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

We prospectively evaluated the use of peripherally inserted central venous catheters to provide ongoing venous access in general medical and surgical patients in a Department of Veterans Affairs medical center. Between 1985 and 1988 trained nurses successfully inserted 393 catheters in 460 suitable patients (an 85.4% success rate). Correct catheter tip placement in the superior vena cava was documented in 359 of the 393 (91.3%) catheter insertions, but an additional 30 catheters were in a position deemed adequate for the intended use. The mean duration of catheter use was 27.6 +/- 5.2 (1 standard deviation) days (median 20 days, range 1 to 370 days). A total of 65 patients left the hospital with catheters in place, with the mean length of catheter use at home being 36.2 +/- 6.0 days (range 2 to 266). In all, 79% of the catheters were in use until the successful completion of therapy or patient death; catheter-related complications led to premature catheter removal in the remaining 21%. Catheter-related complications included bland phlebitis (8.2%), occlusion (8.2%), local infection (3.6%), bacteremia or fungemia (2.1%), mechanical failure or rupture (2.6%), venous thrombosis (0.7%), and other (3.3%). One patient required vein excision for the management of suppurative phlebitis, but no deaths were attributed to catheter use. This study illustrates the use and safety of peripherally inserted central venous catheters to provide reliable vascular access over prolonged periods in an elderly veteran population. At our facility, percutaneous central venous catheters and surgically implanted (Hickman or Broviac) catheters are now reserved for use in patients in whom peripherally inserted catheters cannot be placed.
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PMID:Peripherally inserted central venous catheters. Low-risk alternatives for ongoing venous access. 812 98

Hickman catheters were the major venous access devices utilized at the University of Maryland Cancer Center from November 1978 to 1987. This study provided an opportunity to standardize insertion technique, to manage catheter-related activities and daily maintenance procedures in order to examine the progression of Hickman-catheter-related problems, to identify those factors that may minimize them, and to develop guidelines for the management and prevention of complications and malfunctions. In all, 690 Hickman catheters (368 double lumens) were placed in patients with acute leukemia and other cancers: 401 catheters were placed in patients with leukemia; 269 were placed during neutropenia; and 230 at platelet counts of < 50,000/microliters. Two surgeons inserted 490 catheters, and the remaining 200 were placed by a group of rotating surgeons. All catheters were placed with the intention that they would remain in place as long as clinically necessary. Total Hickman catheter days were 134273. Infectious complications included exit site infections (160), tunnel infections (46) and bacteremias (397). There were 438 instances of noninfectious complications including thrombosis, lack of function, catheter migration, fracture and hemorrhage. Recommendations for prevention and treatment of Hickman-catheter-related complications include the development of a select group committed to placement, daily maintenance and management of problems; prompt removal of catheters with Candida sp. fungemia and bacteremia due to Bacillus sp. or a bacteremia that persists for > 48 h after initiation of appropriate antibiotics, tunnel infections or Hickman-catheter-associated thrombosis. The majority of bacteremias and exit site infections can be effectively treated with antibiotics and local care.
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PMID:Hickman catheters in association with intensive cancer chemotherapy. 814 7

We examined the sensitivity of several BACTEC media options for the detection of bacteremia and fungemia in children at two pediatric health care facilities. At one institution a single aerobic bottle containing PEDS Plus medium was as sensitive in identifying positive blood cultures as the combination of aerobic and anaerobic media (77% vs. 80%; P = 1.0). When data from both facilities were combined, a blood culture set containing both aerobic and anaerobic media detected significantly more positive blood cultures than any single aerobic medium. However, the aerobic/anaerobic bottle combination was not significantly better than a blood culture set containing two aerobic media and, in absolute terms, the latter identified more cases of bacteremia. Of the 116 clinically significant episodes of bacteremia identified in this study, only 1 was caused by an anaerobic bacterium. We conclude that the routine use of anaerobic media for blood cultures of pediatric patients might be unnecessary but that the use of two different aerobic media could increase the sensitivity of the BACTEC blood culture system.
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PMID:Assessing the need for anaerobic medium for the recovery of clinically significant blood culture isolates in children. 780 63

In the midst of technologic advances within blood culture microbiology, several manual blood culture systems, which have an important role in the detection of bacteremia, mycobacteremia, and fungemia, are often overlooked. These include traditional broth-based systems, agar-broth biphasic blood culture techniques, a commercial broth-based manual system in which growth is detected by a broth displacement method, and lysis-centrifugation. This article reviews the operational features, advantages, and disadvantages of each.
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PMID:Manual blood culture systems and the antimicrobial removal device. 818 Dec 27

The clinical and laboratory issues important in pediatric blood cultures are similar to those in adult blood cultures with a few noteworthy exceptions. The collection of an uncontaminated specimen and an ample volume of blood is more difficult, especially in neonates. In addition, children often have previously received oral antibiotics or a broad-spectrum parenteral antibiotic. The relative frequencies of the pathogens causing bacteremia in children are different in important ways from in adults. Haemophilus influenzae b, although much less common than in the past, is still an important pediatric pathogen. Meningococcemia is relatively more common in children than in adults, and enterobacteriaceae and anaerobes are relatively less common. Group B streptococci, E. coli, coagulase-negative staphylococci, and Candida sp. are the principal pathogens in neonates. More changes in the distribution of blood-borne pathogens can be expected in the future with the introduction of new or more effective vaccines against the pneumococcus, meningococcus, and, possibly, group B streptococcus. In suspected community-acquired bacteremia in otherwise normal children, a single aerobic blood culture of adequate volume is sufficient. Sick neonates, hospitalized children with indwelling intravascular devices, and immunocompromised children may need multiple blood cultures, paired cultures from an indwelling vascular catheter and a peripheral vein, or use of special media. There is no single optimal system for pediatric blood cultures. The BACTEC systems have been adopted as a single system in many hospitals serving both children and adults because of the favorable results reported in children and the preference of using a single automated system. To maximize the detection of bacteremia and fungemia, some laboratories may wish to combine a BACTEC system with a second complementary system, such as the Isolator. Anaerobic, mycobacterial, and other special blood culture media should be reserved for selected patients.
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PMID:Pediatric blood cultures. 818 Dec 29

Catheter-related infections with both local inflammation and bacteremia or fungemia are common in hospitalized patients. The diagnosis of these infections is not, however, straightforward. Evidence of local inflammation is helpful, if present, but is not always found with site infections, and blood cultures are not positive. Systemic infection is associated with positive blood cultures, but the finding of a positive blood culture does not identify the catheter as the source. With central catheters, making a diagnosis without having to remove the catheter would be useful, because many of these patients could be treated with antibiotics without catheter removal. Multiple methods have been described for identification of these infections. Semiquantitative cultures of the catheter tip performed by rolling the catheter on the surface of an agar plate are the most popular. For central catheters, many advocate obtaining blood cultures through the catheter and comparing the results by quantitative methods with peripherally obtained blood cultures. No method has clearly demonstrated a clinical benefit in large numbers of patients. Because the most serious manifestation of catheter-related infection is bacteremia or fungemia, ordinary blood cultures are of the most practical importance in the identification of patients requiring therapy. Whether any of the additional studies described can be justified in everyday laboratory practice or simply represent considerable wasted effort is not known. Better methods for identifying infections and for managing such infections in patients with long-term indwelling central catheters are needed.
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PMID:Catheter-related infections and blood cultures. 818 Dec 33

Variables of particular importance to the detection of bacteremia and fungemia include the collection of at least two separate blood cultures per septic episode and the inoculation of a minimum of 20 mL of blood from adults into each set of blood cultures. Switching of needles between venipuncture and inoculation of blood culture systems has been shown not to be necessary to reduce contamination and should be avoided to obviate needle stick injuries. The selection of the most appropriate blood culture system for use in the laboratory depends on numerous factors, including costs, personnel qualifications, and patient demographics.
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PMID:Collection, transport, and processing of blood cultures. 818 Dec 34

Various factors are important in the laboratory detection of bacteremia and fungemia. These include clinical factors, the type of blood culture system, and laboratory processing of blood culture bottles. Most commercial blood culture products have been designed to take these factors into account and, thus, are relatively similar. There are differences, however, and it should not be assumed that these products have identical performance characteristics. To optimize microbial recovery, clinicians should order and collect the proper number of blood cultures at the earliest possible time and before the administration of antimicrobial agents. Clinical microbiologists should select a blood culture system that optimizes the recovery of common microbial pathogens and should use blood culture systems according to the manufacturers' recommendations.
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PMID:General principles in the laboratory detection of bacteremia and fungemia. 818 Dec 35

The presence of bacteremia and fungemia is an indication of the failure of the host's immune system to localize infection at its primary focus or of the physician's failure to remove, drain, or sterilize that focus. This article reviews the ability of the microbiology laboratory to detect bloodstream infections quickly and efficiently.
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PMID:Clinical importance of blood cultures. 818 Dec 37

Five episodes of fungemias are described; all had occurred in children with leukemia or lymphoma between January 1, 1978 and December 31, 1990. These fungemias comprised 3.4% of the total septicemias encountered during that period. Three episodes occurred during the induction phase and two during relapse. All patients had fever of varying degree and duration. In addition to steroids, all were receiving combination antibiotics before the fungemia had occurred. All patients had severe neutropenia lasting more than one week. Bacteremia preceded fungemia in four patients. Two episodes were diagnosed antemortem. The same species were isolated from other sites in three cases. Fever, chills and gastrointestinal symptoms were the most common clinical features; other symptoms included cough, dyspnea, oliguria and azotemia. One patient experienced skin lesion, dysphagia, hoarseness and hemiparesis. Only one patient survived. The prognosis from fungemia in leukemia and lymphoma patients is very poor. Empiric antifungal therapy is indicated in neutropenic patients who have recurrent or persistent fever despite one week of broad spectrum antibiotics. Early diagnosis and treatment will aid in improving the overall poor outcome of this disease.
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PMID:Candida tropicalis fungemia in children with leukemia and lymphoma. 821 55


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