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

From January 1988 to December 1994, 66 consecutive blood culture isolates of viridans group streptococci collected from febrile neutropenic cancer patients were tested for antimicrobial susceptibilities by the agar dilution method. The antibiotics studied were erythromycin, clarithromycin, roxithromycin, dirithromycin, azithromycin, josamycin, diacetyl-midecamycin, spiramycin, and quinupristin-dalfopristin. A total of 26 (39.4%) strains were resistant to erythromycin with an MIC range of 0.5 to > 128 micrograms/ml. The strains were classified into three groups according to their penicillin susceptibility: 42 (63.6%) were susceptible, 8 (12.1%) were intermediately resistant, and 16 (24.3%) were highly resistant. The percentages of erythromycin-resistant strains in each group were 23.8, 62.5, and 68.8%, respectively. Streptococcus mitis was the species most frequently isolated (83.3%) and showed the highest rates of penicillin (40%) and erythromycin (43.6%) resistance. MICs of all macrolide antibiotics tested and of quinupristin-dalfopristin were higher for penicillin-resistant strains than for penicillin-susceptible strains. All macrolide antibiotics tested had cross-resistance to erythromycin, which was not observed with quinupristin-dalfopristin. Our study shows a high rate of macrolide resistance among viridans group streptococci isolated from blood samples of neutropenic cancer patients, especially those infected with penicillin-resistant strains. These findings make macrolides unsuitable prophylactic agents against viridans group streptococcal bacteremia in this patient population.
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PMID:In vitro activities of eight macrolide antibiotics and RP-59500 (quinupristin-dalfopristin) against viridans group streptococci isolated from blood of neutropenic cancer patients. 887 91

Twenty-four blood samples obtained after tooth extraction with intravenous cefuroxime prophylaxis were cultured on Bactec NR16A and NR 17A (Becton Dickinson, Maryland, U. S. A.). MIC of identified microbes and the serum levels of cefuroxime were also measured. The overall incidence of bacteremia was 16.7% (four out of 24). Although nine strains were isolated, no streptococcal bacteremia occurred. The MICs of cefuroxime varied from 0.05 to 12.5 micrograms/ml, and serum levels ranged from 100 to 233 micrograms/ml, which were satisfactory concentrations for the microorganisms isolated. The results suggested that intravenous cefuroxime prophylaxis for tooth extraction reduced the incidence of bacteremia, as well as the isolation rate of streptococci, significantly.
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PMID:Transient bacteremia after tooth extraction with intravenous cefuroxime prophylaxis. 895 69

We report the isolation of a vancomycin-resistant strain of Enterococcus faecalis, designated AH803, from a 76-year-old Taiwanese woman with pneumonia and bacteremia. This is the first documented clinical isolation of a vancomycin-resistant enterococcus in Taiwan. AH803 was repeatedly isolated from sputum specimens of the patient. AH803 had a high level of vancomycin (minimal inhibitory concentration, MIC = 512 micrograms/mL) and gentamicin (MIC > 2,000 micrograms/mL) resistance, but was susceptible to teicoplanin (MIC = 8 micrograms/mL) and ampicillin (MIC = 2 micrograms/mL). AH803 was shown by polymerase chain reaction to have the vanA gene, but not the vanB gene. Despite treatment efforts, the patient's condition continued to deteriorate. She requested to be discharged, against medical advice. The patient died at home the following day after discharge.
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PMID:Clinical isolation of vancomycin-resistant Enterococcus faecalis in Taiwan. 900 Aug 15

Determination of the MIC in vitro is often used as the basis for predicting the clinical efficacy of antibiotics. Listeriae are uniformly susceptible in vitro to most common antibiotics except cephalosporins and fosfomycin. However, the clinical outcome is poor. This is partially because listeriae are refractory to the bactericidal mechanisms of many antibiotics, especially to ampicillin-amoxicillin, which still is regarded as the drug of choice. A true synergism can be achieved by adding gentamicin. Another point is that listeriae are able to reside and multiply within host cells, e.g., macrophages, hepatocytes, and neurons, where they are protected from antibiotics in the extracellular fluid. Only a few agents penetrate, accumulate, and reach the cytosol of host cells, where the listeriae are found. Furthermore, certain host cells may exclude antibiotics from any intracellular compartment. Thus, determination of the antibacterial efficacy of a drug against listeriae in cell cultures may be a better approximation of potential therapeutic value. Certain host cells may have acquired the property of excluding certain antibiotics, for example macrolides, from intracellular spaces, which might explain therapeutic failures of antibiotic therapy in spite of low MICs. Animal models do not completely imitate human listeriosis, which is characterized by meningitis, encephalitis, soft tissue and parenchymal infections, and bacteremia. Meningitis produced in rabbits is a hyperacute disease, whereby most listeriae lie extracellularly, fairly accessible to antibiotics that can cross the blood-cerebrospinal fluid barrier. In the murine model of systemic infection, Listeria monocytogenes is located mainly within macrophages and parenchymal cells of the spleen and liver, hardly accessible to certain drugs, such as ampicillin and gentimicin. The therapeutic efficacy of drugs clearly depends on the model used. Thus, for example, the combination of ampicillin with gentamicin acts synergistically in the rabbit meningitis model but not in the mouse model. Since conventional antimicrobial therapy with antibiotics is not satisfactory, particularly in the immunocompromised host (about 30% of patients with listeriosis die in spite of a rational choice of antibiotics), other possibilities must be considered for therapy as well as prevention. Indeed, listeriae are highly susceptible to several endogenous antibiotics, such as defensins. Bacteriocins produced by related bacterial species, e.g., lactobacilli and enterococci, are rapidly bactericidal. However, unfortunately, the use of such alternative measures along with immunization and immunmodulation is not yet feasible.
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PMID:Management of listeriosis. 910 58

Streptococcus pneumoniae has become a leading cause of bacteremia, pneumonia, meningitis, and otitis media in the United States. Persons at increased risk include young children, immunocompromised persons, and the elderly. Until 1987, S. pneumoniae was uniformly susceptible to penicillin; since then, in the United States, there has been increased identification of penicillin-nonsusceptible S. pneumoniae (PNSP) (defined as minimum inhibitory concentration [MIC] to penicillin > or = 0.1 microgram/mL), especially penicillin-resistant S. pneumoniae (PRSP) (defined as MIC to penicillin > or = 2.0 micrograms/mL). In addition, PNSP is becoming less susceptible to other antimicrobial drugs, including tetracycline, erythromycin, extended-spectrum cephalosporins, and chloramphenicol; some are susceptible only to vancomycin. Because of the emergence of PNSP, in December 1994, the New York City Department of Health (NYCDOH) amended the New York City health code to require reporting of PNSP to monitor the local prevalence of resistance to penicillin. This report summarizes surveillance findings from NYCDOH's data for 1995, which indicate that the highest case rates were among children aged < 4 years and that, among adults aged 20-44 years with PNSP infections, 71.4% also were infected with human immunodeficiency virus (HIV).
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PMID:Surveillance for penicillin-nonsusceptible Streptococcus pneumoniae--New York City, 1995. 913 81

Emergence of vancomycin-resistant enterococci has become an increasing problem in many medical centers. We report a liver transplant recipient with vancomycin-resistant Enterococcus faecium bacteremia who was successfully treated using very high dose continuous infusion ampicillin/sulbactam, plus gentamicin after he remained bacteremic on high dose ampicillin and gentamicin. At our institution, 83% of E. faecium isolates from 1994 were inhibited by ampicillin/sulbactam compared to 66% for ampicillin at an MIC < or = 64 micrograms/ml. None of these strains produced beta-lactamase, suggesting sulbactam may have an unexplained beneficial effect against some enterococci. Although an MIC of < or = 8 micrograms/ml is required for ampicillin to be considered active against enterococci, much higher levels of ampicillin or ampicillin/sulbactam are safely achievable. The response of our patient and the reported in vivo data have implications for future treatment of this pathogen, and may necessitate a reevaluation of susceptibility interpretation guidelines by clinical laboratories, and therapeutic drug dosing by clinicians.
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PMID:Successful treatment of persistent bacteremia due to vancomycin-resistant, ampicillin-resistant Enterococcus faecium. 915 83

Streptococcus pneumoniae was isolated from patients with bacteremia, meningitis, pneumonia, and otitis media and used to determine susceptibility to various antibiotics. Of 105 isolates, 51% to 83% were resistant to 6 antibiotics (i.e., the percentages of resistance to penicillin, ampicillin, cephalothin, chloramphenicol, tetracycline, and erythromycin were 78%, 67%, 51%, 56%, 83%, and 58%, respectively). Also, 66 of the 105 isolates were multidrug resistant. Seventy-eight percent of multidrug-resistant strains were highly resistant to tetracycline (minimum inhibitory concentration [MIC] > or = 50 micrograms/ml), and 39% of multidrug-resistant strains were also highly resistant to erythromycin (MIC > or = 128 micrograms/ml). However, only 4% of the 105 isolates were resistant to cefotaxime.
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PMID:High incidence of multidrug-resistant Streptococcus pneumoniae in South Korea. 915 10

The incidence of bacteremia and meningitis due to Streptococcus pneumoniae is highest among preschool-age children, particularly those < 2 years of age. Clinical trials of capsular polysaccharide vaccines among young children have been disappointing. Conjugation of bacterial polysaccharides to proteins can increase antibody responses following vaccination of young children. Most conjugate vaccines proposed to date have been seven-valent. To identify serotypes most commonly associated with infection in young children, we serotyped pneumococcal isolates submitted to the CDC through national surveillance from 3884 children < 6 years old with pneumococcal bacteremia (n = 3169), meningitis (n = 401), or otitis media (n = 314) from 1978 to 1994. Seven serotypes (14, 6B, 19F, 18C, 23F, 4, and 9V) accounted for 3045 (78%) isolates. A conjugate pneumococcal vaccine protecting against these seven serotypes and serologically cross-reactive serotypes could potentially prevent 86% of bacteremia, 83% of meningitis, and 65% of otitis media cases. The proportion of isolates covered by such a vaccine increased from 78% to 87% from 1978 to 1994. Of 70 isolates submitted during 1992-1994 which were nonsusceptible to penicillin (minimal inhibitory concentration [MIC] > 0.1 microgram/mL, 56 (80%) were among the seven most prevalent serotypes. All 21 isolates resistant to penicillin (MIC > or = 2.0 micrograms/mL) were among these seven serotypes.
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PMID:Epidemiology of pneumococcal serotypes and conjugate vaccine formulations. 918 38

In April 1993 a national survey of pneumococcal bacteremia in hospitalized Israeli adults was started, and this survey covered 23 of the 24 Israeli medical centers. During the first 2 years, 603 episodes of pneumococcal bacteremia were recorded. The overall annual incidence of pneumococcal bacteremia in Israeli adults was 14.5 episodes per 100,000 inhabitants, and the overall mortality rate was 27.8%. Pneumonia was the source of bacteremia in 70.8% of cases, primary bacteremia was the source in 17.5%, meningitis was the source in 7.5%, and otitis media/sinusitis was the source in 4.2%. Of the 258 pneumococcal isolates for which an MIC was determined, 88.8% were susceptible to penicillin, 9.3% were partially resistant, and only 1.9% were highly resistant. Twenty-four serogroups were identified from 398 strains tested. The highest percentage of penicillin-resistant strains belonged to serogroups 23, 19, 9, 4, and 6. Although only 13 of these 24 serogroups correspond to the serotypes included in the 23-valent pneumococcal vaccine, they accounted for 94% of all isolates.
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PMID:Pneumococcal bacteremia in hospitalized Israeli adults: epidemiology and resistance to penicillin. Israeli Adult Pneumococcal Bacteremia Group. 919 76

Streptococcus pneumoniae is the most common cause of pediatric invasive infections and an important cause of morbidity and mortality. In the past, S. pneumoniae responded universally to penicillin until nonsusceptible isolates were first noted in the 1960s. Before 1990, penicillin-nonsusceptible isolates remained a minor component of all reported isolates. Since that time, 20-30% of isolates in many centers in the United States and up to 50% of isolates in some other countries are penicillin-nonsusceptible. Of greater concern has been the development of isolates which are nonsusceptible to more than one antimicrobial agent. This review presents data on pediatric invasive pneumococcal disease in Arkansas and outlines the new treatment recommendations which have been developed in response to these problems. Streptococcus pneumoniae is an important pathogen worldwide and is considered the most common etiology of bacterial sinusitis, otitis media, pneumonia, meningitis and bacteremia. Before 1990, 95-96% of pneumococcal isolates were susceptible to penicillin. The first report of penicillin-nonsusceptible S. pneumoniae was made by Hansman and Bullen in 1967, who identified the strain in the sputum of a patient with hypogammaglobulinemia. Soon thereafter, penicillin-nonsusceptible pneumococci were reported in New Guinea and Australia as well. Over the last several years, the incidence of penicillin-nonsusceptible isolates has greatly increased. Of particular concern is the concomitant increase in the number of organisms that are nonsusceptible to more than one antimicrobial agent. Due to the development of such isolates, clinicians are having to approach patients with invasive disease due to pneumococci more cautiously. In an attempt to clarify confusion with terminology, the Centers for Disease Control and Prevention (CDC) have recommended the same nomenclature be used to classify resistance for all organisms: nonsusceptible organisms are those with an MIC (minimal inhibitory concentration) greater than or equal to that defined for the intermediate category of resistance and the term resistant should be reserved for those organisms with an MIC greater than or equal to that defined for the resistant category. Therefore, resistant isolates are a subgroup of the nonsusceptible isolates.
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PMID:The approach to treatment of invasive pneumococcal disease in the 1990s. 939 28


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