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

Infection remains a major complication of severe granulocytopenia. The administration of empiric antibiotic therapy at the first sign of infection or fever has significantly reduced the sequelae of infection in such compromised patients. Yet, the appropriate composition of the empiric antibiotic regimen continues to be debated. Antibiotic combinations have been the standard approach; multiple studies have confirmed the importance of antibiotic combinations in patients who are profoundly granulocytopenic and have gram-negative rod bacteremia. The presence of a synergistic antibacterial effect and high serum bactericidal activity of the antimicrobial regimen improves the response rate in such severe infectious episodes. However, the occurrence of such infections at certain centers is declining, and the introduction of new, highly active, broad-spectrum beta-lactam antibiotics has raised the question of using a single agent, or monotherapy, as empiric treatment of febrile granulocytopenic cancer patients. Approximately 20 studies have been completed, and although these trials have demonstrated support for this approach, caution must be exercised because of the inconsistent study designs, wide range of response definitions, small patient numbers, and limited frequency of treated documented infections. Therefore, at present, a broad-spectrum antibiotic combination still remains the treatment of choice for empiric therapy of febrile granulocytopenic cancer patients. Carefully designed, prospective, randomized, double-blind trials investigating new approaches, such as monotherapy, must continue.
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PMID:Monotherapy for empiric treatment of fever in granulocytopenic cancer patients. 352 Dec 73

Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1, 1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology--4.9% and general surgery patients--4.0%, and lowest among newborns--0.3% and pediatric patients--0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections. The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nosocomial infections in 15 rural Wisconsin hospitals--results and conclusions from 6 months of comprehensive surveillance. 352 17

The rate of infectious complications differed significantly in two groups of heart transplant recipients who received different immunosuppressive regimens. Compared with patients who received conventional immunosuppression, patients treated with cyclosporine had a lower rate of infectious complications, and the contribution of infection to observed mortality was lower. Herpes simplex virus caused less morbidity and there were fewer active cytomegalovirus infections in seropositive recipients treated with cyclosporine. The incidence of bacterial pulmonary infections and associated bacteremia also decreased impressively. A decrease in nocardial infections was offset by a rise in those due to Legionella species. The frequency of aspergillosis was decreased by 54% in the cyclosporine-treated group, but half of these infections disseminated beyond the lung and such dissemination was always fatal. Infections with Pneumocystis carinii were significantly less common with cyclosporine-based immunosuppression. Screening serologic tests for toxoplasma should be done routinely and consideration given to prophylaxis in heart transplant recipients at high risk.
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PMID:Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids. 354 23

A prospective randomised study was conducted comparing the efficacy and toxicity of the antibiotics ticarcillin and cefamandole (TC) with or without tobramycin (TCT) in 100 febrile neutropenic patients with solid tumours undergoing conventional chemotherapy. In this study, neutropenia less than 100/microliter was noted in 31% of 106 evaluable infectious episodes and neutrophil counts less than 1,000/microliter persisted for a median 4 days. Infection was microbiologically documented in 42% of episodes (bacteremia 24%) with gram-negative organisms responsible for 63% of bacterial isolates. Overall, 65% of episodes responded to TC and 76% to TCT (p greater than 0.05). Patients with initial shock bacteremia, pulmonary infection, or gram-negative sepsis responded relatively poorly. Neutrophil nadir and pathogen susceptibility did not influence outcome. Antibiotic toxicity was minimal with no tobramycin-related nephrotoxicity. These results are broadly comparable to those observed with leukemic patients, but the relatively short duration of neutropenia in the solid-tumour patients appears to minimize the need for additional antibiotics provided there is adequate antimicrobial coverage with the initial choice of antibiotics.
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PMID:Randomised study of ticarcillin, cefamandole with or without tobramycin in febrile, neutropenic patients with solid tumors. 356 30

To determine the infectious complications associated with transhepatic biliary drainage devices, an analysis of the records of 38 patients who underwent placement of a pigtail catheter (n = 11), a Ring catheter/feeding tube (n = 13), or a Carey-Coons endoprosthesis (n = 15) was carried out. Nineteen infectious events occurred in 38 patients with 39 biliary devices. Infections consisted of bacteremia, cholangitis with and without documented bacteribilia, and intrahepatic abscesses and were frequently associated with obstruction (66.7 percent of infectious episodes). The most frequent organisms isolated from blood were Escherichia coli and Pseudomonas aeruginosa, and the most frequent organisms isolated from bile were P. aeruginosa, Klebsiella pneumoniae and Streptococcus faecalis. Trends for more frequent occurrence of neoplasms involving the gallbladder or biliary tract, recent surgical procedures and catheter manipulations in infected as compared with noninfected patients, and a delayed time to infection were noted in patients with an endoprosthesis.
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PMID:Infections associated with transhepatic biliary drainage devices. 357 61

A bacteriological survey of 50 consecutive patients undergoing transurethral resection of the prostate was performed. Preoperatively, 28% of the patients had asymptomatic bacteriuria. In the postoperative period, 46% of all the patients developed transient bacteremia. A significantly higher rate of bacteremia was found in patients with hypertrophy of the prostate than in those with cancer of the prostate and in patients undergoing long-lasting surgical intervention. Patients who developed bacteremia due to pathogenic bacteria were hospitalized for a significantly longer period of time.
Infection
PMID:Bacteremia in connection with transurethral resection of the prostate. 366 67

In a five-year retrospective study, there were 57 episodes of bacteremia among 1623 admissions (3.5%) of patients suffering from cirrhosis. Gram-positive bacteria were found in 70% of the episodes, gram-negative bacteria in 30%. All of the gram-positive bacteria found were fully sensitive to methicillin and to gentamicin. The gram-negative bacteria found were all sensitive to gentamicin, but only 50% were sensitive to ampicillin. The distribution between gram-positive and gram-negative bacteria was the same, irrespective of whether the patients acquired the infection inside or outside the hospital. More than 50% of the patients suffered from one or more of the following complications of cirrhosis: ascites, encephalopathy and haematemesis. Twenty-one patients died within seven days after the bacteremia was diagnosed. Bacteremia is a serious complication of advanced cirrhosis, and it is recommended that adequate antibiotic treatment is started when septicemia is suspected.
Infection
PMID:Bacteremia in patients suffering from cirrhosis. 371 May 95

Methicillin-resistant staphylococci (M-R staphylococci) represent 30% of the staphylococcal strains isolated in our hospital and pose important therapeutic problems. In a preliminary in vitro checkerboard study the bactericidal effect of various cephalosporins (cephalothin, cefamandole, cefotaxime and cefoperazone) in combination with other antibiotics (netilmicin, amikacin, vancomycin and fosfomycin) was studied on ten M-R staphylococcal strains. The combinations of cefoperazone with amikacin, cephalothin with vancomycin and of the four cephalosporins with fosfomycin were synergistic on the ten strains (FBC indexes less than or equal to 0.75). According to the CSF and bone levels achieved by these antibiotics and their bactericidal concentrations in combination, the combination of cefotaxime and fosfomycin was the most interesting, a concentration of less than or equal to 2 mg/l cefotaxime being bactericidal on five homogeneous M-R Staphylococcus aureus when combined with 4 mg/l of fosfomycin. This combination of cefotaxime (25 mg/kg, i.v. infusion over 30 min) and fosfomycin (50 mg/kg, i.v. infusion over three hours) three to four times daily was used to treat 16 patients: three patients with meningitis, six with bone and joint infections and seven with persistent bacteremia. The FBC indexes were less than or equal to 0.625 for the 12 strains studied. All the patients were cured without relapses. The concentrations of cefotaxime, desacetyl cefotaxime and fosfomycin in the CSF during meningitis three hours after the end of the infusion on the second day of treatment were 8.76, 6.82 and 58.0 mg/l, respectively, for patient one and 2.0, 0.53 and 31.0 mg/l, respectively, for patient two.(ABSTRACT TRUNCATED AT 250 WORDS)
Infection 1985
PMID:Cefotaxime in combination with other antibiotics for the treatment of severe methicillin-resistant staphylococcal infections. 385 Aug 54

Imipenem-cilastatin was given in doses of 1 g intravenously every 6 h to 31 patients. Twenty-five patients, with 27 infections, were clinically evaluable and received 20 to 210 g of imipenem for a duration of 5 to 56 days (average 16.3 days). Infections included seven cases of osteomyelitis, seven of bacteremia, five of cellulitis, two of pneumonia, three of pelvic cellulitis, two of intraabdominal abscess, and one each of empyema, mediastinitis, and endometritis. Fifty-five percent of the infections were caused by gram-negative bacilli, 33% were due to gram-positive organisms, and 10% were caused by anaerobes. Twenty-two patients (81%) were cured, three improved, one relapsed, and one became superinfected with a resistant organism. In 5 of 11 cases with Pseudomonas aeruginosa, the imipenem MIC for organisms isolated by the end of treatment was higher than it was initially, raising concern that imipenem should not be used alone to treat Pseudomonas aeruginosa infections. Twenty-one patients had no adverse reaction; of the remaining 10 patients, 4 had nausea, 1 had urticaria, and 6 had mild abnormalities in hepatic function; three episodes of diarrhea included two with Clostridium difficile toxin in stool and one with pseudomembranous colitis, as determined by sigmoidoscopy. Levels of creatinine, hemoglobin, leukocytes, platelets, prothrombin, and urine components were unchanged. Imipenem-cilastatin is a clinically effective antibiotic with freedom from nephrotoxicity and hematological abnormalities in the large doses used in this study.
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PMID:Safety and efficacy of high-dose treatment with imipenem-cilastatin in seriously ill patients. 386 Jan 87

A rapid technique has been developed to quantitate the degree of bacteremia in laboratory animals. Direct staining of blood smears with acridine orange and enumeration using fluorescent microscopy allowed quantitation of Haemophilus influenzae in blood at densities from 10(5) to 10(8) cfu/ml. This technique will facilitate the accuracy with which therapeutic trials are conducted in laboratory models of infection.
Infection
PMID:The use of acridine orange as a rapid method for the quantitation of bacteremia in laboratory animals. 387 64


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