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PubMed1985

Cefoxitin resistance in community-acquired gram-negative bacillary bacteremia. Associated clinical risk factors.

Among 185 patients with nonneutropenic, community-acquired gram-negative bacillary bacteremias, clinical risk factors for cefoxitin resistance included any antibiotic taken within the last three weeks (25.6% cefoxitin resistance), long-term bladder catheterization or surgical urinary diversion (23.3%), hospitalization within the last 30 days (22.9%), and nursing home residence before admission (20.8%). Patients with none of these risk factors were less likely to have cefoxitin-resistant bacteremias (0.9%). When these risk factors were examined in the subgroups of urinary tract and non-urinary tract sources of community-acquired gram-negative bacillary bacteremia, they were also helpful in predicting sensitivity to trimethoprim-sulfamethoxazole and gentamicin. The presence of one or more of the risk factors identified may be a useful adjunct in determining initial empiric antimicrobial therapy for community-acquired gram-negative bacillary bacteremia.

Cefoxitin↗
PubMed1985

Netilmicin in the treatment of Pseudomonas bacteremia.

The effectiveness of netilmicin was evaluated retrospectively in 40 patients with culture-documented bacteremia due to Pseudomonas aeruginosa. Netilmicin was the only antibiotic active in vitro against P aeruginosa that was administered to these patients. In 18 patients, Pseudomonas bacteremia developed in association with a Pseudomonas infection of the urinary tract; in 22 patients, Pseudomonas bacteremia developed from nonurinary or unknown sources. A clinical resolution or improvement was observed in 92% of the evaluable patients, and P aeruginosa was eliminated from the blood of 90% of the patients. The drug had nephrotoxic effects in two patients, but in no patient was there subjective or audiometric evidence of ototoxic effects. Three patients died during therapy. Based on these data, netilmicin is effective, and is associated with a low incidence of toxic effects, in the treatment of patients with Pseudomonas bacteremia.

Female↗
PubMedDate not supplied

Coagulase-negative Staphylococcus bacteremia--a rising threat in the newborn infant.

Based on a three year surveillance in the neonatal intensive and transitional care nurseries (NICU) at the Hospital of the University of Pennsylvania (HUP), an analysis of all cases of nosocomial bacteremia was made. From January 1982 to September 1984, a total of 57 nosocomial bacteremic episodes were identified. This gave a rate of 3.6 episodes per 100 NICU admissions or 6.5 per 1000 live hospital births. While coagulase-negative staphylococci (CNS) accounted for approximately 40 percent of all positive blood cultures, it was responsible for 73 and 66 percent of the nosocomial bacteremias in 1982 and 1983, respectively. In 1984, coagulase-negative staphylococcus was the responsible pathogen for 92 percent of all nosocomial bacteremic episodes. Of 139 infants weighing less than or equal to 1250 g at birth, 30 (22 percent) developed CNS bacteremia. The risk of coagulase-negative staphylococcus bacteremia was associated with low birth weight, respiratory distress, prolonged hyperalimentation, and multiple supportive measures. Infants were treated with vancomycin hydrochloride, as most of the CNS were resistant to methicillin and/or gentamicin. There were no deaths related to coagulase-negative staphylococcal septicemia.

Coagulase↗
PubMed1985

Endemic nosocomial Acinetobacter calcoaceticus bacteremia. Clinical significance, treatment, and prognosis.

The medical records of 27 patients with blood cultures positive for Acinetobacter calcoaceticus over a recent five-year period (0.7% of all positive blood cultures) were reviewed retrospectively to determine the epidemiologic and clinical significance of these isolates. Eighteen isolates represented true bacteremias, 16 of which were hospital acquired. Patients most frequently were located in an intensive care unit or on a surgical ward. A seasonal July-to-September peak incidence was noted. The most common site of primary infection was the respiratory tract. Aminoglycosides, alone or in combination with a second agent, were used to treat all but one infection. Bacteriologic cure was achieved in 15 cases (88%); six patients had polymicrobial sepsis that carried a higher mortality than pure A calcoaceticus bacteremia (50% vs 0%). Acinetobacter, a low-virulence opportunistic pathogen, may be an infrequent but potentially serious endemic agent of nosocomial bacteremia in some institutions. The prognosis of bacteremia, when appropriately treated, appears to be good.

Acinetobacter Infections↗
PubMedDate not supplied

Shigellosis with bacteremia: a report of two cases and a review of the literature.

It is widely believed by both physicians and microbiologists that bacteremia is a rare event in shigellosis. We report two cases of shigellosis with positive blood cultures and review 68 cases reported in the literature between 1963 and 1981. We suggest that detection of bacteremia in shigellosis may be facilitated by a greater awareness of the following findings. 1. Eighty-seven percent of all cases of shigellosis with bacteremia reported in the literature during the 18-year period reviewed occurred in pediatric patients under 16 years of age. The majority of detected shigellemia cases were in children under 5 years of age. 2. Bacteremia is frequently intermittent and its detection is aided by collection of serial blood cultures with an adequate volume of blood. 3. Positive blood cultures were obtained most frequently on Days 1 to 2 and on Days 5 to 7 following onset of symptoms. 4. The case fatality rate of reported shigellemia cases was 46%. Although some of these findings may reflect a patient selection bias of cases reported in the literature, we believe that a greater awareness among clinicians and microbiologists of the potential value of blood cultures in the diagnosis and management of shigellosis will eventually lead to a better understanding of the pathogenesis of this infectious disease.

Adolescent↗
PubMed1983

Treatment of occult bacteremia: a prospective randomized clinical trial.

Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial. A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia. A total of 96 children (aged 6 to 24 months) with temperature of more than 40 degrees C, no identifiable source of infection, and a leukocyte count greater than or equal to 15,000/microL and/or sedimentation rate greater than or equal to 30 were enrolled. The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture. A lumbar puncture was performed if a child was 12 months or less. Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days. Patients were examined at 24 and 72 hours. Fifty patients were treated expectantly and 46 received no antimicrobial therapy. Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae). Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection). The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P less than or equal to .05, Fisher exact test). No complications of expectant therapy were detected. Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.

Child, Preschool↗
PubMed1983

Bacteremia associated with decubitus ulcers.

We studied 104 episodes of bacteremia in 102 patients with decubitus ulcers observed over five years in the hospitals of one metropolitan area. The ulcers were considered to be the "probable" source of bacteremia in 49% of episodes. Another site of infection was documented in 86% of patients. Proteus mirabilis, Staphylococcus aureus, and Escherichia coli were the most frequent blood isolates in these patients, but only Bacteroides species correlated with "probable" origin of bacteremia from the ulcers. The overall mortality was 55%, with 51% of deaths being attributed to infection. These findings emphasize the importance of decubitus ulcers as potential sources of bacteremia in hospitalized patients.

Adolescent↗
PubMed1984

Complications associated with Staphylococcus aureus bacteremia.

Thirty-nine consecutive Staphylococcus aureus bacteremias were reviewed with particular attention to complications. Thirty-four (87%) of the bacteremias were nosocomial, with intravascular catheters (20 episodes) and dialysis-access sites (six episodes) the most common sources. Complications developed in 36% (14/39) of all bacteremias and in 30% (6/20) of those that were catheter-associated. Acute complications (shock, adult respiratory distress syndrome, disseminated intravascular coagulation) occurred in six patients and were fatal in four. In nine patients metastatic suppurative complications developed, six at sites of preexisting abnormalities. There were no episodes of endocarditis. Most patients received prolonged antibiotic therapy, and the majority of all suppurative complications required surgical intervention. Staphylococcus aureus bacteremia, even when not associated with endocarditis, is a cause of considerable morbidity and mortality in hospitalized patients.

Adult↗
PubMed1984

Bacteremia in obstetrics and gynecology.

Surveillance of all episodes of bacteremia in the four major hospitals of a metropolitan area of 400,000 population between 1977 and 1981 revealed that bacteremia was documented in only 92 patients on obstetrics and gynecology services. Death was attributed to bacteremia in only four of these patients, three of whom had severe underlying diseases. These data confirm that death due to bacteremia in present-day obstetric and gynecology practice is extremely uncommon.

Adult↗
PubMed1982

Relationship between the magnitude of bacteremia in children and the clinical disease.

The relationship between the magnitude of bacteremia due to Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis and the clinical diagnosis was determined on 79 children who were not receiving prior antibiotic therapy and had fever, either in the presence or absence of focal signs of infection. Bacteremia was quantitated by the recently described Quantitative Direct Plating procedure in which heparinized blood (0.5 ml each) is plated onto blood and chocolate agar plates. Additionally, blood was cultured by means of the radiometric Bactec technique. In the case of H. influenzae and S pneumoniae, 23 (92%) of 25 patients with more than 100 organisms per milliliter of blood had meningitis or epiglottitis in contrast to only four (9.5%) of 42 patients with less than 100 organisms (P less than .001). No significant difference was noted in the magnitude of bacteremia due to N meningitidis among 12 patients with meningitis or other serious infections. The possible predictive value of the quantitation of bacteremia is illustrated by the observation of three children with seemingly mild respiratory infection and counts in excess of 100 organisms per milliliter who, within 20 hours, developed meningitis or epiglottitis. High bacterial counts of H influenzae and S pneumoniae in excess of 100 organisms per milliliter of blood should alert the physician to the existence or possible development of serious disease.

Adolescent↗
PubMed1983

Coagulase-negative staphylococcal bacteremia in patients receiving immunosuppressive therapy.

From January 1977 to June 1980, coagulase-negative staphylococci caused bacteremia in 22 (17%) of 130 patients receiving immunosuppressive therapy and were the most common cause of all bacteremias. Sixteen (73%) of the 22 patients had granulocytopenia, and eight were isolated in a laminar air-flow room. A Broviac or Hickman central intravenous (IV) catheter was present in 20 (91%) of 22 patients, and soft-tissue inflammation at the catheter exit site was a significant risk factor for bacteremia. Except for debilitating fevers and local mucocutaneous infections, there were no distinguishing clinical features in patients with bacteremia. Most infections responded to cefazolin sodium or vancomycin hydrochloride therapy; catheter removal was necessary in only seven patients. These data show that coagulase-negative staphylococci can be important pathogens in patients receiving immunosuppressive therapy, even when the patients are isolated in a laminar air-flow room, if normal mucocutaneous, host-defence barriers are interrupted by IV catheter-insertion or chemotherapy.

Adolescent↗
PubMed1982

The association of remote Streptococcus bovis bacteremia with colonic neoplasia.

We prospectively studied five patients with a remote history of Streptococcus bovis bacteremia who had not previously been evaluated for colonic pathology. This study was prompted by several reports of concomitant neoplasia in patients with recent S. bovis bacteremia. The patients were studied at a mean of 32 months after bacteremia. Despite the absence of other signs or symptoms suggestive of bowel disease, a negative test for occult blood in stool and a negative fecal culture for S. bovis, two patients were found to have neoplastic polyps of the colon. These findings suggest that the risk of colonic neoplasia in patients with remote S. bovis septicemia is similar to that found in patients with recent bacteremia, but evaluation of a larger group of these patients will be necessary to establish this risk.

Adult↗
PubMed1981

Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient's illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient's illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient's illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.

Child, Preschool↗
PubMed1981

Does bacteremia follow upper gastrointestinal endoscopy?

To determine the risk of bacteremia, 53 patients had blood collected for culture before and five, ten and 15 minutes following fiberoptic endoscopy of the upper digestive tract. One patient had transient bacteremia with Acinetobacter Sp. five minutes after endoscopy. Combining our study with four others, 447 patients have been evaluated of which 6% had bacteremia after upper gastrointestinal endoscopy. Biopsy or other endoscopic operation does not increase the likelihood of bacteremia. We recommend careful attention to instrument and accessory cleaning and prophylactic antibiotics (probably penicillin or oxacillin alone suffices) only for patients with prosthetic heart valves.

Acinetobacter Infections↗
PubMed1977

Hepatic reticuloendothelial protection against bacteremia in experimental hemorrhagic shock.

Gram-negative septicemia is an increasingly common problem, and various suggestions have been made about the cause. One not often considered is that it may be the result of failure of hepatic removal of organisms which have crossed the intestinal mucosal barrier from the large bowel lumen to the portal blood stream. Splanchnic hypoperfusion both increases mucosal permeability and reduces the ability of the hepatic reticuloendothelial system (RES) to remove particulate matter from the blood. If RES funciton is reduced further by blockade with colloidal carbon, then any tnedency for bacteremia to occur in shock might be enhanced. Splenectomized greyhounds, who had received a portal perfusion of either colloidal carbon or saline, were subjected to a period of hypovolemia and then were resucitated. Peripheral blood cultures were sterile at all times in the control animals and before bleeding in the dogs that recived carbon. However, all the RE-blockaded animals developed bacteremia during shock, It was condluded that hepatic RES funciton was essential in the prevention of bacteremia in the hypovolemic dog and that investigation should be directed toward studies of RES function in man with a view to determining the importance or otherwise of the RES in relation to gram-negative bacteremia.

Animals↗
PubMed1953

On the nature of bacteremia in experimental pneumococcal pneumonia in the dog. II. Disappearance of pneumococci from the circulation in relation to the bactericidal action of the blood in vitro.

With the purpose of ascertaining the influence exerted by the pneumococcidal activity of the blood on the course of bacteremia occurring in experimental canine pneumococcal pneumonia, a study was made of the rates at which intravenously injected pneumococci disappeared from the circulation and the shed blood of diseased dogs. Preliminary studies on normal animals showed that blood containing hundreds of thousands of pneumococci per cc. immediately after injection usually became sterile or nearly so within an hour's time. Simultaneous observations carried out on the blood in vitro showed an analogous rapid disappearance of the microorganisms, although the effect was not quite as marked. Similar tests on non-bacteremic dogs with pneumonia revealed essentially the same ability of the body to dispose of large numbers of circulating pneumococci. The shed blood likewise exhibited marked bactericidal power. The occurrence of bacteremia during pneumonia did not retard greatly the rate at which injected pneumococci disappeared from the circulation, as compared with the non-bacteremic state. After several hours the numbers of circulating microorganisms were approximately the same as prior to the intravenous injection. Blood in vitro often cleared as fully as it did in vivo over the same length of time. Studies on the role played by humoral immune substances in the bactericidal action of the blood showed that while their presence was necessary for maximum killing power, and that bacteremic blood lacking humoral immune properties was rarely capable of self-sterilization in vitro, nevertheless such blood often retained considerable bactericidal potency as shown by its ability to reduce materially the numbers of pneumococci added to it. This phenomenon is discussed. The marked pneumococcidal capacity of the blood exhibited by dogs with experimental pneumococcal pneumonia and its persistence during bacteremia suggest that this constitutes the principal mechanism for limiting the degree of blood invasion. The similarity of the findings in canine and human pneumococcal lobar pneumonia is pointed out.

Animals↗
PubMed1998

Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia.

OBJECTIVE: To evaluate the efficacy of triple-lumen central venous catheters coated with a combination product of chlorhexidine and silver sulfadiazine (CSS) in reducing the incidence of local catheter infection and catheter-related bacteremia. DESIGN: Randomized, controlled trial. SETTING: The surgical intensive care units in a university hospital. PATIENTS: All patients who needed central venous catheterization were randomized to receive either an uncoated triple-lumen catheter (n = 157) or a catheter coated with CSS (n = 151). MAIN OUTCOME MEASURE: Catheters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of the catheter were cultured semiquantitatively. Blood cultures were obtained when clinically indicated. The remaining segment of catheters coated with CSS were cut and incubated on an agar plate with strains of Staphylococcus aureus and Enterococcus. Zone of inhibition was determined 24 hours later. Data were analyzed by survival and logistic multivariate regression methods. RESULTS: Catheters coated with CSS were effective in reducing the rate of significant bacterial growth on either the tip or intradermal segment (40%) compared with control catheters (52%; P = .04). However, there was no difference in the incidence of catheter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P = .81). In vitro activity of catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organisms were coagulase-negative staphylococcus and enterococcus. Variables that were associated with a significant amount of growth on the tip or intradermal segment were a duration of catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the catheter was removed was associated with a lower risk of significant bacterial growth. CONCLUSIONS: The use of CSS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated triple-lumen catheters but has no effect on the incidence of catheter-related bacteremia. In this patient population, catheters coated with CSS provide no additional benefit over uncoated catheters.

Anti-Infective Agents, Local↗
PubMed2002

Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases.

BACKGROUND: Staphylococcus aureus bacteremia is still a serious problem, and the optimal treatment is under debate. Only a few studies concerning treatment are available. METHODS: The study population was all patients with a positive blood culture result for S aureus in Copenhagen County, Denmark, from May 1994 through April 1996. Of 278 patients with S aureus bacteremia, 186 were evaluated according to outcome in a prospective, observational follow-up study. The time above the minimum inhibitory concentration was estimated for dicloxacillin sodium for each treatment regimen and evaluated by logistic regression along with other potential risk factors. RESULTS: The following variables were statistically associated with death: the presence of an uneradicated focus (odds ratio [OR], 6.7; 95% confidence interval [CI], 2.1-21.0); the presence of septic shock (OR, 3.7; 95% CI, 1.5-9.1); the total daily dose of penicillinase-stable penicillin less than 4 g (OR, 3.7; 95% CI, 1.3-11.1); and age 60 years or older (OR, 2.4; 95% CI, 1.1-5.3). The following variables were significantly associated with recurrence: the total daily dose of penicillinase-stable penicillin less than 3 g (OR, 3.9; 95% CI, 1.6-10.0) and the presence of a secondary focus (OR, 3.2; 95% CI, 1.3-7.7). Among 155 patients with observation time longer than duration of treatment, this factor (duration of treatment, <14 days) was significantly related to mortality (OR, 0.84; 95% CI, 0.76-0.94). CONCLUSIONS: Focus eradication and the dosing of penicillinase-stable penicillin are important to the outcome of S aureus bacteremia. We recommend treatment with at least 1 g of penicillinase-stable penicillins 4 times daily for longer than 14 days.

Aged↗