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PubMed2004

Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona.

In this study, 90 episodes of pneumococcal bacteremia that occurred over an 8-year period in two hospitals in Barcelona were analyzed retrospectively to determine the clinical and bacteriological characteristics of pneumococcal bacteremia, the risk factors for antibiotic resistance, the outcome, and the vaccine coverage. The mean age of the patients was 3.1 years and the male/female ratio was 1.7. The overall rates of penicillin-non-susceptible, cefotaxime-non-susceptible, and erythromycin-resistant isolates were 48.8, 24.4, and 25.5%, respectively. Antibiotic resistance was associated with children under the age of 2 years and with previous antibiotic treatment. The percentage of antibiotic resistance was higher in the nine episodes that occurred in patients with an underlying illness. The most prevalent serotypes identified were 1, 14, 6B, 18C, 5, and 19A. Serotypes 6A/B, 14, and 19A/F were isolated primarily from children under 2, whereas serotypes 1 and 5 were recovered more frequently from older children. Apparent relationships between serotypes 6A/B, 14, and 19A/F and occult bacteremia and between serotypes 1 and 5 and bacteremic pneumonia were confounded by the age variable. The proportion of bacteremic episodes preventable by all (7-valent, 9-valent, and 11-valent) of the conjugate pneumococcal vaccines was 60% in children under 2. In older children, the serotype coverage rate for the three formulations was 48, 87, and 87%, respectively. In summary, these data expand upon previous Spanish studies in which serotypes 1 and 5 were reported to be among the leading causes of severe systemic pneumococcal infections in children over 2, findings that should be taken into consideration when planning vaccine programmes.

Adolescent↗
PubMed2004

A case of cellulitis complicating Campylobacter jejuni subspecies jejuni bacteremia and review of the literature.

Infection with Campylobacter species is a predominant cause of food-borne gastroenteritis in the industrialized world. Bacteremia is detected in <1% of patients with diarrhea, mainly in immunocompromised hosts or those in the extremes of age. Reported here is the case of a 78-year-old, immunocompromised male patient with Campylobacter jejuni subsp. jejuni bacteremia complicated by cellulitis. The infection was characterized by a protracted course with several recurrences and refractoriness to multiple antibiotic regimens, responding only to a prolonged course of meropenem treatment. The frequency of cellulitis as reflected in previously reported series of Campylobacter bacteremia and the clinical characteristics of this difficult-to-treat infection are reviewed.

Aged↗
PubMed2004

Epidemiological and clinical characteristics of occult bacteremia in an adult emergency department in Spain: influence of blood culture results on changes in initial diagnosis and empiric antibiotic treatment.

A prospective study was carried out to analyze the usefulness of blood culture results for adult patients who were discharged from the emergency department with bacteremia. Over a 29-month period, 110 patients with significant bacteremia who were seen in the emergency department and discharged home were studied. The mean age of the patients was 61.8 years. The most frequent initial major diagnosis was urinary tract infection (UTI) (n=63; 57.3%). Gram-negative organisms were isolated in 79 (71.8%) cases. A change in diagnosis (44.5% cases) was more common when the initial diagnosis was something other than UTI or when empiric antimicrobial therapy was ineffective or was not given (P<0.001). The significant predictors of modification of the initial empiric antibiotic therapy were ineffective empiric antimicrobial therapy and transfer of the patient from the emergency department to an infectious diseases outpatient clinic (P=0.01). Blood culture results may be useful for achieving the correct diagnosis in adult patients with bacteremia and for guiding treatment in the subsequent management of outpatients.

Adult↗
PubMed2005

Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit.

Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.

Achromobacter denitrificans↗
PubMed2001

Usefulness of procalcitonin serum level for the diagnosis of bacteremia.

The predictive value of procalcitonin serum levels to detect or rule out bacteremia was investigated prospectively in a case-control study with 200 hospitalized adults from whom blood samples were taken for culture. Fifty bacteremic patients (cases) had higher procalcitonin serum levels than the 150 controls with sterile blood cultures (11.7 vs. 0.7 ng/ml; P=0.0001), a difference that remained significant after controlling for potential confounders in multivariate analysis. At cut-off values of 0.5 and 0.2 ng/ml, the sensitivity of procalcitonin was 56 and 92%, and the specificity was 83 and 43%, respectively. These results yielded low positive (22 and 12%) and high negative predictive values (96 and 99%), reflecting primarily the low prevalence of bacteremia among patients who undergo blood cultures in hospitals (low pretest probability). Although caution is mandatory when using such markers at the individual level, procalcitonin, possibly together with other parameters, could nonetheless prove useful in future studies to rapidly rule out bacteremia.

Aged↗
PubMed2004

Helicobacter cinaedi bacteremia presenting as macules in an afebrile patient with X-linked agammaglobulinemia.

We describe a 54-year-old man with X-linked agammaglobulinemia (XLA) and Helicobacter cinaedi bacteremia, who presented with tender, hyper-pigmented skin macules without increased local warmth or fever. We propose that this presentation may be a characteristic early sign of bacteremia caused by H. cinaedi and related organisms in otherwise healthy immunocompromised patients. This case demonstrates the importance of a high index of suspicion for H. cinaedi bacteremia in immunocompromised patients with unexplained skin lesions.

Agammaglobulinemia↗
PubMed1994

Bacteremia due to viridans streptococci in neutropenic patients: a review.

Viridans streptococci have long been considered, with the exception of the ability to cause endocarditis, as minor pathogenic agents. More recently, however, these bacteria have become a major concern in neutropenic patients undergoing a chemotherapeutic treatment. In this high-risk population, they can be responsible for up to 39% of bacteremia cases and are the most frequent cause of this type of infection. The most frequently isolated species in blood cultures are Streptococcus mitis and Streptococcus sanguis II. Viridans streptococcus bacteremia can be accompanied by serious complications, like adult respiratory distress syndrome (ARDS) (3% to 33%), shock (7% to 18%) or endocarditis (7% to 8%). Mortality rates range from 6% to 30%. Case-control studies have identified the following risk factors: severe neutropenia (< 100 neutrophils/mm3), prophylactic antibiotic treatments with quinolone or co-trimoxazole, absence of intravenous antibiotics at the time of bacteremia, high doses of cytosine arabinoside, oropharyngeal mucositis, and heavy colonization by viridans streptococci. The introduction of penicillin in prophylactic antibiotic treatments has reduced the incidence of these infections, but the long-term use of penicillin could be compromised by the emergence of resistant strains.

Bacteremia↗
PubMed2004

Pneumococcal bacteremia in a single center in Argentina.

OBJECTIVE: To determine the clinical and microbiologic characteristics of pneumococcal bacteremia at Sanatorio Mitre, Buenos Aires, Argentina. METHODS: One-hundred-and-seven episodes of pneumococcal bacteremia were prospectively analyzed from 1993 to 1998. Demographics, clinical and microbiological variables were studied. RESULTS: Eighty-one patients (76%) were adults and 26 children (24%). Most cases (98%) were acquired in the community. Seventy-nine patients (74%) had at least one underlying condition. The primary source of bacteremia was found in 91 patients (85%), the lungs being the most common source. Streptococcus pneumoniae was isolated from one sterile site other than the primary focus in 25 patients (23%). Eighty-five (79%) of the Streptococcus pneumoniae were susceptible to penicillin and 22 (21%) showed intermediate or high resistance to penicillin and 2% were additionally resistant to ceftriaxone. Initial antimicrobial therapy was appropriate in 95% of the cases. The overall mortality was 21%, however adults admitted to the intensive care unit (ICU) had higher mortality (81%). No patients under 14 years old died. Multivariate analysis showed that age and recovery of the organisms from a sterile site other than the primary focus were statistically significant predictors of mortality. CONCLUSION: Bacteremic pneumococcal infections continue to be an important worldwide problem causing morbidity and high mortality despite supportive care and appropriate antimicrobial therapy.

Adolescent↗
PubMed2004

Community-onset methicillin-resistant Staphylococcus aureus bacteremia in Northern Australia.

BACKGROUND: Community-onset infections caused by methicillin-resistant Staphylococcus aureus (COMRSA) are being increasingly reported worldwide. METHODS: A retrospective study was performed of 14 patients with 15 episodes of COMRSA bacteremia (COMRSAB) admitted to the Royal Darwin Hospital, Northern Territory, Australia from 1998 to 2001. Isolates from COMRSAB episodes underwent extended susceptibility testing and molecular typing by pulsed field gel electrophoresis and allotyping of the staphylococcal cassette chromosome mec (SCCmec) region by polymerase chain reaction. RESULTS: The proportion of community-onset S. aureus bacteremia episodes that were due to COMRSA increased from 9% in 1998 to 20% in 2001. The clinical features of COMRSAB were similar to those seen with methicillin-susceptible strains, including sepsis, endocarditis and metastatic infection. Ineffective empiric antimicrobial therapy was administered in the majority (80%) of episodes. All COMRSAB isolates tested contained allotype IV SCCmec, which is commonly found in community isolates of MRSA and rarely found in isolates from healthcare-associated MRSA infection. CONCLUSION: The increasing incidence of COMRSAB in our region has resulted in the addition of vancomycin to standard empiric therapy in certain patients with suspected S. aureus bacteremia acquired in the community.

Anti-Bacterial Agents↗
PubMed2004

[Retrospective study of bacteremia diagnosed in an emergency department: frequency, susceptibility of microorganisms, and impact on therapeutic management].

OBJECTIVE: The authors had for aim to determine the prevalence of bacteremia diagnosed in an emergency department (ED), the susceptibility of microorganisms to antibiotics, and the impact on therapeutic management. DESIGN: A retrospective analysis was made on patient features, microbiological ecology, susceptibility to antibiotics, and modalities of antimicrobial therapy in the Georges Pompidou European hospital ED of Hôpital, between 1 November 2001 and 30 June 2002. RESULTS: One thousand four hundred and thirty two blood cultures were obtained from 1069 patients. The rate of positive cultures was 12%, but only 8.7% (n = 125) were proved as true bacteremia. The most frequently identified organisms were: Enterobacteriaceae (n = 63, 39.4%) with a predominance of Escherichia coli (n = 48, 30%), and Streptococcus pneumoniae (n = 16, 10%). Forty two cases of pyelonephritis and 34 of prostatitis both due to E. coli were diagnosed. 76.5% of these were resistant to amoxicillin, 64.7% to amoxicillin-clavulanic acid, 11.8% to ciprofloxacin, and 44% to cotrimoxazole. No resistance to third generation cephalosporin was detected in E. coli isolates. Fourteen S. pneumoniae pneumonia cases were diagnosed. 57.1% of isolates presented with a decreased susceptibility to penicillin (CMI > 0.1 mg/l). Susceptibility to amoxicillin and cefotaxim was 85.7% and 92.9% respectively. Blood culture was the only exam available for bacterial diagnosis in 51.5% of true bacteremia. 1.6% of blood cultures from ED samples had an impact on therapeutic management. CONCLUSIONS: Blood culture is a relevant exam for the diagnosis of infection in patients admitted to the ED.

Bacteremia↗
PubMed2003

Prospective study of bacteremia after cardiac catheterization.

Nine hundred sixty consecutive cardiac catheterization procedures were studied prospectively for the presence of periprocedural bacteremia. Overall, among 960 procedures, only 4 were associated with clinically significant bacteremia. All 4 were related to the intravenous line and none to the cardiac procedure itself. Clinically nonsignificant bacteremias were correlated with procedural duration, multiple skin punctures, use of multiple balloons, and obesity.

Adult↗
PubMed1996

Absence of bacteremia after gastrointestinal procedures in children.

BACKGROUND: Transient bacteremia after certain gastrointestinal endoscopies is well documented in adult patients; however, experience in pediatric patients is very limited. We conducted a prospective study to determine the frequency of bacteremia after common endoscopic procedures in children. METHODS: A total of 108 endoscopies were performed in 95 patients (age range 8 months to 17 years; mean age 10.2 years). Procedures included 68 esophagogastroduodenoscopies (EGDs), 29 colonoscopies, and 11 flexible sigmoidoscopies. Most procedures (88) were performed with patients under conscious sedation; 20 were under general anesthesia with endotracheal intubation. Biopsy specimens were obtained from all patients. Blood samples for aerobic and anaerobic cultures were obtained prior to, and within 5 minutes of, completion of the procedure. In patients who underwent general anesthesia, a third sample was obtained 5 minutes after endotracheal intubation and before endoscopy. RESULTS: Four of the pre-endoscopic blood cultures were positive. Two cultures were positive after endotracheal intubation, but were negative after endoscopy. Four cultures were positive after endoscopy. All organisms were skin or environmental flora and were considered contaminants. All patients with positive cultures remained asymptomatic during the 72 hours after the procedure. CONCLUSION: We conclude that clinically relevant bacteremia is very infrequent following routine endoscopic procedures with biopsies in immunocompetent children.

Adolescent↗
PubMed1997

Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis.

BACKGROUND: Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia. There are few studies comparing the two methods. The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis. METHODS: Endoscopic sclerotherapy and band ligation were performed using standard techniques. Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms. RESULTS: In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive (Peptostreptococcus sp and Streptococcus mitis). A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus. CONCLUSIONS: There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.

Adult↗
PubMed1998

Viridans streptococcal bacteremia after esophageal stricture dilation.

BACKGROUND: The incidence of bacteremia with organisms that may cause infective endocarditis after esophageal stricture dilation is unknown. There is disagreement among physicians regarding the need for antibiotic prophylaxis for patients with valvular heart disease undergoing dilation. Our aim was to determine the frequency and duration of bacteremia associated with esophageal stricture dilation. METHODS: Blood cultures were obtained before and after stricture dilation in patients without valvular heart disease and in a control group of patients undergoing upper endoscopy without dilation. RESULTS: A total of 103 patients undergoing dilation and 50 control patients were studied; 22 of 103 patients (21%) undergoing dilation had at least one post-procedure blood culture positive for viridans streptococcus, compared with 1 of 50 (2%) of control patients (p = 0. 001). Blood cultures obtained 1 minute after stricture dilation were positive for viridans streptococcus in 19 of 81 (23%), in 16 of 96 (17%) 5 minutes post-dilation, and in 3 of 63 (5%) 20 to 30 minutes post-dilation. Of the 19 patients with viridans streptococcus bacteremia 1 minute after dilation, cultures were still positive in 14 of 19 (74%) at 5 minutes and in 2 of 19 (10%) 20 to 30 minutes post-dilation. CONCLUSIONS: These data support the use of antibiotic prophylaxis before esophageal stricture dilation for patients with valvular heart disease at risk for the development of infective endocarditis.

Antibiotic Prophylaxis↗
PubMed1994

Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia.

Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.

Administration, Oral↗
PubMed1996

Effect of number of blood cultures and volume of blood on detection of bacteremia in children.

OBJECTIVE: To determine whether bacteremia can be detected more rapidly and completely by (1) obtaining two blood cultures instead of one and/or (2) collecting a larger volume of blood. STUDY DESIGN: Prospective comparison of different strategies in 300 patients undergoing blood culture for suspected bacteremia. Each patient had two samples of blood, A (2 ml) and B (9.5 ml), obtained sequentially from separate sites. The B sample was divided into three aliquots: B1 (2 ml), B2 (6 ml), and ISO (1.5 ml, quantitative culture). RESULTS: A pathogen was isolated from one or more blood cultures in 30 patients (10% of cases). When measured at 24 hours, the pathogen recovery rate for the B2 sample (72%) was higher than that for the individual small-volume samples (A = 37%, B1 = 33%; p < 0.01 for each comparison) and for the combination of the two small-volume samples (A + B1 = 47%; p = 0.04). At final (7-day) reading the pathogen recovery rate for the B2 sample (83%) was higher than that for B1 (60%; p = 0.02) and similar to the recovery rate observed with the combination of the two small-volume cultures (A + B1 = 73%; p = 0.55). CONCLUSIONS: Increasing the volume of blood inoculated into blood culture bottles improves the timely detection of bacteremia in pediatric patients and spares the patients the cost and pain of an additional venipuncture.

Adolescent↗
PubMed1999

Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals.

BACKGROUND: The prevalence of nosocomial infection in Australian hospitals is estimated to be between 5.5% and 6.3%. Since 1989, infection control professionals (ICPs) in hospitals accredited by the Australian Council on Health Care Standards (ACHS) have been encouraged to collect nosocomial infection data according to ACHS methodology. METHOD: In 1996, we surveyed members of the Australian Infection Control Association to examine the time spent on surveillance, the practice of surveillance of all hospital infections (hospital-wide surveillance), case-finding methods, case definitions, and reporting routinely used by ICPs in acute care hospitals. We also examined the ICPs' education and experience in infection control (IC). RESULTS: The survey was completed and returned by 65% (644 of 993) of Australian Infection Control Association members. Of the ICPs who completed the survey, 47.8% (308 of 644; 95% CI, 43.9%-51.7%) met the criteria for inclusion, because they coordinated an IC program in an acute care or surgical hospital and performed surveillance for either surgical wound infection, intravascular device-related bacteremia, or non-device-related bacteremia. Of the ICPs who reported their facility's accreditation status, 93.5% participated in ACHS system. Most (97.6%) ICPs had completed hospital-based general registered nurse training. Only 1.9% (6 of 308) of ICPs reported completion of continuing education relating to hospital epidemiology. The number of years of IC experience ranged from zero to 35 years, with a median of 4 years. ICPs spent a substantial proportion of their total weekly IC time on surveillance irrespective of ACHS accreditation; 19.5 hours in ACHS hospitals and 15.6 hours in non-ACHS hospitals (P =.33). More than three quarters (76.0%) of ICPs performed hospital-wide surveillance. The case-finding methods, definitions of infections, and reporting formats varied greatly. The definition most commonly applied by ICPs (6.8%; 95% CI, 4.1%-10.4%) to define surgical wound infection was infection within 30 days after the operative procedure, plus purulent drainage, plus isolation of organisms from a culture from the incision site, plus diagnosis by a medical officer. A 5-item definition of a patient being asymptomatic, plus afebrile on admission, plus infection occurring at least 48 hours after admission, plus the patient having a fever of >38 degrees C, plus a recognized culture from one or more bottles was used by 15.7% (95% CI, 11.3%-21.0%) of ICPs to define a case of bacteremia. CONCLUSION: Surveillance is the core business of Australian ICPs and consumes a substantial proportion of their time. The importance of surveillance, the epidemiologic limitations of the current ACHS system, and the nonstandard methods we report indicate that improved methodology is required for case finding and reporting of nosocomial infections. Australian ICPs should complete training in the principles of surveillance and epidemiology. With this training, ICPs can work collaboratively with other health care professionals to develop epidemiologically sound, local, nosocomial surveillance systems and lobby for a voluntary, national, standardized, risk-adjusted system of targeted nosocomial surveillance.

Australia↗
PubMed2003

[Incidence of bacteremia among histologic groups of hematologic malignancies].

INTRODUCTION: Subgroups having dissimilar prognoses are being identified among cancer patients with infection. Previous studies have suggested that these differences may be related to the histologic diagnosis, but this issue has not as yet been demonstrated. METHODS: We reviewed the medical records of all patients admitted with acute leukemia (AL) or lymphoma (ML) from 1988 to 1998. Incidence of bacteremia was calculated for the following subgroups: acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), AML following refractory anaemia with excess blasts (AML-RAEB), high-grade ML (HGML), intermediate-grade ML (IGML), low-grade ML (LGML) and indeterminate ML (IML). Kaplan-Meier curves of time to the first positive blood culture were constructed and compared by means of log-rank test. RESULTS: In the period covered there were 244 new diagnoses of AL or ML: 62 AML, 32 ALL, 20 AML-RAEB, 78 HGML, 7 IGML, 37 LGML and 6 IML. At the end of the study period, 44 patients were alive, 147 were known to have died at a certain date and 53 had been formally lost to follow-up (most of them, transferred for hospice care). Among 684 blood cultures, there were 51 contaminations and 155 significant isolates. Among the latter, gram-positive bacteria were isolated in 74 and gram-negative bacteria in 47; in 27 cases more than 1 bacterial species were recovered. Fungi were isolated in 7 cases. The incidence of bacteremia expressed as cases per 1000 patient-days was 5.80 for AML, 5.03 for AML-RAEB, 1.56 for ALL, 0.21 for HGML and 0.40 for the remaining ML. Time to the first positive blood culture was significantly shorter for AML than for any other group, and was shorted for ALL and AML-RAEB than for ML. CONCLUSION: Differences in the incidence of bacteremia were observed among histologically-defined groups of unselected patients with hematologic malignancies.

Adolescent↗