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Query: UMLS:C0004610 (bacteremia)
 13,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The in vitro activity, pharmacokinetics, bactericidal activity, and tissue penetration of aztreonam suggest that it may play a role in therapy for serious gram-negative bacterial infections in children. Several thousand children throughout the world received aztreonam during open or comparative clinical trials for treatment of infections including pyelonephritis, bacteremia, meningitis, skeletal infection, pneumonia, and peritonitis. Cure rates have ranged from 92% to 100%, with relapses seen mainly in children with obstructive renal lesions and those with infections caused by Salmonella. A comparative trial of aztreonam for treatment of neonatal sepsis showed it to be at least as effective as amikacin for this infection. Aztreonam yielded clinical results comparable to those of conventional combined therapy for pulmonary infection in patients with cystic fibrosis. Adverse effects in pediatric trials have been uncommon; fever, diarrhea, or rash occurred in less than 2% of treated children. Reversible laboratory abnormalities have occasionally been noted. On the basis of these data, aztreonam is considered an appropriate alternative agent for the treatment of serious gram-negative bacterial infections in neonates and children. Further comparative clinical trials will delineate specific indications.
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PMID:Clinical experience with aztreonam for treatment of infections in children. 206 62

Accumulating evidence suggests that the therapeutic margin of aminoglycoside therapy may be improved by manipulation of dosing strategy. Recent understanding of concentration-dependent bactericidal activity and postantibiotic effect argues that the aminoglycosides may be administered in larger doses and at longer dosing intervals than currently recommended without compromising efficacy. Preliminary clinical experience suggests that once-daily regimens are as efficacious as conventional intermittent injections in the treatment of gram-negative infectious including urinary tract infections, cystic fibrosis, and bacteremia in nonneutropenic patients. The transient, high peak serum concentrations achieved in once-daily dosing have not been associated with excessive nephrotoxicity or ototoxicity thus far. Decreased accumulation in renal cortex as a result of saturable renal uptake after the single daily dose may even reduce the incidence or severity of renal damage. Further studies on more patients are required to substantiate these preliminary findings.
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PMID:Alternative dosing strategy for aminoglycosides: impact on efficacy, nephrotoxicity, and ototoxicity. 209 50

The maternal death rate and rate of preterm delivery associated with pneumonia during pregnancy have not decreased since the introduction of antibiotics four decades ago. We retrospectively reviewed 25 cases of pneumonia during pregnancy; these cases occurred among 32,179 deliveries. Medical complications included: bacteremia, 16%; empyema, 8%; atrial fibrillation, 4%; respiratory failure necessitating mechanical ventilation, 20%. Obstetric complications occurring during the pneumonia episode included: preterm labor, 44%; preterm delivery, 36%. A patient with cystic fibrosis died; one stillbirth and two neonatal deaths occurred. Underlying maternal disease was significantly associated with maternal medical complications (p = 0.023) and preterm delivery (p = 0.012). Significant medical and obstetric complications continue to occur frequently despite modern antimicrobial, tocolytic, and supportive therapy. Underlying maternal disease, including acquired immunodeficiency syndrome and cystic fibrosis, was associated with preterm delivery and neonatal and maternal death.
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PMID:Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome? 278 48

The first case of mucoid Pseudomonas aeruginosa bacteremia is reported in a hospitalized 78-yr-old woman with drug-induced hepatitis attributed to antituberculous therapy. The bacteremia was successfully treated with tobramycin and carbenicillin. Furthermore, the extracellular material of this mucoid strain was extracted, purified, and characterized as an alginate of high molecular weight, similar to that of mucoid Pseudomonas aeruginosa strains from cystic fibrosis.
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PMID:Nonfatal bacteremia caused by a mucoid, alginate-producing strain of Pseudomonas aeruginosa. 309 27

Human IgG response to Pseudomonas aeruginosa core lipopolysaccharide determinants was measured after both acute and chronic pseudomonas infection by using lipopolysaccharide purified from PAC605 cells (the most lipopolysaccharide-defective or "roughest" mutant of P. aeruginosa yet described) as a solid phase antigen in ELISA and Western blot immunoassay. The geometric mean IgG anti-PAC605 lipopolysaccharide titer of sera from 18 cystic fibrosis (CF) patients with chronic pseudomonas pulmonary infection was 1808, compared to 171 for convalescent sera of 10 patients with acute pseudomonas bacteremia (p less than 0.001) and 211 for 5 normal human volunteers (p less than 0.001). Western blot immunoassay demonstrated specific IgG anti-core antibodies in 11/18 sera from CF patients but not in the sera of the convalescent bacteremic patients or normal volunteers. IgG anti-Pseudomonas core lipopolysaccharide antibodies appear to be a marker of chronic infection; the possible protective role of these antibodies remains to be established.
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PMID:Human IgG antibodies to Pseudomonas aeruginosa core lipopolysaccharide determinants are detected in chronic but not acute pseudomonas infection. 312 49

Pseudomonas cepacia, originally described as a plant pathogen, has emerged as an important cause of infection in altered hosts, particularly in the hospital setting. This organism's ability to survive and proliferate in a variety of solutions, medications, and even disinfectants and antiseptics has resulted in numerous clusters of common-source nosocomial infections. Many patients exposed to P. cepacia are merely colonized, but serious infections, including surgical and burn wound infections, bacteremia, meningitis, pneumonia, peritonitis, and urinary tract infections, are not rare. The virulence properties of this pathogen remain poorly characterized. Recently, P. cepacia has been reported in some cystic fibrosis centers as an increasingly frequent pulmonary pathogen. This trend has caused considerable concern because of reports of occasional cases of fulminant necrotizing pneumonia and bacteremia. Conversely, many patients with CF who become colonized with this organism have no ill effects. The epidemiology of P. cepacia in the CF population is unclear, but some patients probably acquire the organism from colonized siblings with CF. Circumstantial evidence suggests that the organism may also be acquired in the hospital. Treatment of infections is exceedingly difficult, particularly in patients with CF, because P. cepacia is resistant to a broad range of antibiotics.
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PMID:Pseudomonas cepacia: biology, mechanisms of virulence, epidemiology. 351 71

A 4 1/2-month-old, white girl was admitted to the hospital with respiratory distress and persistent polymicrobial bacteremia. Cystic fibrosis associated with malnutrition and a transient defect in peripheral neutrophil chemotaxis was diagnosed. This remarkable combination of presenting features in a patient with cystic fibrosis is the focus of this case report.
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PMID:Polymicrobial bacterial sepsis and defective neutrophil chemotaxis in an infant with cystic fibrosis. 378 35

Between 1981 and 1983, some 85 patients with cystic fibrosis at Rainbow Babies and Childrens Hospital, Cleveland, developed colonization or infection of the respiratory tract with Pseudomonas cepacia. Twenty-nine (34 percent) of the colonized patients died; four were female patients with fulminant bacteremia with P cepacia prior to death. Case-control studies showed that increasing severity of underlying cystic fibrosis, increasing age, having a sibling with cystic fibrosis who was colonized with P cepacia, and previous hospitalizations were associated with increased risk of colonization. In patients with mild cystic fibrosis, no differences in clinical outcome were seen during the period of study; however, patients colonized with P cepacia who had moderate or advanced cystic fibrosis were hospitalized longer and died sooner after colonization, compared with control subjects with similar severity of cystic fibrosis. The excess mortality associated with such colonization varied in magnitude and trend according to the patient's sex and severity of underlying cystic fibrosis, reflecting the combined influence of colonization with P cepacia, sex, and severity of cystic fibrosis on the mortality of the patients. The source and mode of transmission of P cepacia were not determined, but the data suggest a possible nosocomial source. The results of this investigation showed that colonization with P cepacia most often affected patients with moderate or advanced cystic fibrosis and was associated with an adverse clinical outcome in these patients.
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PMID:Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis. Risk factors and outcomes. 382 45

In nature Pseudomonas aeruginosa grows in two modes, the mobile "swarmer" cell and the glycocalyx-enclosed microcolony. The microcolony mode is numerically dominant perhaps because it provides adhesion in a favorable niche and protection from bacteriophages and phagocytic predators. When this organism colonizes the compromised human host, a broad spectrum of different types of infection is produced, ranging from asymptomatic persistent cystitis to the overwhelming bacteremia seen in neutropenic patients. These infections differ radically both in their degree of toxicity and invasiveness and in their susceptibility to control with specific antibodies and/or antibiotics. These differences may reflect the degree to which intact host defense mechanisms force the bacteria to adopt the defensive, microcolony mode of growth. As examples, the nearly intact host defense mechanisms and vigorous immune response of patients with cystic fibrosis force P. aeruginosa in pulmonary infections into a demonstrably cryptic, microcolony mode of growth that allows its persistence in the face of specific antibodies and antibiotics but limits its toxic activity and its dissemination. In contrast, the ruined defense mechanisms of burned skin allow the spread of bacteria in the mobile mode; toxic effects are seen in neighboring tissues, and a mixed mobile-microcolony reservoir population, whose mobile members can subsequently invade the circulatory system, is built up in the burned tissue. Thus, it is important to define the mode of bacterial growth in each type of P. aeruginosa infection and, where the microcolony mode is predominant, to understand the chemistry of the enveloping exopolysaccharide in order to limit its synthesis and/or facilitate its penetration by antibodies and antibiotics.
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PMID:The role of the microcolony mode of growth in the pathogenesis of Pseudomonas aeruginosa infections. 641 12

The effects of a home care program with 102 courses (2336 patient-days) of intravenous antibiotic therapy were evaluated. Home care nurses changed the intravenous cannula site every 3 days. The initial hospital stay averaged 11.8 days and the duration of home therapy averaged 22.9 days. The diseases treated included osteomyelitis, septic arthritis, endocarditis, cystic fibrosis and pneumonia, staphylococcal bacteremia, blastomycosis, actinomycosis and other soft tissue infections. All classes of commonly used antibiotics, including penicillins, cephalosporins, aminoglycosides and amphotericin B, were administered, alone or in combination. There were no side effects that necessitated discontinuation of home treatment or readmission to hospital. The average cost per patient-day was $58, compared with an estimated $193 for in-hospital therapy; in addition, 2336 hospital bed-days were made available. Most patients were able to resume many or all of their daily activities while receiving intravenous antibiotic therapy.
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PMID:Self-administration of intravenous antibiotics: an efficient, cost-effective home care program. 680 5


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