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PubMedDate not supplied

Inappropriate antibiotic therapy in febrile cancer patients with bacteremia.

OBJECTIVE: The aim of the study was to assess the outcome of inappropriately treated cancer patients with documented bacteremia. DESIGN/SETTING: 95 cases of inappropriately treated bacteremias in febrile cancer patients in a tertiary-care center were analyzed and compared with a group of appropriately treated bacteremias to assess risk factors for inappropriate therapy and outcome. RESULTS: Among 285 bacteremias, 95 (33.3%) were not treated appropriately, with 42 receiving the wrong antibiotics and 17 having too short a therapeutic course of appropriate antibiotics. In 13, therapy was delayed for more than 48 hours after the onset of fever. Twenty-three patients did not receive antibiotic therapy at all despite bacteremia. A group of 95 inappropriately treated bacteremias was compared to 190 appropriately treated bacteremias occurring in the same period. Microbiological cure after the initial course of therapy was achieved more often (76.8% vs 38.9%, P < .001) in the group of appropriately treated bacteremias in all cases and also in the subgroup of leukemic patients (P < .01). Overall and attributable mortality were significantly lower in patients who were treated appropriately. There was no difference in the number of antibiotics administered in appropriately versus inappropriately treated bacteremias. Cost of therapy between both groups was similar. CONCLUSIONS: Inappropriately treated bacteremic cancer patients had outcomes that were significantly worse than patients who were treated appropriately. The reasons for inappropriate therapy were selection of the wrong antimicrobials, too short a duration of therapy, delayed onset of therapy, or absence of antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed2001

[Vertically transmitted bacteremias: to treat or not to treat?].

OBJECTIVE: To analyze the incidence, etiology and management of infants born in 1977 with vertically transmitted bacteremia or suspected early neonatal sepsis. PATIENTS AND METHODS: The total number of newborn infants in this period was 2,365. We revised the clinical histories of the infants diagnosed with bacteremia and classified them into two groups: a) those with vertically transmitted bacteremias, according to the recommendations of the Castrillo Group, and b) those with suspected early onset neonatal sepsis in whom blood culture was positive and analytical data suggested bacterial infection but who showed no clinical symptoms of vertically transmitted sepsis. Birthweight, sex, gestational age, risk factors for neonatal infection, clinical signs and laboratory tests suggestive of bacterial infection and microbiological agents were analyzed. The clinical and analytical evolution of the treated and untreated newborn infants was studied. RESULTS: The newborn infants were diagnosed with vertically transmitted bacteremia (an incidence of 4.2x1,000 live newborn infants) and 17 were diagnosed with suspected early onset neonatal sepsis (7.8x1,000 live newborns). All the infants had risk factors for neonatal sepsis. The most common of them was prolonged membrane rupture (>- 18 hours) due to which sepsis screening was carried out (hemogram, C-reactive protein at 12 and 36-48 hours of life, and blood culture). In both groups the most commonly isolated microorganism was group B streptococcus, which was found in 30% of vertically transmitted bacteremias and in 41.2% of suspected early onset neonatal sepsis. All the newborn infants with suspected sepsis and two with vertically transmitted bacteremia were treated without incident. The remaining eight infants with untreated vertically transmitted bacteremia were followed-up clinically ana analytically for one year, and remained asymptomatic. CONCLUSIONS: The most common microorganism in vertically transmitted bacteremia and suspected early onset neonatal sepsis was group B streptococcus. None of the untreated infants developed late sepsis or meningitis. Our findings suggest that non-treatment of asymptomatic infants with vertically transmitted bacteremias is appropriate as long and close clinical surveillance is maintained.

Age Factors↗
PubMed2001

[Community-acquired bacteremia].

Bacteremia continues to be one of the main causes of mortality despite the existence of numerous antimicrobial agents and an increase in means of support. A variety of factors, such as the type of microorganism, age, the underlying disease and where the bacteremia was acquired, can change the prognosis of the infection. The aim of this study was to analyze the cases of community-acquired bacteremia gathered prospectively from the Basurto hospital in Bilbao, Spain. The incidence of bacteremia was estimated using preestablished protocol (SEPSIS-DATA) from January 1994 to September 2001. Information was gathered on all the cases of bacteremia at the hospital and only those which were of non-hospital origin (2886 cases) were selected for the study. In our hospital, 67.82% of the bacteremia cases were community-acquired, a figure which remained stable throughout the 8-year study period. A total of 54.64% of the patients were male, 1603 (55.54%) of whom were over age 60 years. The most common underlying diseases were diabetes (15.75%), neoplasia (14.96%) and HIV infection (12.9%). The majority of the cases (2216, 76.8%) were admitted to the general medicine ward, 335 (11.6%) to surgery, 200 (6.9%) to pediatrics and 135 (4.67%) to ICU. The origin of the bacteremia was urinary (33%), gastrointestinal (18%) or respiratory (18.26%). The most common microorganisms were E. coli (36%), S. pneumoniae (13%), S. aureus (9.46%), S. enteritidis (2.87%), P. aeruginosa (2.71%), P. mirabilis (2.65%) and N. meningitidis (2.45%). The bacteremia was polymicrobial in 6.27% of the cases. The most used antibiotics were ceftriaxone (31%), gentamicin (7.3%) and amoxicillin-clavulanic acid (6.9%). Overall mortality was 13.82%. The relative frequency of community-acquired/nosocomial infection remained stable in two-thirds of the total cases. The incidence of bacteremia decreased in the 20-40 year age group and in those with HIV infection. E. coli and S. pneumoniae increased, while S. aureus decreased. The use of imipenem and quinolones increased. E. coli resistance to quinolones increased from 3.54% in 1995 to 14.36% in 2000. Mortality decreased slightly, with no significant differences.

Adolescent↗
PubMedDate not supplied

Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush.

PURPOSE: Several investigations have demonstrated toothbrush-induced bacteremias. Transient bacteremias are well tolerated by healthy individuals but may increase endocarditis risk in patients with cardiac conditions. This study assessed bacteremia levels after brushing with either the Sonicare electric toothbrush or a manual toothbrush. METHODS: Fifty healthy children receiving dental treatment under general anesthesia with oral intubation were randomly assigned to a manual or Sonicare group. Plaque levels and gingival health were scored and a blood sample collected. Teeth were brushed for 1 minute and a postbrushing blood sample was drawn. Samples were analyzed for aerobic and anaerobic bacterial growth. RESULTS: Gingival health and plaque scores did not differ between groups. No correlation was detected between plaque and gingival scores and occurrence of bacteremia. The frequency of bacteremia was 46% with manual brushing: 18% aerobic, 9% anaerobic and 73% both. This differed significantly (P = .022) with 78% bacteremias in the Sonicare group: 22% aerobic, 22% anaerobic and 56% both. CONCLUSIONS: The Sonicare induced significantly more bacteremias than manual toothbrushing. These results show that vigorous brushing increased bacteremia from one brushing but does not answer whether bacteremia incidence would decrease with a program of vigorous daily brushing; this should be clarified before recommending brushing methods for patients with compromised cardiac conditions.

Bacteremia↗
PubMed2004

Dialysis catheter-related bacteremia: treatment and prophylaxis.

Catheter-related bacteremia is a major cause of morbidity among hemodialysis patients. This article reviews the medical literature regarding the treatment and prophylaxis of catheter-related bacteremia. Bacterial biofilm that forms in the catheter lumen is the source of catheter-related bacteremia. Treatment with systemic antibiotics alone fails to definitively eradicate the infection in most patients. Catheter-related bacteremia can be managed by either catheter removal with delayed placement of a new catheter or exchange of the infected catheter with a new catheter over a guidewire. More recent studies suggested that instillation of an antibiotic-anticoagulant lock into the catheter lumen, as an adjunct to systemic antibiotic therapy, can cure approximately two thirds of catheter-related bacteremias without requiring catheter replacement. The frequency of catheter-related bacteremia may be reduced by using tunneled, rather than nontunneled, dialysis catheters and strict aseptic technique. In addition, several pharmacological measures may be useful for prophylaxis against catheter-related bacteremia. These include application of an antimicrobial ointment (mupirocin or polysporin [Pfizer, New York, NY]) to the catheter exit site or instillation of an antimicrobial solution (gentamicin or taurolidine) into the catheter lumen. Subcutaneous dialysis devices do not reduce the frequency of catheter-related bacteremia unless an antimicrobial solution is instilled into the device. The development and widespread adoption of effective approaches to the treatment and prophylaxis of catheter-related bacteremia will dramatically reduce the morbidity and economic burden associated with this complication.

Antibiotic Prophylaxis↗
PubMed1995

Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome.

OBJECTIVE: To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. METHODS: The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. RESULTS: Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 +/- 231 vs 1127 +/- 258 g; P < .01) and gestational age (26.4 +/- 2.1 vs 28.9 +/- 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 +/- 6.5 vs 12.2 +/- 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (chi 2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 +/- 4.0 days (P < .01) and an increase in hospital charges of $25,090 +/- 12,051 (P < .05), even after adjustment for birth weight and admission-day SNAP. CONCLUSIONS: Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.

Bacteremia↗
PubMed1994

Incidence and risk factors of recurrent episodes of bacteremia in adults.

BACKGROUND: Bacteremia is a cause of high morbidity and mortality. Recurrent episodes of bacteremia, its risk factors and characteristics, have been poorly evaluated in the literature, although its occurrence has been established. PATIENTS AND METHODS: Analysis of 1426 patients who presented with 1579 episodes of bacteremia and who were prospectively evaluated in a university-affiliated hospital during a 48-month period. The risk factors for a patient to develop a recurrence of bacteremia was assessed comparing those with recurrent episodes with those who survived an episode of bacteremia with no recurrence during the follow-up period. RESULTS: A total of 105 patients presented with 248 episodes of bacteremia, of which 143 episodes were recurrent (recurrence rate, 9% of all bacteremic episodes). Two factors were independently predictive of recurrent bacteremia: (1) the presence of an underlying disease (especially a rapidly fatal one [odds ratio, 7.27]) or (2) any complication during the initial episode of bacteremia. Using these factors, the prediction model was significant, but misclassification was high, with a sensitivity of 61% and a specificity of 67% for a cutoff point that maximized both factors. CONCLUSIONS: We identified risk factors for patients who presented with an initial episode of bacteremia to develop a recurrence rate. The recurrence risk factors may be used as a form of guidance for extreme preventive measures, but these factors could not predict recurrence with a high degree of accuracy.

Bacteremia↗
PubMed1993

A comparison of Streptococcus pyogenes (group A streptococcal) bacteremia at an urban and a suburban hospital. The importance of intravenous drug use.

BACKGROUND: There has been a recent resurgence of severe infections with Streptococcus pyogenes, including bacteremias and a toxic shock-like syndrome. The purpose of this study was to examine the influence of intravenous drug use on the incidence, clinical epidemiology, and severity of S pyogenes bacteremia. METHODS: We conducted a retrospective survey of medical records at a 500-bed tertiary care urban hospital and at a nearby 500-bed suburban university-affiliated hospital. All patients from each hospital with documented S pyogenes bacteremia from January 1, 1979, to December 31, 1989, were included. We examined demographic and clinical data from cases at the two institutions, serologic findings from a subset of isolates from the urban hospital, and factors associated with mortality from S pyogenes bacteremia by stepwise logistic regression analysis. RESULTS: Ninety-five cases of S pyogenes bacteremia were identified, with 65% (62 cases) occurring at the urban center. Intravenous drug use occurred more frequently at the urban center (P < .005); the injecting drug users were significantly younger than the non-drug-using population (P = .001). Infection with the human immunodeficiency virus occurred in a subset of the injecting drug users at the urban center. Cellulitis and cutaneous abscesses were the most common sources of bacteremia at both centers. During the study period, the numbers of S pyogenes bacteremias increased at the urban center (P = .007), accompanied by a significant increase in the proportion of infections associated with parenteral drug use (P = .003). There was no change in the prevalence of any T type throughout the study period and no clustering of T types among injecting drug users. The overall mortality was 23% (20/89). By logistic regression analysis, age older than 65 years (relative risk [RR], 14; 95% confidence interval [CI], 3.2 to 68) and the presence of the toxic shock-like syndrome (RR, 36; 95% CI, 2.2 to 600) were significantly associated with mortality due to S pyogenes bacteremia. CONCLUSIONS: Intravenous drug use accounted for an increase in cases of S pyogenes bacteremia at an inner-city hospital. However, advanced age and the toxic shock-like syndrome were the most important predictors of mortality.

Age Factors↗
PubMedDate not supplied

[Bacteremia and sepsis in patients hospitalized at the Dr. Fran Mihaljevíc Clinic for Infectious Diseases in Zagreb 1987-1991].

A total number of 836 episodes of bacteremia and fungemia were examined in 823 hospitalized patients in the University Hospital of Infectious Diseases "Dr Fran Mihaljević" Zagreb from the beginning of 1987 to the end of 1991. Twenty-five percent of them were nosocomial bacteremias and 5% were polymicrobial bacteremias. The most frequently isolated causative agents were Salmonella spp. (26%), Escherichia coli (17%), Streptococcus pneumoniae (11%) and Staphylococcus aureus (8%). There were 34% of gram-positive bacteremias. The increased frequency of nosocomial bacteremias caused by coagulase-negative staphylococci was recorded. The frequency of coagulase-negative staphylococci strains resistant to gentamicin and Klebsiella spp. strains resistant to cefotaxime was increased. Shock was present in 19% of episodes. Relation between septic shock occurrence and causative agent of bacteremia was not proved. Mortality in patients with bacteremia was 13%, and total mortality was 20%. The outcome of the disease was in direct relation with causative agent of bacteremia. The initial empiric antimicrobial therapy was prolonged in 91% of episodes of bacteremia after blood culture results were known.

Bacteremia↗
PubMed1996

Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes.

OBJECTIVE: To evaluate the trend in incidence of Pseudomonas aeruginosa bacteremia, underlying conditions of patients, mortality rate, and factors associated with poor outcome. PATIENTS AND METHODS: Medical charts of 189 consecutive episodes of P aeruginosa bacteremia, detected between January 1, 1991, and December 31, 1994, were prospectively evaluated. Associated risk factors, treatment, and outcome were recorded. RESULTS: Pseudomonas aeruginosa bacteremia represented 5.7% of the total number of bacteremias, 6.9% of nosocomial bacteremias, and 23.6% of nosocomial gram-negative bacteremias. There were 1.5 episodes per 1000 discharges. These numbers were slightly lower than those recorded at our hospital 10 years earlier. Human immunodeficiency virus infection was the most frequent underlying disease (28/189 [15%]). Overall mortality was 18% (34/189). The presence of fatal underlying disease (P < .001), surgery (P = .001), pneumonia (P = .02), and severe sepsis (P < .001) were associated with poor prognosis, the mortality of the patients with these variables being 28%, 28%, 47%, and 62%, respectively. The presence of inappropriate definitive antimicrobial treatment became an independent factor predictive of death (P = .04) only when the subset of patients with intravenous catheter-associated bacteremia was excluded from the analysis. The survival rate was no greater in patients who received 2 or more antibiotics active in vitro against P aeruginosa than in those who received only 1. Neutropenia was not associated with increased mortality. The use of colony-stimulating factors did not affect the outcome of the neutropenic patients. CONCLUSIONS: The rate of P aeruginosa bacteremia is falling slightly at our hospital. The emergence of the human immunodeficiency virus epidemic has had a considerable impact on both epidemiology and mortality. The presence of severe underlying disease, surgery, pneumonia, and, especially, severe sepsis are associated with a poor outcome. With the exclusion of patients with intravenous catheter-associated P aeruginosa bacteremia, the administration of an appropriate antimicrobial therapy is essential to a good outcome. Treatment with 1 active antibiotic seems to be sufficient.

Aged↗
PubMedDate not supplied

[Clinical significance, epidemiology and microbiology of coagulase-negative staphylococcal nosocomial bacteremia at a teaching hospital].

Coagulase-negative staphylococci (CNS) are an important cause of nosocomial bacteremia and they are frequently considered as contaminants of blood-cultures. From October 1990 to September 1992, 300 positive blood-cultures for CNS at the Hospital São Paulo were studied and 141 CNS bacteremias were characterized as nosocomial bacteremias. Clinical and microbiological criteria were defined to differentiate between true CNS bacteremia and contaminated cultures. Only 20.6% of the CNS nosocomial bacteremia were considered as true bacteremia. Most of the CNS true nosocomial bacteremia were detected among newborns admitted to the neonatal intensive care unit; the presence of intravascular catheter and parenteral nutrition were significant findings. We did not detect significant difference between true nosocomial bacteremia and contaminated cultures regarding to resistance to oxacillin and SLIME production. The clinical criteria and the positivity of the blood-cultures up to 48 hours after incubation, utilized in our definitions, were useful parameters to characterize the CNS true nosocomial bacteremia.

Adolescent↗
PubMedDate not supplied

Bacteremia in patients with hematological malignancies. Analysis of risk factors, etiological agents and prognostic indicators.

BACKGROUND AND OBJECTIVE: Patients with hematological malignancies are at increased risk for developing bacteremia. No previous study has investigated the risk and prognostic indicators of bacteremia in such patients using a statistical approach. METHODS: A case-control study was performed in 106 patients with hematological malignancies (group A). Two hundred and twelve patients were included as controls and divided into two groups: 106 patients with hematological malignancy without bacteremia (group B) and 106 HIV-infected patients with bacteremia (group C). RESULTS: At univariate analysis, bacteremia risk factors in group A were: neutropenia for more than six days (p = 0.03 vs. group B), central venous catheter usage (p = 0.04) and absence of antibiotic prophylaxis (p = 0.03). At multivariate analysis, the use of CVC and neutropenia were independent bacteremia risk factors. The most frequent etiological agents were: Staphylococcus epidermidis and Pseudomonas aeruginosa. Comparing groups A and C, the distribution of Staphylococcus spp. was different, with S. epidermidis being prevalent in hematological patients only. As regards gram-negative organisms, it is of note that no episode of NT-Salmonella bacteremia was observed in group A, unlike group C, where they represent the second leading etiological agents. In group A, 14% of the patients died. Persistent neutropenia (p = 0.01) and the presence of relapsed neoplasm (p = 0.04) were prognostic indicators of bacteremia. INTERPRETATION AND CONCLUSIONS: Our findings suggest that bacteremia in patients with hematological malignancies strictly correlates with the intensity and length of neutropenia and CVC usage. Although we observed a low mortality rate, we stress that this clinical condition requires special attention from the physician, who must recognize and treat it promptly.

Adult↗
PubMed1998

[Detection of bacteremia in patients discharged from an emergency unit: study of 61 cases].

BACKGROUND: To know the prevalence, the clinical and microbiological characteristics of bacteremia episodes detected on discharged patients at the emergency unit, as well as the accordance of diagnostics and the predicting factors. PATIENTS AND METHODS: We analysed the cases with bacteria detected on discharged patients during 2 years (1995-1996) in an university hospital. We reported: age, sex isolated organism in blood cultures, bacteremia source, leukocytes count, presence of underlying conditions, and accordance between initial and final diagnosis. We compared the characteristics of the groups with bacteremia without apparent origin and the ones with evident clinical source. RESULTS: We detected 61 cases, the mean age was 55 years (SD = 21), and 54% were males. The most commonly isolated agent was E. coli (50%). The leukocytes count was higher 10 x 10(9)/l in 15%. The source of bacteremia was: urinary tract infection (54%) no clinical focus (31%), respiratory tract (11%) and biliary duct (3%). The 90% of urinary tract and the 71% of respiratory infections were correctly diagnosed. However only the 5% of bacteremias without apparent source was correctly diagnosed. We found these differences statistically a significant (p < 0.001 and p = 0.002). Underlying conditions were detected in the 84% of cases in bacteremia without apparently source: AIDS (22%), cirrhosis (22%), parenteral drugs addiction (17%) and venous catheter (17%). Comparing both groups, with apparent focus and without it, we found that the presence of underlying condition is the only independent factor which predispose to bacteremia (p = 0.000; RR = 4.6; IC 95% = 1.9-11.8). CONCLUSIONS: The prevalence of bacteremia detected in discharged patients at the emergency unit seems acceptable. However those results suggest that we could decrease the number of patients with bacteremia without apparently source, because this group shows up to be the less successful in diagnosis. In patients with fever and no clinical focus in the emergency unit, it is useful to consider the presence of underlying factors to decide its management.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Bacteremia due to vancomycin-resistant enterococci in neutropenic cancer patients].

BACKGROUND: The aim of this study was to determine the incidence, clinical characteristics and outcome of vancomycin-resistant enterococcal bacteremia. PATIENTS AND METHODS: We included all cases of enterococcal bacteremia in neutropenic cancer patients documented between January 1986 and December 1995 in a 1,000-bed university hospital, where a prospective surveillance of all cases of bacteremia is regularly done. Molecular typing was performed on all vancomycin-resistant strains with the analysis of chromosomic DNA by macrorestriction. RESULTS: Seventeen cases of enterococcal bacteremia were documented. Seven (41%) were caused by vancomycin-resistant strains (E. faecium 3 and E. gallinarum 4), six of which occurred in the last 5 years of the study period. The average age of patients was 43 years (18-69) and most of them had acute leukemia. Eighty percent of these patients had received vancomycin and/or cephalosporins within 2 weeks prior to bacteremia. Previous administration of antibiotics was more frequent in patients with bacteremia caused by vancomycin-resistant enterococci than in those with bacteremia caused by susceptible strains (86% vs 30%; p < 0.05). The mean number of previous antibiotics (2.4 vs 0.8; p < 0.05) as well as days of treatment (13.6 vs 4.3; p = 0.05) were also higher among patients with resistant enterococcal bacteremia. The overall mortality was 57%. CONCLUSIONS: This study shows the emergence of sporadic cases of bacteremia caused by vancomycin-resistant enterococci in neutropenic cancer patients in our area. This fact seems to be related with the previous administration of antibiotics and advice that a rational use of these agents is needed.

Adolescent↗
PubMed1980

Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients.

Evaluation of 612 episodes of gram-negative bacteremia over a 10-year period demonstrated its progressively increasing frequency. This increase was associated with an increasing proportion of patients with more severe underlying disease, increasing patient age, increasing frequency of cardiac surgery and manipulative procedures, and increasing frequency of treatment with antibiotics, corticosteroids and antimetabolites in patients with bacteremia. Fatality rates paralleled the severity of the host's underlying disease as noted in previous reports. The urinary tract was the most frequent source of bacteremia, but in 30 per cent of the patients, predominantly those with more severe underlying disease, the original source could not be identified. Of all blood cultures obtained in these patients, 72 per cent were positive. Bacteremia was of low magnitude with 77 per cent of the patients have quantitative blood cultures with less than 10 gram-negative bacilli per milliliter of blood. Escherichia coli was the most frequent etiologic agent followed in frequency by Klebsiella-Enterobacter-Serratia species, Pseudomonas aeruginosa, Proteus and Providencia species, and species of Bacteroides. Sixteen per cent of the bacteremias were polymicrobic. K and O-antigen typing of Escherichia coli and capsular typing of K. pneumoniae demonstrated that a large number of serologic types of these strains were responsible for bacteremia. Over-all, bacteremia caused by multiple species of bacteria was associated with higher fatality rates, but no significant differences in fatality rates could be demonstrated for bacteremias caused by individual species of gram-negative bacilli when comparisons were made between patients with underlying diseases of similar severity. The presence or type of K-antigen did not influence the lethality of Esch. coli infections. Although some O-antigen types, 0:4, 0:6 and 0:8, were associated with higher fatality rates than other O-antigen types, "rough" or autoagglutinable Esch. coli were as lethal as smooth strains. These findings indicate that bacterial factors, other than antibiotic resistance, have little influence on the outcome of gram-negative bacteremia and that gram-negative bacilli function primarily as "opportunistic" pathogens.

Adolescent↗
PubMed1981

Teichoic acid antibody and circulating immune complexes in the management of Staphylococcus aureus bacteremia.

Optimal antibiotic therapy for patients with Staphylococcus aureus bacteremia remains controversial. The results of two serologic tests, teichoic acid antibody and circulating immune complexes, have shown promise in detecting patients who have serious bacteremia (sustained bacteremia with endocarditis or metastatic abscess) and require longer, more intensive treatment. These tests were performed on serial samples from 38 patients with staphylococcal bacteremia prospectively categorized by severity of infection and by risk factors associated with serious disease (sustained bacteremia, valvular heart disease, absence of focus of infection, metastatic abscess). A surprisingly large group of these patients (20, or 53 percent) could not be prospectively defined as having "serious" or "benign" bacteremia. Neither test differentiated patients with serious bacteremia from those with benign bacteremia. Although it is possible that additional significant associations with risk factors might have been obtained with the teichoic acid antibody test had more patients been included, positive tests were found more frequently only in patients in whom metastatic abscesses developed. The teichoic acid antibody test was found to be a sensitive, but not specific, indicator of serious staphylococcal disease and was of value in excluding serious infection only when a negative results was supported by clinical evidence for benign disease. Other than this use, neither assay was helpful in determining optimal therapy of staphylococcal bacteremia.

Adult↗
PubMed1990

Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients.

PURPOSE: To determine the prevalence of clinically relevant bacteremia after upper endoscopy in patients undergoing bone marrow transplantation. PATIENTS AND METHODS: We retrospectively reviewed the records of 151 patients who received an HLA-identical allogeneic bone marrow transplant (BMT) at the Seattle Veterans Affairs Medical Center between September 1983 and December 1988. Forty-seven patients who required esophago-gastroduodenoscopy (EGD) during their first 100 days after transplant were selected for evaluation. Clinically relevant bacteremia was defined as the development of hypotension, temperature greater than 38.5 degrees C, and a positive blood culture occurring within 24 hours after endoscopy. The presence of acute graft-versus-host disease (GVHD) at the time of endoscopy and the use of prednisone prior to endoscopy were considered possible risk factors for the development of bacteremia. The proportion of subjects who became bacteremic were compared using Fisher's exact test. RESULTS: Within 24 hours following endoscopy, nine patients (19%) developed clinically evident bacteremia (hypotension, temperature greater than 38.5 degrees C, and a positive blood culture). Eight of 14 patients receiving prednisone at the time of endoscopy developed bacteremia, compared to one of 33 not receiving prednisone (p less than 0.01). Nineteen patients had acute GVHD of at least grade 2 at the time of EGD, six of whom developed bacteremia. Although acute GVHD alone did not increase the risk of post-EGD bacteremia in patients not receiving prednisone (one of 21 versus zero of 12, p greater than 0.9), the risk of bacteremia was particularly high in patients with acute GVHD treated with prednisone at the time of EGD (six of seven). CONCLUSION: Allogeneic BMT recipients receiving prednisone for immunoprophylaxis after grafting or for treatment of acute GVHD are at high risk for clinically relevant bacteremia following EGD. Such patients are candidates for antibiotic prophylaxis prior to endoscopy.

Bone Marrow Transplantation↗
PubMed1988

Staphylococcus aureus bacteremia and recurrent staphylococcal infection in patients with acquired immunodeficiency syndrome and AIDS-related complex.

PURPOSE: An increased incidence of Staphylococcus aureus bacteremia has recently been described in patients with the acquired immunodeficiency syndrome (AIDS). However, other risk factors for community-acquired S. aureus bacteremia (including intravenous drug abuse and lymphedema) were present in nearly all these AIDS-related cases of S. aureus infection. Our purpose was to review cases of S. aureus bacteremia that occurred in patients with AIDS or AIDS-related complex (ARC) who did not have a recent history of intravenous drug use, lymphatic obstruction, or neutropenia. PATIENTS AND METHODS: Patients at San Francisco General Hospital between October 1984 and October 1987 with blood culture results positive for S. aureus were identified. A review of this group revealed 22 cases of S. aureus bacteremia that occurred in 18 patients with an underlying diagnosis of AIDS or ARC, none of whom had a recent history of intravenous drug use, lymphedema secondary to Kaposi's sarcoma, or neutropenia. RESULTS: An intravenous catheter was the single most important risk factor for S. aureus bacteremia and was identified as the source for bacteremia in 16 (73 percent) of the 22 episodes. Based on 1986 outpatient clinic records, we calculated an incidence of S. aureus bacteremia occurring in non-intravenous-drug-using male AIDS or ARC patients, 18 to 44 years old, that was 5.4 episodes/1,000 patients. Although the mean duration of appropriate antibiotic therapy was 18 days, late metastatic complications of S. aureus bacteremia occurred in six (35 percent) of 17 AIDS/ARC patients who survived initial antibiotic therapy. CONCLUSION: Non-intravenous-drug-using AIDS and ARC patients (especially those with indwelling venous catheters) appear to be at high risk for S. aureus bacteremia, with a higher late metastatic complication rate than that reported for recent historical control subjects.

AIDS-Related Complex↗