients seen in our center during the study period. Spontaneous bacteremia represented 46% of all episodes (virtually always in patients with ascites), followed by the urinary origin (30%). Gram negative organisms were isolated in 71% of episodes. 43% of these were hospital-acquired 25% of patients had spontaneous peritonitis. Among other complications of bacteremia there were shock (28%), renal failure (24%), and disseminated intravascular coagulation (6%). The mortality rate due to sepsis was 28%, that due to complications of cirrhosis by itself was 20%, and that of nonrelated diseases was 8%. Shock and renal failure secondary to bacteremia were independent predictors of a poor prognosis.

Acute Kidney Injury↗
PubMed1990

[Early detection of bacteremia in infancy].

The detection of bacteremia in children less than 24 months of age with fever, is very important, since these patients are at serious risk pyogenic complication. The administration of antibiotics in accordance with the results of cultures is too time consuming. So, several laboratory detection bacteremia must be carried out. In this study, blood cultures, the elevation of white blood cell count, toxic granulation and vacuolization in neutrophils were investigated in 56 children with suspicion of bacteremia. 32 of them were males and 24 females. The positive results were obtained in 41.1% in blood cultures. Positive predictive accuracy were 66.6% and 52.3% for vacuolization and toxic granulation respectively. The presence of these were considered as adjunctive procedures in the early diagnosis of bacteremia.

Cytoplasmic Granules↗
PubMed1989

[Bacteremia secondary to decubitus ulcer].

We have prospectively evaluated 16 episodes of bacteremia induced by decubitus ulcers. The most commonly isolated microorganisms were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa and Bacteroides fragilis. Bacteremia was polymicrobial in 5 cases (31%). Most ulcers were already present at the time of admission, but bacteremia developed within the hospital in 13 patients. In 3 patients, ulcers did not show local features of infection. The initial antibiotic therapy was satisfactory in 13 cases. Mortality rate directly associated with bacteremia was 18%, but the overall mortality rate was 62%. We did not identify data permitting a reliable prediction of the findings of blood culture; therefore, the initial empirical therapy should be active against Staphylococcus aureus, Pseudomonas, enteric Gram-negative bacilli and anaerobes including Bacteroides fragilis.

Aged↗
PubMed1989

Dental bacteremia and its relationship to bacterial endocarditis: preventive measures.

This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone. In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated. This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash. The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately. Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens.

Animals↗
PubMed1985

Clostridium perfringens bacteremia. Opportunist or killer?

Clostridia septicemia has traditionally been associated with severe histocytotoxic infections. Recently, due to better anaerobic culture techniques, clostridia bacteremia is seen with increasing frequency in patients without an obvious source of infection. The authors reviewed their experience with 29 patients with clostridia bacteremia. The overall mortality rate was 45 per cent. No obvious source for the clostridia bacteremia was identified in 21 patients (72%). Eighty-three per cent of the patients had polymicrobial infections. The patients were generally debilitated with significant associated systemic disease. Antibiotic therapy did not appear to have any effect on mortality. Patients with asymptomatic clostridial bacteremia are, in general, patients with advanced malignancies and chronic illnesses. Antibiotic therapy appears to have little effect on the patient's outcome.

Adult↗
PubMed1989

[Serious infections in alcoholics. 2. Etiology of bacteremia and meningitis in alcoholics discharged from hospitals in Funen 1981, 1984 and 1986].

In 1981, 1984 and 1986 relatively more episodes of bacteremia with Corynebacterium in one or two tubes out of twelve were found in alcoholics and these normally negligible episodes may be a iatrogenic marker of intubation and esophagoscopy in alcoholics. Definite bacteremic episodes with E. coli, Staphylococcus aureus, Klebsiella, Streptococcus pneumoniae, Proteus, Pseudomonas aeruginosa, Enterobacter, Streptococcus faecalis, haemolytic Streptococcus and Bacteroides were found in 0.79% of alcoholics and 0.37% of non-alcoholics (0.01 greater than p greater than 0.001). The frequency per 100,000 discharged patients with positive blood cultures irrespective of bacteriological diagnosis, and also alcoholic liver cirrhosis was 8.12 = about two thirds of the number of deaths from cirrhosis per year. In selected cases of severe infections in alcoholics, the frequency of cirrhosis or steatosis was 29/48 = 60%. Foci were more often demonstrated bacteriologically in patients without cirrhosis or steatosis (0.01 greater than p greater than 0.001). Bacteremia with Staphylococcus aureus was a complication of treatment 6-18 days from admission, whereas bacteremia with E. coli and Pneumococci was present on admission. Serious bacteremia in alcoholics was not found in patients over 70 years of age and the many geriatric alcoholics (4.7%) did not show a greater morbidity than the average geriatric patient. The mortality of bacteremic alcoholics was more than 45% over a 6-year period.

Alcoholism↗
PubMedDate not supplied

Intraoperative bacteremia during foot surgery.

Numerous studies have shown that bacteremias occur in patients during and immediately after some types of surgeries, placing the patient at risk of serious infection. This study was designed to ascertain whether a bacteremia will exist following routine podiatric surgery. Blood cultures were taken perioperatively from 42 subjects, and were incubated both aerobically and anaerobically, and swabs of the incision were made during the surgery. No bacteremias occurred during this study. This suggests that podiatric surgery, when properly performed, does not present a risk of bacteremia to the patient.

Adolescent↗
PubMed1978

Antiserum treatment of gram-negative bacteremia.

In order to lower the mortality rate from gram-negative bacteremia, 136 patients were treated with human antiserum against core glycolipid, or with control nonimmune human serum, in a double-blind clinical trial. The antiserum was prepared by immunizing healthy young men with a vaccine composed of heat killed cells of the J5 mutant of E. coli 0111 B4. Since the core glycolipid in this mutant is not encumbered with "O" side chains, it can stimulate antibody against the core glycolipid possessed in common by the different species of gram-negative bacteria responsible for lethal bacteremia in patients. No serious reactions occurred in over 300 men receiving this vaccine, and the J5 antiserum gave striking broad-spectrum protection against experimental gram-negative bacteremia and endotoxemia. When human J5 antiserum was administered to seriously ill bacteremic patients, the mortality rate was virtually cut in half, as compared to controls. The death rate from gram-negative bacteremia was 14% in patients treated with J5 antiserum, and 26% in those given nonimmune control human serum. Among patients in profound gram-negative bacteremic shock, the recovery rate rose from 29% in controls to 82% in those treated with J5 antiserum (p = 0.02). On the basis of these encouraging results we propose to treat more bacteremic patients with J5 antiserum, because larger groups are needed to establish the full significance of the initial findings.

Animals↗
PubMed1986

Nosocomial pneumococcal bacteremia.

In five years we studied 56 episodes of pneumococcal bacteremia. Twenty-three (41%) were nosocomial and 33 (59%) community acquired. Most of our patients were elderly men with multiple underlying diseases; however, those patients with nosocomial infections had a significantly higher incidence of malignant neoplasms (57% vs 24%), poor functional status (70% vs 25%), and ultimately fatal underlying disease (61% vs 21%). Alcoholism was more common among the patients with community-acquired bacteremia (45% vs 17%). Nosocomial infections carried a significantly higher overall mortality (73.9% vs 45.4%). The mortality directly related to the pneumococcal bacteremia was also higher (52% vs 39%), but not significantly. Most of the isolated strains were serotypes present in the new pneumococcal vaccine, which only one study patient had received. Mixed pneumococcal bacteremia with gram-negative bacilli was more frequent in nosocomial infections. Streptococcus pneumoniae can be a nosocomial pathogen in elderly, debilitated patients. Pneumococcal vaccination should be incorporated in a hospital-based prevention program for high-risk patients.

Aged↗
PubMed1986

[Meningitis following lumbar puncture in bacteremia?].

We report on two infants with bacteremia and the clinical signs of meningitis who developed overt meningitis following an extended period after the first lumbar puncture, in which inconspicuous (cytological and bacteriological) cerebrospinal fluid were found. The causative infective agents of bacteremia and meningitis were identical. The iatrogenic induction of meningitis by the procedure of lumbar puncture in the presence of a bacteremia is imaginable, but has not been proven. Diagnostic consequences are: Every lumbar puncture for bacterial meningitis has to be complemented with a simultaneous blood culture. Lumbar puncture should be repeated when clinical signs of meningitis persists in children, especially in infants with positive blood culture and with inconspicuous cerebrospinal fluid findings in the initial lumbar puncture. Such children should be hospitalized for clinical observation. Therapeutical consequences are presently unclear. Proven recommendations are lacking for the different possible procedures after initial lumbar puncture in children with suspicion of a bacteremia: for instance no therapy or one single antibiotic dose given i.v. immediately following the lumbar puncture or the same treatment as in proven meningitis until microbiological results are obtained.

Humans↗