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PubMed1999

[Bacteremia by Staphylococcus aureus: analysis of 311 episodes].

BACKGROUND: The aim of this study was to set up the differences between nosocomial and community acquired S. aureus bacteremia, to identify the features of the patients at high risk of endocarditis and to define the characteristics of the patients with methicillin resistant S. aureus (MRSA). METHODS: We prospectively studied 311 cases of S. aureus bacteremia detected at our hospital during a four-year period. RESULTS: Nosocomial acquisition of bacteremia was found in 63% of the cases, 45% of which were caused by MRSA. Nosocomial bacteria generally presented in older patients with more severe underlying conditions and a higher prevalence of invasive procedures than patients with the community-acquired disease. Likewise, the primary focus of infection was identifiable in most of the nosocomial episodes and mortality was also higher. Endocarditis presented in 19% of the bacteremia episodes and almost 90% of patients with endocarditis were intravenous drug users (IDU). The risk of endocarditis in this group was 64% whereas it was only 3% in non-IDU patients. Overall mortality was 33% and mortality directly due to the bacteremia was 22%. CONCLUSIONS: IDU patients were at high risk of endocarditis but most had a favourable outcome. Bacteremia was community-acquired in these patients and they rarely presented MRSA bacteremia. Patients with previous valvular diseases were at high risk of endocarditis and had a high mortality. Non-IDU patients with community-acquired bacteremia were at a low risk of endocarditis, regardless of whether a primary focus of infection had been identified or not. Mortality was lower in this group than in patients with nosocomial bacteremia and there were no cases of MRSA bacteremia. Mortality was higher in patients treated with vancomycin than in patients treated with other antibiotics active against S. aureus.

Adult↗
PubMed2001

Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients.

Bacteremic episodes caused by anaerobes are unusual and the clinical importance of Clostridium bacteremia remains unclear. This retrospective case study examined the risk factors among a group of patients who developed Clostridium bacteremia. Medical records from 73 episodes of clostridial bacteremia in 73 patients treated in a medical center during an 11-year period were reviewed. Of all episodes, 96% were community-acquired. Twelve percent of patients had polymicrobial bacteremia, with Escherichia coli being the most common accompanying bacterium. Diabetes mellitus (26%) and liver cirrhosis (25%) were the most common underlying diseases. The most common etiological organisms were Clostridium perfringens (77%), Clostridium bifermentans (9%), and Clostridium septicum (4%). Only one patient with C. septicum bacteremia had a histocytotoxic infection, which was a fatal gas gangrene. Univariate analysis of data from patients with monomicrobial Clostridium bacteremia revealed that younger age (age < 65 years), underlying liver cirrhosis, and presence of septic shock at initial presentation were associated with fatality; but only the latter two variables were independently associated with fatality in multivariate logistic regression analysis. Appropriate antimicrobial therapy for monomicrobial Clostridium bacteremia did not significantly affect clinical outcomes, which might suggest that Clostridium species in the bloodstream can be regarded as merely contaminants or transient bacteremia. This suggestion was not supported by the finding that seven of 13 cirrhotic patients with monomicrobial Clostridium bacteremia died of sepsis, of whom six had not receive appropriate antimicrobial therapy. Therefore, the clinical importance of Clostridium bacteremia should be interpreted with caution because of its high risk of mortality in susceptible hosts, particularly cirrhotic patients, who do not receive appropriate therapy timely.

Adult↗
PubMed2004

The relationship between preoperative serum immunoglobulin levels and the development of bacteremia after tonsillectomy.

OBJECTIVES: We examined the risk for the development of bacteremia during tonsillectomy and evaluated the presence of an association between bacteremia and preoperative serum immunoglobulin levels. PATIENTS AND METHODS: The study included 40 patients (16 males, 24 females; mean age 16.8 years; range 5 to 35 years) who underwent tonsillectomy with the use of the dissection-snear technique. Preoperatively, venous blood samples were collected from all the patients to determine serum immunoglobulin levels and the presence or absence of bacteremia. Bacteremia was also investigated in blood samples postoperatively. RESULTS: There was no growth in the preoperative blood cultures, but bacteremia was documented in 10 patients (25%) after tonsillectomy. Increased serum IgG levels were determined in 15 patients before operation, seven of whom developed bacteremia after tonsillectomy (p<0.05). There was no correlation between postoperative bacteremia and preoperative serum IgM or IgA levels (p>0.05). CONCLUSION: Although our current knowledge does not allow to predict bacteremia following tonsillectomy in advance, the finding that seven of 10 patients who developed bacteremia had increased preoperative IgG levels draws attention to serum IgG, especially in patents in whom bacteremia may present additional risks.

Adolescent↗
PubMedDate not supplied

Extremely high levels of alkaline phosphatase in adult patients as a manifestation of bacteremia.

BACKGROUND/AIMS: Jaundice resulting from severe bacterial infection is well known, particularly in pediatric literature. Extremely high levels of alkaline phosphatase (ALP) have rarely been emphasized as a manifestation of bacteremia in adults. The aim of this study was to evaluate the characteristics of extremely high levels of ALP in adult patients as a manifestation of bacteremia. METHODOLOGY: Extremely high levels of ALP were defined as being more than 1000 U/L. From April 1998 to May 1999, we retrospectively reviewed those patients' charts who had ALP above 1000 U/L. Sixteen patients that had bacteremia among 96 patients with extremely high levels of ALP at the emergency department of Taichung Veterans General Hospital were included in this study. RESULTS: Sixteen patients had bacteremia with extremely high levels of ALP, including 9 patients with malignant biliary obstruction (MBO), and 7 patients without MBO. The ALP levels ranged from 1002 to 2061 (1430.13+/-353.84) U/L. Ten patients were male, and 6 were female. Their ages ranged from 19 to 83 (56.13+/-16.51) years. A variety of gram-negative, and gram-positive organisms were identified, and Escherichia coli was the most common pathogen. Among the seven patients of bacteremia without MBO, 5 patients had underlying diabetes mellitus as the predisposing factor for development of the bacteremia. The ages of the bacteremia patients with MBO were older than those of patients without MBO (66.3+/-10.1 us. 43.0+/-13.7 years, P=0.0025). CONCLUSIONS: Bacteremia from a variety of organisms is a common cause for extreme elevation of ALP. Escherichia coli is the most common pathogen and presented more often in patients with MBO than those without MBO. In the setting o f extremely high levels of ALP as a manifestation of bacteremia, the patients with MBO are as common as those without MBO. We have demonstrated clinically that hepatic dysfunction during bacteremia may be manifested predominantly by extreme elevation of alkaline phosphatase with little abnormality in serum bilirubin.

Adolescent↗
PubMedDate not supplied

[Bacteremia caused by Alcaligenes (Achromobacter) xylosoxidans. Description of 3 cases and review of the literature].

BACKGROUND: Alcaligenes (Achromobacter) xylosoxidans occasionally cause infections, mainly in immunocompromised hosts. METHODS: Three cases of bacteremia due to A. xylosoxidans observed at the Fundación Jiménez Díaz between 1985-1994 were described. Moreover, 38 single cases of bacteremia due to A. xylosoxidans and 21 episodes associated with outbreak were reviewed by using computerized bibliography data base MEDLINE (1970-december 1994). RESULTS: From 41 patients with bacteremia (including our 3 cases) reviewed, 27 were immunosuppressed hosts (twenty had neoplasia disease). The most common clinical presentation was primary bacteremia (11 cases, 27%) and pneumonia (10, 24%), followed by catheter-associated bacteremia (8, 20%), meningitis (4), bacteremia from abdominal cavity (4), endocarditis (3) and pyelonephritis (1). The mortality rate was higher (39%), specially in patients whom were a intensive care unit acquisition (87%), and illness with endocarditis (100%). No patient with catheter-related bacteremia died. All of 21 outbreak episodes of bacteremia had a autolimited form and low mortality (4.8%). CONCLUSION: A. xylosoxidans is a microorganism with demonstrated capacity of cause bacteremia, mainly in immunocompromised hosts, with high mortality rates. Sometimes, it causes outbreaks of bacteremia with low mortality.

Adolescent↗
PubMedDate not supplied

Dentists are innocent! "Everyday" bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children.

The literature related to three aspects of dental bacteremia has been reviewed in regard to postprocedure bleeding and bacteremia, intensity of bacteremia, and cumulative exposure to bacteremia from "everyday" events. The data on postprocedure bleeding and bacteremia show that there is no relationship between bleeding and bacteremia. Significant bacteremia can occur in the absence of clinically discernible bleeding. The intensity of bacteremia in humans is significantly less than that used in experimental endocarditis models. It is unlikely that the intensity of bacteremia following dental procedures in children could readily lead to endocarditis. The cumulative exposure to bacteremia is significantly greater from everyday procedures when compared to dental operative procedures. It is far more likely that such everyday procedures are the cause of bacterial endocarditis because the cumulative exposure is often hundreds, thousands, or even millions of times greater than that occurring following surgical procedures such as extraction of teeth. The value of antibiotic prophylaxis prior to dental treatment is questioned.

Adult↗
PubMed1978

Escherichia coli in bacteremia: K and O antigens and serum sensitivity of strains from adults and neonates.

Comparisons of O- and K-antigenic types and serum sensitivity were carried out with 149 strains of Escherichia coli isolated from adults with bacteremia and 46 strains from neonates with bacteremia. O-antigenic types O6, O4, O2, O16, O18, and O7 were observed most frequently, but their relative prevalence did not differ materially between adult and neonatal bacteremias. A greater proportion of strains from neonatal bacteremia contained K1 antigen and were autoagglutinable compared with strains from adult bacteremia, although K1 was the most frequent K antigen found in strains from adults. K-antigen-containing strains did not appear to be associated with enhanced severity of bacteremia, but nontypable strains, auto-agglutinable strains, and strains of O-antigenic types O4, O6, and O8 were associated with a greater frequency of shock and fatal outcome in adults. No differences could be detected between the serum sensitivities of E. coli isolated from adult bacteremia and those from neonatal bacteremia. K antigen did not affect serum sensitivity, but E. coli strains of O types O18, O2, O4, and O7 were more serum-resistant than other E. coli. Bacteremia caused by serum-sensitive E. coli was less often associated with shock and death than bacteremia caused by serum-resistant E. coli.

Adult↗
PubMed1989

[Investigations on the etiology of sepsis by using an experimental mouse model with leukocytopenia. 2. The role of the reticuloendothelial system in the etiology of bacteremia].

It has been recognized by clinical data that most of sepsis occurring in the immunocompromised host are endogenous infection. In recent years, we have investigated the mechanism of these bacteremia and sepsis by experimental studies using neutropenic mice treated with cyclophosphamide. And we evidenced that most pathogens causing bacteremia originated in the intestinal flora of the host. It has been shown that bacteria causing bacteremia were divided into two main groups, causing systemic bacteremia and causing portal bacteremia. Pseudomonas aeruginosa and Morganella morganii belonged to the former, on the other hand, Escherichia coli, Enterobacter cloacae and some other bacteria belonged to the latter. In this study, we studied the role of the reticuloendothelial system (RES) in the etiology of bacteremia or sepsis, using various kinds of bacteria isolated from bacteremic mice. As a result, the following facts were revealed. 1. It was suggested that the low blood clearance rate of the bacteria was one of the great risk factor of systemic bacteremia, since the blood clearance rate of bacteria causing systemic bacteremia was significantly lower than those of bacteria causing portal bacteremia. 2. Bacteria in the blood were eliminated by the RES, mainly by the liver, and the level of bacterial clearance by the liver was relative to the type of bacteremia which was systemic or portal. 3. It was suggested that the bacterial clearance by the liver mainly reflected the phagocytosis by Kupffer cells, and especially the adherence of these cells to bacteria as the first step of phagocytosis.

Animals↗
PubMed1987

Pneumococcal and Haemophilus influenzae type b antigen detection in children at risk for occult bacteremia.

We prospectively evaluated pneumococcal and Haemophilus influenzae type b antigen detection in serum and urine of young (3 to 30 months of age) febrile (temperature greater than or equal to 39 degrees C) children at risk for occult bacteremia. Patients with septic shock, meningitis, or epiglottitis were excluded. Of 576 patients, 16 had pneumococcal bacteremia (final diagnoses: primary bacteremia, nine; otitis media, four; pneumonia, two; unknown, one), and five had H influenzae b bacteremia (final diagnoses: primary bacteremia, two; cellulitis, two; arthritis, one). Latex agglutination was positive in all five patients with H influenzae b bacteremia (positive in three of three urine specimens, three of four sera tested) but only one of 16 patients with pneumococcal bacteremia (positive in one of seven urine samples, zero of 13 sera tested). Both assays had specificities of greater than 95%. Nonspecific agglutination occurred in 7% of specimens tested. Enzyme immunoassay for pneumococcal antigen, although more sensitive than latex agglutination, failed to detect antigen in ten sera and three urine specimens from patients with pneumococcal bacteremia. Thus, neither latex agglutination nor enzyme immunoassay was sufficiently sensitive for detection of occult pneumococcal bacteremia. Latex agglutination for H influenzae b holds promise as a sensitive and specific test for rapid diagnosis of occult bacteremia due to H influenzae b.

Agglutination Tests↗
PubMed1978

A descriptive study of nosocomial bacteremias at The Johns Hopkins Hospital, 1968--1974.

Patient, infection and pathogen characteristics are analyzed for 935 cases of nosocomial bacteremia at The Johns Hopkins Hospital, 1968--1974. The overall nosocomial bacteremia attack rate was 4.1 cases per 1,000 hospital patients. Rougly 6% of all hospital deaths were among patients with nosocomial bacteremias. The case-fatality rate for the seven years was 37.1% compared with an overall hospital mortality rate of 2.7 deaths per 100 hospital patients. The mortality rate for the entire hospital and the case-fatality rate declined significantly (P less than 0.1) over the seven-year study period. There was a significant increase (P less than .01) in Gram-positive nosocomial bacteremias over the seven-year period. During the period, Bacteroides species and Escherichia coli bacteremias increased significantly (P less than .01) while Candida species and Klebsiella species bacteremias had significant decreases (P less than .01). The nosocomial bacteremia attack rate was high for infacts under one year of age, excluding newborns. The attack rates were low for young adults but increased markedly with age in adults older than 40. The cardiac surgery service had the highest nosocomial bacteremia attack rate of 12.4 cases per 1,000 patients. Hospital patients with infective diseases, neoplasms, digestive diseases, diseases of early infancy or circulatory diseases had a much greater risk of acquiring nosocomial bacteremias. Of the 935 cases, 9.5% had multiple episodes of bacteremia.

Adolescent↗
PubMed2001

Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients.

We studied a cohort of 2201 patients hospitalized in 15 French intensive care units (ICUs) for > or = 48 h during a 4-mo period to assess the incidence and outcomes of primary and definite catheter-related bloodstream (CRB) or secondary nosocomial bloodstream infection (NBSI). Variables associated with ICU death and duration of stay were determined by logistic regression, and attributable mortality and length of stay (LOS) from a nested matched case-control (96 pairs) study, stratified on the source of bacteremia. Bacteremia occurred in 5% (95% CI 4.1-6%) of patients with > or = 48 h ICU stay. Primary, CRB, and secondary NBSI accounted for 29%, 26%, and 45% of the 111 episodes, respectively. NBSI was associated with a markedly increased risk of death (OR = 4.6; 95% CI 2.9-7.1) and an attributable mortality of 35% (95% CI, 28%-47%). In the case-control study, the excess mortality was 20% (p = 0.03) in patients with primary bacteremia and CRB, and 55% (p < 0.001) for secondary bacteremia; in patients with CRB only, the excess mortality was 11.5%. The median excess ICU LOS in survivors of NBSI was 9.5 d, and was similar, irrespective of its source. The risk of mortality associated with primary and catheter-related bacteremia appears much lower than that of secondary bacteremia, but is sizable, and the excess LOS incurred by the various categories of bacteremia is comparable. Differentiating catheter-related bacteremia from both primary and other secondary bacteremia appears warranted in studies conducted in critically ill patients.

Bacteremia↗
PubMed1997

Enterococcal bacteremia in the surgical intensive care unit. Does vancomycin resistance affect mortality? The Johns Hopkins SICU Study Group.

OBJECTIVE: To determine the incidence and mortality rate associated with nosocomial bacteremia caused by vancomycin-resistant Enterococcus in a surgical intensive care unit. DESIGN: A retrospective study. SETTING: The surgical intensive care unit of a large university hospital tertiary referral center. PATIENTS: All patients in the surgical intensive care unit with a documented nosocomial bacteremia between January 1, 1992, and December 31, 1994. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Mortality rate. RESULTS: Of the 134 nosocomial bacteremic episodes, 30.6% involved enterococci; 24.4% of the enterococci were resistant to vancomycin. Patients with vancomycin-resistant enterococcal bacteremia had a significantly longer hospital stay (mean +/- SD, 28 +/- 18 vs 12 +/- 10 days; P = .005) and were more likely to have been treated with vancomycin (70% vs 10.3%; P = .001) than patients with vancomycin-sensitive enterococcal bacteremia. The mortality (41.0%) associated with enterococcal bacteremia was similar to the overall bacteremic mortality (41.7%). There was no difference in episode-specific mortality associated with vancomycin-resistant enterococci (40%) vs vancomycin-sensitive enterococci (38.7%). Of the 4 deaths associated with vancomycin-resistant enterococcal bacteremia, only 2 occurred within 14 days of the bacteremia, as did 8 of 12 deaths associated with vancomycin-sensitive enterococcal bacteremia (P = .64). CONCLUSIONS: Enterococci were the most commonly isolated nosocomial blood-borne pathogens in the surgical intensive care unit. Nearly 25% of the enterococcal bacteremic episodes were resistant to vancomycin. Vancomycin-resistant Enterococcus is associated with a prolonged hospital stay and with vancomycin use. Nevertheless, vancomycin resistance itself does not increase the mortality rate associated with enterococcal bacteremia.

Adult↗
PubMed1996

Seven-year review of bacteremia caused by Streptococcus milleri and other viridans streptococci.

The Streptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined. The purposes of this study were to ascertain the clinical significance of Streptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci. All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed. Of 137 cases of Streptococcus milleri infection, 33 (24%) were documented cases of bacteremia. Twenty-four patients were men (mean age 57.8 +/- 17.4 years). The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%). The origin of infection could not be established in three cases. Nine cases of bacteremia (27%) were polymicrobial. Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin. Eighteen of the 33 patients (54%) required surgery. Five patients died. All 33 Streptococcus milleri isolates were susceptible to penicillin. Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period. There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock. An abdominal origin of infection was more frequent in Streptococcus milleri bacteremia (p = 0.0001); a cardiovascular origin was more frequent in the viridans group (p = 0.01), as was a diagnosis of endocarditis (p = 0.004). Four patients with viridans streptococci bacteremia required surgery versus 18 patients with Streptococcus milleri bacteremia (p = 0.01). Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%).

Adolescent↗
PubMed2003

Persistent bacteremia in the absence of defined intravascular foci: clinical significance and risk factors.

The clinical significance of and the risk factors for persistent bacteremia were assessed in 299 episodes. Persistent bacteremia was defined as at least two positive blood cultures obtained on different calendar days during the same infectious episode. Short-term bacteremia was defined as positive blood cultures solely on the first day of the infectious episode. A total of 4,277 episodes of bloodstream infections were detected, of which 299 episodes (7%) were persistent bacteremia. The following were independent risk factors were for persistent bacteremia: burns, presence of a central vascular catheter, cirrhosis, infections caused by Salmonella spp., polymicrobial infections, and inappropriate empirical antibiotic treatment. Irrespective of the source of infection, the presence of a central vascular catheter was correlated with an increased risk for persistent bacteremia. Mortality among patients with persistent bacteremia was 50%, compared to 35% among patients with short-term bacteremia. Because of the high mortality associated with persistent bacteremia, a thorough search for the source of infection is essential to ensure timely and appropriate therapy.

Adolescent↗
PubMed2005

Characteristics of community-acquired and health care-associated Staphylococcus aureus bacteremia in patients treated at the emergency department of a teaching hospital.

The changing epidemiology of Staphylococcus aureus bacteremia has been noted worldwide. This enhanced awareness appears to be closely associated with the evolution of health care systems. To further delineate this change and to clarify the prevalence of true community-acquired methicillin-resistant S. aureus (MRSA), reclassification for community-onset bacteremia was proposed. Exposure to health care system, such as nursing home residence, regular outpatient invasive interventions, and prior hospitalization within 1 year, was identified among the community-onset S. aureus bacteremia patients. During the 1-year study period, 102 episodes of S. aureus bacteremia from the emergency department patients of a teaching hospital were prospectively enrolled. Nine of the episodes were hospital-acquired, 56 episodes were associated with health care system exposure, and the remaining 37 episodes were classified as true community-acquired bacteremia. The characteristics of patients, primary site of infection, antimicrobial susceptibilities of S. aureus isolates, adequacy of initial antimicrobial therapy, and percentage of metastatic infections differed significantly between health care-associated and true community-acquired S. aureus bacteremias. Prevalence of MRSA infection in true community-acquired bacteremia was low in contrast to bacteremia with health care-associated exposure (2.7% versus 42.9%, P < 0.01). In conclusion, clinical characteristics and risk of contracting methicillin-resistant S. aureus bacteremia among community patients with and without exposure to health care system are distinct. Precise classification of patients is mandatory for the surveillance of antimicrobial resistance and selection of rationale empirical antibiotics.

Adult↗
PubMed2005

Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures.

OBJECTIVE: The aim of this study was to determine the incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. METHODS: A total of 237 patients who underwent oral and maxillofacial surgery were included in this study. Blood samples were obtained for bacteriological examination immediately after the essential steps of the surgical procedure had been performed. RESULTS: Bacteremia was detected in patients who underwent surgery for tumor, infection and trauma, and surgical reconstruction of jaw. In particular, decortication for osteomyelitis and tooth extraction resulted in a higher incidence of bacteremia compared with other surgical procedures. The incidence of bacteremia was not affected by oral hygiene, gingival inflammation, blood loss, and duration of surgery. Furthermore, concerning tooth extraction, there was no statistical difference in the incidence of bacteremia with respect to the number of teeth extracted and the method of extraction. Extraction of teeth with odontogenic infection (periodontitis, periapical infection, and pericoronitis) did however produce a significantly increased incidence of bacteremia compared with infection-free teeth (P < .01). Viridans streptococci were the predominant group of bacteria isolated from the bacteremias. CONCLUSION: Oral and maxillofacial surgery involving transoral incision produces bacteremia, regardless of the extent and degree of surgical invasion. In particular, surgical procedure at infected sites is more likely to result in bacteremia compared with infection-free sites.

Adult↗
PubMed2004

Risk factors for recurrent bacteremia in adult patients with nontyphoid salmonellosis.

BACKGROUND: This study sought to find the risk factors for recurrent bacteremia in adult patients with nontyphoid salmonellosis. METHOD: Retrospective chart review. RESULT: Between September 1984 and December 2003, 235 adult (age > or = 18 years old) patients with bacteremia with nontyphoid salmonellosis were admitted to our hospital. Among them, 130 patients (55%) had immunodeficiency, 31 patients (13%) had systemic lupus erythematosus, 26 patients (11%) had hematologic malignancies, 50 patients (21%) had solid organ cancers, and 39 patients (17%) had endovascular infections. Thirty-seven patients had recurrent bacteremia during the study period. Both univariate and multivariate analysis showed that immunodeficiency was the only predictor of recurrent bacteremia (odds ratio, 2.79; P = 0.013). The overall hospital mortality rate was 26%: 8% for patients with recurrent bacteremia and 29% for patients without recurrence. The independent risk factors of hospital death were old age, not recurrent infection, and solid organ cancers. CONCLUSION: Old age, systemic lupus erythematosus, malignancies, and immunodeficiency were common in adult patients with nontyphoid Salmonella bacteremia. The incidence of recurrent bacteremia was 16%. Immunodeficiency predisposed patients to recurrent bacteremia. Recurrent bacteremia was associated with a lower hospital mortality rate, however.

Bacteremia↗
PubMed2001

[Risk and prognostic factors of Pseudomonas aeruginosa bacteremia in critically ill patients].

BACKGROUND: To determine risk and prognostic factors in patients admitted to the intensive care unit (ICU) in which an episode of bacteremia caused by Pseudomonas aeruginosa has been diagnosed. PATIENTS AND METHOD: Cohort, observational, prospective, multicenter study. Patients admitted to 30 ICUs in Spain in whom one or more pathogens were isolated from blood cultures were included. RESULTS: In a total of 16,216 patients admitted to the participating ICUs during the study period, 949 episodes of bacteremia were diagnosed In 77 cases (8.11%), P. aeruginosa was the causative pathogen, with an infection rate of 4.7 episodes per 1000 patients. Independent risk factors associated with P. aeruginosa bacteremia were as follows: respiratory infection focus (OR 3.92; 95% IC 2.33-6.59; p </= 0.0001), previous use of antibiotics (OR 2.13; 95% IC 1.18-3.81; p </= 0.0078), arterial catheter (OR 4.09; 95% IC 2.26-7.38; p </= 0.0001), and previous longer ICU stay (days) (OR 1.02; 95% IC 1.003-1.033; p = 0.0274). Crude mortality rate in patients with bacteremia caused by P. aeruginosa was 50.6% (39/77), whereas mortality rate of bacteremia caused by other pathogens was 38.6% (337/872) (p = 0.039). This difference was also found for attributed mortality (31.2% [24/77] vs. 20.4% [178/872], (p = 0.027). In the multivariate analysis adjusted by respiratory infection focus, previous ICU stay, and age, crude mortality (OR 1.55; 95% CI 0.96-2.51; p = 0.071) and attributed mortality (OR 1.63; 95% CI 0.96-2.78; p = 0.0709) of P. aeruginosa bacteremia were higher than in bacteremia caused by other pathogens. In the multivariate analysis, risk factors significantly associated with crude mortality were respiratory infection focus (OR 4.13; 95% IC 1.15-14.76; p = 0.0293) and severe sepsis or septic shock (OR 4.96; 95% IC 1.23-20.09; p = 0.0248). CONCLUSIONS: Bacteremia caused by P. aeruginosa admitted to the ICU have a higher crude and attributed mortality than bacteremias caused by other pathogens. Prognosis is associated with the presence of severe sepsis or septic shock and respiratory infection focus.

Anti-Bacterial Agents↗