Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004610 (bacteremia)
 13,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From July 1999 to June 2004, we evaluated Streptococcus pneumoniae bacteremia in 40 children in Kamikawa and Soya Subprefectures in Hokkaido by obtaining the patient's information from 7 out of 9 hospitals in the area. The incidences of S. pneumoniae bacteremia in children aged < 2 years and < 5 years were 79.1 and 63.4. Median age was 19.6 months with a range from 4 months to 4 years. Thirty-one (77.5%) of the total were less than 2 years old. All of the children were admitted. The diagnoses were occult bacteremia in 12 patients, pneumonia or bronchitis in 11, pharyngitis in 7, pneumonia and acute otitis media in 5, acute otitis media in 3, orbital cellulitis in 1, and arthritis in 1. All of the patients had fever and temperatures and 35 (87.5%) of them were more than 39 degrees C. Ten patients had a febrile convulsion. Twenty-nine had a high total white blood cell counts (> 15,000/microg/ml) and 31 had positive CRP values (> 0.6 mg/dl) on admission. Meningitis and poor prognosis did not occur after occult bacteremia in our patients. We studied the susceptibility to penicillin G in 22 strains of S. pneumoniae isolated from the children. One and 18 strains were penicillin-resistant (MIC > or = 2.0 microg/ml) and intermediate (MIC 0.1-1.0 microg/ml).
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PMID:[Study of Streptococcus pneumoniae bacteremia in children]. 1571 76

Antimicrobial susceptibilities of 156 Streptococcus pneumoniae strains isolated from 1994 through 2002 were studied. Of this total, 38.7, 26.3, 16.7, 8.9, and 9.6% were recovered from patients with bacteremia, pneumonia, otitis media, sinusitis, and meningitis, respectively. All S. pneumoniae strains were fully susceptible to amoxicillin-clavulanic acid and ampicillin, with 9.0 and 2.6% being resistant to penicillin and ceftriaxone, respectively. The ratios of resistant strains to tetracycline, co-trimoxazole, and chloramphenicol were 73.7, 69.3, and 63.5%, respectively. Approximately 90% of strains remain sensitive to erythromycin. A high prevalence of resistance to the penicillins and cephalosporins does not exist in Trinidad, although a trend toward such a pattern appears to be developing. The most frequent serotype was 14 (38.0%), followed by 6B (20%), 23F (10.3%), and 4 (6.4%), and all were recovered from children. The other serotypes accounted for <6% of the total isolates. All penicillin- and ceftriaxone-resistant strains belonged to serotype 14 (MIC > or = 2 microg/ml and > or = 4 microg/ml), respectively. Identifiable risk factors for resistant isolates included the prevalence of otitis media and sinusitis among children treated inadequately with oral cephalosporins; the ease of obtaining antibiotics without a prescription at many pharmacies; and the indiscriminate prescribing of antibiotics by general practitioners.
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PMID:Pneumococcal infections in Trinidad: patterns of antimicrobial susceptibility: 1994-2002. 1572 85

Vancomycin-resistant enterococci (VRE) have emerged as an important nosocomial pathogen. Since 1989, a rapid increase in the incidence of enterococcal bacteremia and endocarditis by VRE has been reported. The use of avoparcin in animal husbandry is reportedly associated with the appearance of VRE. In this study, a multiplex polymerase chain reaction (PCR) method was established to detect and differentiate resistant types of enterococci, which specifically amplify the four van genes that encode vancomycin resistance elements. Using this method, we investigated the incidence rates and types of VRE from two types of farms: those that had used avoparcin and those that had not used avoparcin. A total of 1091 animal fecal samples were collected from 70 pig farms and 32 poultry farms. A total of 425 enterococci were isolated from the fecal samples. Among the 425 isolates, six showed a pattern of high-level vancomycin resistance (Minimal Inhibitory Concentration, MIC: 64-256 microg/ml). Out of six high-level VRE, three were isolated from poultry farms that had used avoparcin and three were not. The six high-level VRE harbored the vanA gene. Sixty-seven of 425 isolates that showed a pattern of low-level vancomycin resistance (MIC: 4-8 microg/ml) were associated with the presence of vanC-1 or vanC-2/3 gene. We also performed a repetitive extragenic palindromic PCR (rep-PCR) method to compare the genetic relatedness between the high-level VRE of six animal isolates and 31 human isolates. None of the animal isolates had a similar rep-PCR pattern as the human isolates but similarities between human VRE isolates were observed.
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PMID:Comparison of vancomycin-resistant enterococci isolates from human, poultry and pigs in Korea. 1577 28

Multidrug resistance among Salmonella typhi is well known. Reports of treatment failure in enteric fever with Ciprofloxacin made us undertake this study to determine the antibiotic susceptibility pattern of S. typhi and S. paratyphi A isolated from typhoid bacteremia cases, by disc diffusion and MIC by broth dilution method. A total of 50 strains were tested, 48 of Salmonella typhi and 2 of S. paratyphi A. The disc diffusion method was done using ampicillin, chloramphenicol, cotrimoxazole, tetracycline, ciprofloxacin, ofloxacin, cefuroxime and ceftriaxone as antibiotics. The MIC was performed using ciproloxacin, ofloxacin and ceftriaxone based on standard procedure. ACCOT resistance as determined by disc diffusion method was seen in 68% of isolates. All the strains remained susceptible to flouroquinolones cephalosporins and aminoglycosides. The MIC of ciprofloxacin, ofloxacin and ceftriaxone were in the recommended range of susceptibility as given by NCCLS, 14 (28%) strains had MIC of ciprofloxacin greater than 0.5 ug/ml with 4 strains having an MIC of 1.56 ug/ml; 25 (50%) strains had MIC of ofloxacin greater than 0.5 ug/ml and 20 (40%) strains had MIC of ceftriaxone greater than 0.5 ug/ml. The high levels of MIC of ciprofloxacin may account for treatment failure cases. The rising levels of MIC of ofloxacin and ceftriaxone in S. typhi and S. paratyphi is also of concern. We document here the emergence of high levels of MIC not only to ciprofloxacin, but also ofloxacin and ceftriaxone in S. typhi and S. paratyphi A. We recommend that MIC levels of ofloxacin and ceftriaxone should be monitored along with ciprofloxacin in treatment failure cases of enteric fever.
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PMID:Increase in minimum inhibitory concentration to quinolones and ceftriaxone in salmonellae causing enteric fever. 1579 8

At Tenri Hospital in Nara prefecture of Japan, the blood culture system is managed by a medical technologist with a microbiology specialty, and the other medical technologists manage the blood culture system when the primary technologist who specializes in microbiology is not working in 24 hours. For positive cultures, the Gram staining morphology of the organism is reported direct by to the clinician by telephone within 24 hours after culture bottles are submitted to the laboratory. We, the medical technologist, discuss with the clinician the focus of infection, use of antibiotics, effects of antimicrobial therapy, and clinical background of the patient. In some cases, we examine the MICs of specific bacteria isolated from patients and calculate the pharmacokinetic (PK)/pharmacodynamic (PD) parameters(e.g., time above the MIC, area under the curve/MIC and peak concentration/MIC). We then recommend to the clinician the most suitable dosage regimen. For patients with a serious infection or renal failure requiring a special dosing regimen, we perform therapeutic-drug monitoring with various antimicrobial agents. Information for rapid diagnosis of bacteremia and suitable dosing regimens for antimicrobial agents should be provided to the clinician with the following considerations: (1)findings should be reported within 24 hours of receiving a specimen, (2)the report should include a therapeutic regimen that considers the MIC of the target bacteria, and (3)the MIC interpretive criteria that correspond to the dosage regimen should be adopted.
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PMID:[Sepsis and blood culture management]. 1591 71

In the current era of multidrug-resistant organisms, the clinical spectrum of Streptococcus pneumoniae infection remains unclear, especially in immunosuppressed patients with cancer. We sought to define the characteristics of pneumococcal bacteremia in patients who were receiving care at a comprehensive cancer center. All consecutive episodes of S. pneumoniae bacteremia between January 1998 and December 2002 were evaluated retrospectively. One hundred thirty-five episodes of pneumococcal bacteremia occurred in 122 patients. Sixty-three (52%) of 122 patients had hematologic malignancies; the others had solid tumors. The median Acute Physiology and Chronic Health Evaluation II score was 14 +/- 5. Twenty-four episodes (18%) occurred during neutropenia (<500 cells/microL). Sixty-five patients (53%) were receiving antineoplastic therapy, and 36 (30%) were receiving systemic corticosteroids. Twelve (41%) of 29 hematopoietic stem cell transplant (HSCT) recipients had received transplantation within 12 months of the infection diagnosis; 11 patients had graft-versus-host disease (chronic in 10). In 27 episodes (22%), S. pneumoniae bacteremia was considered as a breakthrough infection. Nine (56%) of 16 hospital-acquired episodes of S. pneumoniae bloodstream infection occurred in patients with profound neutropenia, whereas 15 (13%) of 119 episodes of community-acquired infection occurred during neutropenia (p < 0.0002). In 91 episodes (67%), patients had radiographic evidence of pneumonia. Infected catheters were associated with 21 episodes (16%). Forty-eight (36%) of 135 isolates were not susceptible to penicillin (minimum inhibitory concentration [MIC] > or = 2 microg/mL); 9 (7%) showed intermediate susceptibility to ceftriaxone (MIC >0.5 and <2.0 microg/mL). Nineteen patients (16%) died within 2 weeks of diagnosis; 18 deaths were attributed to systemic pneumococcal infection. Univariate analysis showed no significant increase in the risk of short-term death in patients with infection due to penicillin non-susceptible organisms (OR [odds ratio], 1.47; 95% confidence intervals [CI], 0.53-4.05; p < 0.46), initially discordant treatment (OR, 1.0; 95% CI, 0.62-665.4; p < 0.16), presence of pneumonia (OR, 1.19; 95% CI, 0.39-3.62; p < 0.76), neutropenia (OR, 1.0; 95% CI, 0.28-4.09; p < 0.92), systemic corticosteroid use (OR, 1.96; 95% CI, 0.69-5.60; p < 0.21), or antineoplastic therapy (OR, 1.45; 95% CI, 1.52-4.05; p < 0.47). Similarly, patients with hematologic cancers compared to those with solid cancers (OR, 1.0; 95% CI, 0.49-3.70; p < 0.56) and recipients of HSCT compared to those with no history of transplantation (OR, 1.0; 95% CI 0.59-12.71; p < 0.20) did not have a less favorable outcome. In conclusion, most pneumococcal bloodstream infections were community acquired, although hospital-acquired infections were common in neutropenic patients. It is noteworthy that initially discordant therapy, penicillin non-susceptible S. pneumoniae, and other conventional predictors of unfavorable outcome were not associated with increased mortality rates in these high-risk patients with cancer.
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PMID:Streptococcus pneumoniae bacteremia in patients with cancer: disease characteristics and outcomes in the era of escalating drug resistance (1998-2002). 1614 30

This investigation compared the effect of ethanol on fluoroquinolone antibiotic efficacy and pharmacodynamics in an ethanol-fed rat model of pneumococcal pneumonia. Male Sprague-Dawley rats received a liquid diet containing 36% of total calories as ethanol. Paired controls (pair-fed controls) were fed a liquid diet without ethanol or received rat chow. Diets began 7 days before and continued for 10 days after transtracheal infections with 10 times the 50% lethal dose of type 3 Streptococcus pneumoniae. Beginning 18 h after infection, the rats received once daily subcutaneous phosphate-buffered saline, levofloxacin, moxifloxacin, or trovafloxacin at 50 or 100 mg/kg of body weight. White blood cell counts were determined, blood samples were collected for culture, and mortality was recorded. Additional rats were killed on day 5 for pharmacodynamic studies and quantitative cultures of bronchoalveolar lavage fluid. Bacteremia occurred by day 3 in 20 of 22 untreated rats. All 22 untreated rats died by day 9. Moxifloxacin treatment was effective in all diet groups at both the 50- and 100-mg/kg doses. In contrast, 50-mg/kg doses of levofloxacin and trovafloxacin improved survival in ethanol-fed rats but were ineffective in chow-fed rats. High-dose trovafloxacin at 100 mg/kg was associated with increased mortality in pair-fed rats. The free-fraction area under the concentration-time curve/MIC ratio exceeded 50 with all antibiotics in the ethanol group but dropped below 30 with levofloxacin and trovafloxacin in the pair- and chow-fed rats, with higher mortality. Achievement of adequate antibiotic-free fraction area under the concentration-time curve/MIC ratios helps overcome ethanol-induced immune defects induced in experimental pneumococcal pneumonia.
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PMID:Effect of ethanol on fluoroquinolone efficacy in a rat model of pneumococcal pneumonia. 1637 88

Clinical and microbiologic studies of 50 cases of viridans streptococcal bacteremia in cancer patients were performed. The bacteria were identified to species level by sequencing analysis of the 16S rRNA gene. At least nine Streptococcus spp. were found, including S. mitis (25 strains, 50.0% of 50); currently unnamed Streptococcus spp. (11 strains); S. parasanguis (five strains); S. anginosus (three strains); S. salivarius (two strains); and one strain each of S. gordonii, S. sanguis, S. sobrinus, and S. vestibularis. There were no S. oralis strains. Among 11 antibiotics of nine classes tested, no resistance to vancomycin, linezolid, or quinupristin-dalfopristin was seen. Resistance to penicillin (MIC, 4 to 12 mug/ml) was noted only among S. mitis strains (28.0%, 7/25) and not non-S. mitis strains (0/25) (P = 0.004). Significantly more S. mitis strains than non-S. mitis strains were resistant to fluoroquinolones and to > or =3 classes of antibiotics. Isolation of quinolone-resistant organisms was associated with the prior usage of quinolones (P = 0.002). Quantitative blood cultures showed that the strains resistant to levofloxacin or gatifloxacin were associated with higher colony counts than were their corresponding nonresistant strains. The young and elderly patients also had higher levels of bacteremia caused predominantly by S. mitis. Septic shock was present in 17 (34.0% of 50) patients, and 13 of those cases were caused by S. mitis (P = 0.007). These results suggest that S. mitis is the most common cause of viridans streptococcal bacteremia in cancer patients and is more resistant to antibiotics than other species.
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PMID:Viridans streptococci isolated by culture from blood of cancer patients: clinical and microbiologic analysis of 50 cases. 1639 Sep 64

A 54-y-old morbidly obese male presented with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia secondary to chronic right hip arthroplasty infection. Bacteremia persisted despite prolonged vancomycin-based therapy (MIC < or = 1 microg/ml) and prosthetic removal. Adding daptomycin-rifampin resolved bacteremia within 48 h; hip cultures remained negative post-discharge. This case describes alternative treatment for chronic MRSA infections.
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PMID:Daptomycin-rifampin for a recurrent MRSA joint infection unresponsive to vancomycin-based therapy. 1644 8

The emergence of a clinically daptomycin-resistant Staphylococcus aureus isolate occurred during treatment of methicillin-resistant S. aureus bacteremia and probable vertebral osteomyelitis. The breakthrough isolate was indistinguishable from pretreatment daptomycin-susceptible isolates by pulsed-field gel electrophoresis. Daptomycin nonsusceptibility was confirmed by MIC and time-kill curve analyses.
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PMID:Emergence of a clinical daptomycin-resistant Staphylococcus aureus isolate during treatment of methicillin-resistant Staphylococcus aureus bacteremia and osteomyelitis. 1645 20


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