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

Fifty-one episodes of bacteremia and a single episode of fungemia occurred during treatment with seemingly adequate doses of appropriate antibiotics. Clinical findings in these "breakthrough" bacteremias and fungemia were compared with those in 448 non-breakthrough episodes. Breakthrough was more likely to be caused by facultative or aerobic gram-negative rods (e.g., Enterobacteriaceae and Pseudomonas species) than by anaerobes. Of the underlying conditions examined, immunosuppressive doses of glucocorticosteroids, diabetes mellitus, and moderate renal failure were significantly more frequent in patients with breakthrough. A significant association was also observed between an intra-abdominal primary focus of infection (abscesses, biliary tract or bowel infections) and the occurrence of breakthrough. Mortality in breakthrough bacteremia was 61 percent compared with 40 percent in non-breakthrough episodes. The phenomenon of breakthrough bacteremia shows the potential limitations of antibiotic therapy alone.
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PMID:Clinical importance of "breakthrough" bacteremia. 669 45

To evaluate the role of atmosphere of incubation in the detection of clinically important bacteremia and fungemia in adults, we compared the yield of microorganisms from 10,541 paired 5-ml samples of blood incubated aerobically and anaerobically. The medium, supplemented peptone broth (SPB) with 0.03% sodium polyanetholesulfonate, and the ratio of blood to broth (1:10) were the same for all cultures. Only cultures with adequate blood samples (greater than or equal to 80% of stated volume) were compared statistically. More fungi (P less than 10(-7) ) grew in continuously vented bottles of SPB. Aerobic incubation also favored (P less than 0.01) isolation of Neisseria gonorrhoeae and Eubacterium; more than 80% of these bacterial organisms were detected only in vented bottles. Anaerobic incubation (plugged venting units) did not significantly favor the isolation of any genus of microorganisms, although an estimated 11% more Bacteroidaceae grew in the unvented bottle of SPB. By comparison of our data with published results for other media, we conclude that the need for both aerobic and anaerobic incubation of blood cultures is dependent upon the medium used and the microorganisms likely to be encountered. Vented incubation of blood cultured in SPB is crucial for detection of fungi and some bacteria. Routine use of an unvented bottle of SPB may not be worthwhile for patients in whom Bacteroidaceae cause bacteremia infrequently. However, when Bacteroidaceae are suspected as the cause of sepsis, use of an unvented bottle of SPB is prudent.
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PMID:Controlled evaluation of the effect of atmosphere of incubation on detection of bacteremia and fungemia in supplemented peptone broth. 675 84

All strains of bacteria and fungi isolated from blood cultures of patients hospitalized in a large primary and tertiary care center were studied prospectively for determination of their clinical significance and probable source. In some instances the immediate mortality rate was also determined. The sensitivity patterns of all aerobic organisms to antibiotics were studied in relation to the role of antibiotic therapy. A positive culture was obtained from 6.8% of all blood specimens cultured and these positive cultures represented 639 episodes of bacteremia or fungemia. The organism isolated most of ten was Escherichia coli, and the most common known source was the urinary tract. Anaerobic organisms were isolated from 9.2% of the episodes of bacteremia, with the bowel being the most common probable source of infection. Antibiotic sensitivity testing revealed that all staphylococci were sensitive to methicillin, but only 22% were sensitive to penicillin. No penicillin-resistant pneumococci were encountered. The Enterobacteriaceae exhibited such a high sensitivity to gentamicin that comparison of its activity with that of other, newer aminoglycosides was impossible.
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PMID:A review of positive blood cultures: identification and source of microorganisms and patterns of sensitivity to antibiotics. 677 1

Commercially manufactured blood-culture bottles with 6 different culture media have been considered in this study. The bottles were respectively supplemented with 10% fresh human blood and inoculated with obligate aerobic and facultative anaerobic microorganisms known to cause bacteremia and fungemia. The inoculum size ranged from less than 10 to 10(2) CFU per blood-culture bottle. The study was carried out by alternately incubating one set of bottles anaerobically for two days before being vented, while the other set was vented immediately after inoculation. The effect of anaerobic and aerobic atmospheres on growth intensity, recovery rate and survival durability of the 11 microbial strains has been studied. The maintenance of anaerobic atmosphere for 2 days before venting the blood-culture bottles caused: a) 2 to 4 days delay in detecting nonfastidious bacteria and fungi; b) rapid death of acid-sensitive bacteria in poorly buffered culture media; c) inability of fastidious bacteria to grow in any of the 6 culture media. On the other hand venting the blood-culture bottles immediately after inoculation enabled: a) rapid detection of bacteria by an early subculture after 8 hours of incubation; b) diagnostic advantage of at least 2 days with rapidly growing bacteria which make more than 50% of the whole microbial spectrum; c) good growth of fastidious bacteria. Collectively, brain heart dipeptone broth proved to be the most effective culture medium for detection of obligate aerobic microorganisms responsible for bacteremia.
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PMID:[Effect of anaerobiosis in 6 blood-culture media on the recovery rate of aerobic microorganisms (author's transl)]. 680 74

Catheter-related sepsis is one of the major complications of total parenteral nutrition (TPN) therapy. The relationship between microbial colonization of the skin at the site of catheter insertion and colonization of the central venous catheter was investigated in 74 catheters used to administer TPN therapy in 53 patients. Semiquantitative culture specimens were obtained from the insertion site and intravascular and subcutaneous catheter segments at the time of catheter removal. Bacteria and/or fungi were recovered from 19 catheters and 19 insertion sites; of the 19 colonized catheters, 6 had sterile insertion sites. Organisms isolated from the remaining 13 catheters were isolated concurrently from the insertion site. Catheter-associated bacteremia or fungemia was observed in 10 of the 19 patients with colonized catheters. The association between colonization of catheters and the presence of more than 10(3) bacterial or fungal colony-forming units at the insertion site was significant (P less than 0.005). These results demonstrated that colonization of catheters by organisms present on the skin at the site of catheter insertion occurred twice as frequently as colonization by the hematogenous route. The results also suggested that colonization of catheters by organisms present at the insertion site occurred only after a threshold number of organisms was reached.
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PMID:Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. 681 29

Among 500 patients with bacteremia and fungemia, total mortality was 42%; about half of all deaths were attributable directly to infection. Mortality increased with age, but deaths unrelated to infection itself were responsible in part for this increase. Mortality was 2.6% among obstetric-gynecologic patients, 42% among medical patients, 49% among surgical patients, and 60% among transplant patients. The risk of death was especially high with enterococcal, facultative gram-negative, fungal, polymicrobial, or hospital-acquired sepsis; in the presence of shock, leukopenia, absolute granulocytopenia, or defined predisposing conditions (neoplasia, cirrhosis, and combinations of factors such as surgery and renal failure); and with a primary infected focus in the respiratory tract, the skin, a surgical wound, an abscess, or an unknown site. Body temperature was inversely related to mortality. Survival was increased by the use of appropriate antibiotics and, where applicable, additional therapeutic maneuvers (e.g., drainage). Multivariate analysis defined seven variables that independently influenced outcome: microorganism, blood pressure, body temperature, primary focus of infection, place of acquisition of infection, age, and predisposing factors. Although some adverse prognostic factors are not amenable to intervention, prevention of nosocomial bacteremia and fungemia and early reversal of hypotension may reduce the death rate from sepsis.
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PMID:The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. 682 12

In a controlled evaluation of 6,010 blood cultures, the yield of clinically significant microorganisms was greater from a lysis-centrifugation system (Isolator, Du Pont Co.) than from a nonvented vacuum bottle containing tryptic soy broth with sodium polyanetholesulfonate and CO2 and a vented bottle containing biphasic brain heart infusion medium with sodium polyanetholesulfonate. The Isolator significantly increased the frequency of isolation of Staphylococcus aureus and Candida spp. and significantly decreased the time required for the detection of S. aureus, Pseudomonas aeruginosa, and Candida spp.; however, anaerobic bacteria were recovered significantly more frequently from nonvented bottles with tryptic soy broth, and pneumococci were recovered significantly more frequently from both bottle systems. Contamination of cultures was significantly greater with the Isolator system than with either bottle system. Regardless of the number of blood cultures obtained per septic episode, the Isolator detected microbiologically proven bacteremia or fungemia in a significantly greater number of patients and significantly decreased the time required for detection.
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PMID:Microbiological and clinical evaluation of the isolator lysis-centrifugation blood culture tube. 686 7

The value of hypertonic media in the detection of bacteremia and fungemia is controversial, since prior clinical trials have yielded conflicting results with different media. Earlier, we showed that the addition of 10% sucrose to supplemented peptone broth at a 1:10 ratio of blood to broth yielded better recovery of Staphylococcus epidermidis, the Enterobacteriaceae, Pseudomonas aeruginosa, and yeasts. To evaluate the effect of 10% sucrose on blood cultured at a 1:5 ratio, we compared the yield and speed of detection of clinically important microorganisms from adult patients in 5,839 blood samples cultured in supplemented peptone broth with 0.03% sodium polyanetholesulfonate with and without 10% sucrose. The atmosphere of incubation (open venting units), 1:5 ratio of blood to broth, and methods of processing were the same for both bottles. Recovery of facultative gram-positive (P less than 0.02) and gram-negative (P less than 0.02) bacteria was improved, but the recovery of anaerobic gram-negative bacteria was both reduced (P less than 0.01) and delayed (P less than 0.02) by sucrose. The total yield of microorganisms including fungi, however, was increased with sucrose. The effect of sucrose on blood cultures appears to depend on the ratio of blood to broth as well as on the medium used and strains of microorganisms encountered.
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PMID:Controlled evaluation of hypertonic sucrose medium at a 1:5 ratio of blood to broth for detection of bacteremia and fungemia in supplemented peptone broth. 687 98

One hundred and ninety-five series of granulocyte transfusions in 144 patients were evaluated with respect to possible severe pulmonary toxicity from concomitant administration of granulocytes and amphotericin B. Dyspnea as a side effect of granulocyte transfusion was equally common among patients receiving amphotericin B and those in a matched control group not receiving amphotericin B. Granulocyte transfusions and amphotericin B were given simultaneously in 35 transfusion series, involving 32 patients. Respiratory deterioration, defined as the appearance of new pulmonary infiltrates on chest x-ray, occurred in 11 of these 35 episodes. Patients developing respiratory deterioration were similar to those not developing respiratory deterioration in age, diagnosis, disease status, duration of concomitant therapy, and outcome, but more often had positive fungal cultures as an indication for treatment (91% versus 58%; p = 0.1). In 8 patients, the episodes of respiratory deterioration were readily explained by congestive heart failure, by simultaneous bacteremia or fungemia, or by fungal pneumonia discovered at autopsy. One patient had a leukoagglutinin reaction (responsive to steroids) and the other 2 had unexplained, but reversible respiratory deterioration. We concluded that concomitant administration of granulocyte transfusions and amphotericin B is not associated with unexpected or rapidly fatal pulmonary toxicity and when appropriate, can be safely accomplished.
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PMID:Concomitant administration of granulocyte transfusions and amphotericin B in neutropenic patients: absence of significant pulmonary toxicity. 700 33

Using an indirect immunofluorescent antibody technic, the authors determined the serum microbial antibody titer (MAT) in 26 patients (five with infective endocarditis, eight with septicemia without endocarditis, and three with access device-related bacteremia, three with fungemia without endocarditis, and seven with false-positive blood cultures). The MAT in the early clinical stage of infective endocarditis (IE) exceeded 350; after appropriate antibiotic therapy, it decreased to below 50 with clinical improvement. MAT in patients with septicemia was above 20 and less than 200; in patients with bacteremia, above 10 and less than 50; and in patients with false-positive blood cultures, it was less than 10. The authors suggest that MAT against isolated bacteria may be useful in diagnosing septicemia with or without IE, in determining the appropriate length of treatment, and in differentiating bacteremia from false-positive blood cultures.
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PMID:Clinical significance of titered circulating microbial antibody in bacteremia. 704 21


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