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From 1980 to 1986, 52 patients presented with an episode of fungemia due to Candida species at the Centre Hospitalier Universitaire Vaudois (representing 2% of the patients with positive blood cultures). In 51 of the 52 patients (98%) the infection was nosocomial, occurring after a median hospital stay of 24 days (range 4-250 days). Only 36 patients (69%) presented with an underlying condition (neoplasms in 18 patients, alcoholism in 7, diabetes in 6, immunosuppressive therapy in 5). In 19 patients (37%) an episode of bacteremia occurred prior to fungemia (median time 14 days, range 1-70 days). Candida albicans was the most commonly isolated species (71%). In 50 patients (96%) the episode of fungemia was associated with a significant, although nonspecific, clinical impairment. The digestive tract (38%) and N intravascular catheter (31%) were the two most common portals of entry for the fungemia. 32 patients (62%) received specific antifungal therapy consisting of amphotericin B in 29 patients (median total dose 450 mg, administered either alone or in association) or of ketoconazole in 3 patients. The global mortality was 46% and the fungemia-related mortality was 21%. Global and fungemia-related mortalities were significantly higher in patients not treated with antifungals than in those treated with them (87% versus 30%, p less than 0.001, and 47% versus 11%, p = 0.01 respectively).
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PMID:[Candida fungemia]. 267 47

Twenty-six episodes of Pseudomonas aeruginosa bacteremia treated with intravenous ceftazidime, 4-6 g/day were evaluated. Treatment was begun within the first 24 hours after the isolation of the microorganism and was maintained for 10-12 days. In two patients with neutropenia amikacin was added during the initial 48-72 hours until the susceptibility to ceftazidime was known. All isolates were sensitive to ceftazidime. The most common underlying diseases were neoplasia (12), diabetes with stroke (4), neurosurgical and vascular procedures (4), rheumatoid arthritis (2), burns (2), cor pulmonale (1), and hypertension (1). The origins of bacteremia were urinary (12), pulmonary (9), and unknown (5). The infection was hospital-acquired in 77% and community-acquired in 23%. A critical clinical status and the presence of complications were significantly (p less than 0.01) associated with an increased mortality rate. Clinical outcome was good in 18/26 (70%), with a 30% mortality rate. The microbiological evolution showed 14 eradications, 6 persistences, 3 relapses and 3 colonizations. Resistance did not develop during therapy. Ceftazidime may be a good alternative therapy for these severe infections, although wider comparative studies are required for a better evaluation.
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PMID:[Evaluation of ceftazidime monotherapy in Pseudomonas aeruginosa bacteremias. Prospective study]. 268 60

In a consecutive material of 652 E. coli bacteremia 70 episodes (11%) were found in 64 patients with diabetes mellitus. 10 patients had insulin-dependent and 54 had non-insulin-dependent diabetes. The E. coli strains were tested for adhesive properties as mediated by P-fimbriae, a virulence factor in human urinary tract infections. Half of the strains were P-fimbriated with a higher occurrence in women (26/42, 62%) than in men (9/27, 33%). Diabetic patients with a positive urine culture had a higher incidence of P-fimbriated E. coli strains (27/37, 73%) in blood culture than patients with negative or no urine culture taken (8/32, 25%). Furthermore, patients without compromising factors, regardless of their diabetes mellitus, had a higher incidence of P-fimbriated E. coli strains (19/29, 66%) than those with malignancies and other debilitating diseases (6/22, 27%). The high incidence of P-fimbriated E. coli strains in the non-compromised patients may depend on the ability of such bacteria to invade the urinary tract and cause acute pyelonephritis, which often precedes E. coli bacteremia. A lower incidence of P-fimbriated E. coli strains was found in patients with proteinuria prior to the bacteremic episode (10/31, 32%), compared to those without proteinuria (25/35, 71%). No correlation was noted between P-fimbriation and duration of diabetes or serum creatinine. The low incidence of P-fimbriated E. coli strains in patients with proteinuria indicates that nephropathy, or some concurrent complication, predisposes the diabetic patient to bacteremia with low virulent, non-P-fimbriated E. coli.
Diabetes Res 1987 Oct
PMID:Bacteremia with P-fimbriated Escherichia coli in diabetic patients: correlation between proteinuria and non-P-fimbriated strains. 289 4

We conducted a randomized, double-blind comparison of prednisone and placebo (group I) v prednisone and azathioprine (1.5 mg/kg/day) (group II) as early treatment of extensive chronic graft-v-host disease (GVHD). Patients with platelet counts less than 100,000/microL were placed into therapy with prednisone alone (group III). All three groups received identical doses of prednisone (1 mg/kg every other day) and one double-strength trimethoprim-sulfamethoxazole (TMP-SMX) tablet twice daily. Between January 1980 and December 1983, 179 previously untreated patients were enrolled and 164 were evaluable. Patients randomized to group I (n = 63) and group II (n = 63) were well matched for prognostic factors; those placed into group III (n = 38) had more frequent acute GVHD and progressive onset of chronic GVHD. Median duration of therapy was 2 years. Complications included diabetes (5%), aseptic necrosis (5%) and infection. For groups I, II, and III, the respective incidence of infection was disseminated varicella, 11%, 24%, 34%; bacteremia, 6%, 11%, 34%; and interstitial pneumonia, 5%, 14%, 18%. Recurrent malignancy was the most frequent cause of death and did not differ significantly across the groups. Nonrelapse mortality, however, did differ: 21% in group I, 40% in group II, and 58% in group III (I v II, P = .003; I v III, P = .001). Forty patients in group I, 30 in group II, and 10 in group III survive with a minimum follow-up of 3.8 years. Karnofsky performance scores for 68 survivors are 90% to 100%, scores for seven survivors are 70% to 89% and scores for five survivors are less than 70%. Actuarial survival at 5 years after transplant is 61% in group I, 47% in group II, and 26% in group III (I v II, P = .03; I v III, P = .0001). Treatment with prednisone alone results in fewer infections and better survival than prednisone and azathioprine in standard-risk chronic GVHD. Treatment with prednisone alone is less effective in high-risk patients with thrombocytopenia, and other strategies are required.
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PMID:Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation. 304 41

A case of Shigella sonnei bacteremia in a 65-year-old patient suffering from diabetes mellitus is discussed. The isolated strain had plasmid-mediated serum resistance and excreted aerobactin. The presence of diabetes mellitus as an underlying disease and the production by the Shigella sonnei isolate of factors related to bacterial invasion may have contributed to the bacteremic episode.
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PMID:Shigella sonnei bacteremia in an elderly diabetic patient. 313 43

Group B streptococcal infection may result in significant morbidity and mortality in both infants and adults. The experience with group B streptococcal disease was analyzed at one medical center over a ten-year period from 1975 to 1984. Streptococcus agalactiae bacteremia was observed in 29 adults and 26 infants, with an attack rate of 0.2 cases per 1000 adult admissions and 3.2 cases per 1000 live births, respectively. The majority of adult infections apparently occurred as a result of nosocomial acquisition and was associated with a high mortality rate of 38%. Risk factors for group B streptococcal sepsis in adults include diabetes mellitus, malignancy, and hepatic failure. The majority (73%) of neonatal cases occurred within seven days of birth and occurred in a setting of maternal fever, prolonged rupture of membranes, or prematurity. The mortality rate in infants was remarkably low at only 15%. Fatalities occurred in both adults and infants, despite appropriate antimicrobial therapy. Infection control strategies against group B streptococcus must address potential nosocomial dissemination in adults as well as vertical transmission in infants.
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PMID:Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. 327 72

Anaerobiospirillum succiniciproducens is a motile, spiral anaerobic bacterium with bipolar tufts of flagella. Reports of clinical illness due to A. succiniciproducens are rare. In a retrospective review of anaerobic isolates referred to the Centers for Disease Control (CDC) from January 1, 1975, through January 31, 1986, isolates of A. succiniciproducens from the blood of 21 patients were identified. A single patient whose blood isolate had not been received at CDC was included in the review. These 22 patients were from 15 states. Their mean age was 58.6 years. Underlying disorders included alcoholism, atherosclerosis, malignancy, surgery, diabetes mellitus, and dental caries. Clinical features included gastrointestinal tract signs and symptoms in 17 (77%) of 22, fever greater than 38 degrees C in seven (37%) of 19, and leukocytosis of more than 10,000 cells/mm3 in 11 (58%) of 19. Although 16 patients received antimicrobial therapy, its effect on outcome was unclear. A. succiniciproducens was reported to have contributed to the deaths of seven patients. Disorders predisposing patients to anaerobic infections may put them at increased risk for A. succiniciproducens bacteremia. The presence of antecedent gastrointestinal tract signs and symptoms suggests that the gastrointestinal tract might be the primary portal of entry.
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PMID:Bacteremia with Anaerobiospirillum succiniciproducens. 332 22

Nosocomial urinary tract infections represent approximately 40 per cent of all nosocomial infections, thereby contributing considerably to secondary bacteremia and sepsis and possibly increased mortality. Urethral catheterization is the single most important predisposing factor in the development of urinary tract infection. Patients at increased risk of nosocomial infectious complications are the elderly, malnourished and debilitated, those with diabetes or prosthetic devices, and those on immunosuppressive therapy. About 75 per cent of nosocomial urinary tract infections are attributable to gram-negative bacteria, a disproportionate number of which when compared with community-acquired infections are caused by Proteus, Klebsiella, and Pseudomonas. There is enough evidence in the literature to support the use of prophylaxis in urologic surgery. Antimicrobial prophylaxis reduces the incidence of postoperative urinary tract infection. It does not seem to reduce the incidence of transient perioperative bacteremia but probably prevents the development of sepsis, thereby reducing the number of serious infective complications, the average hospital stay, and the associated total cost of treatment. To achieve adequate urine, blood, and tissue levels of the antimicrobial agent at the time of surgery, the drug should be given preoperatively. A short perioperative course represents sufficient prophylaxis. Regimens with combinations of beta-lactam and aminoglycoside antibiotics or single use of an extended spectrum beta-lactam antibiotic are acceptable for this purpose.
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PMID:Antimicrobial prophylaxis in urologic surgery. 353 3

There are fewer studies on bacteremia coming from the community hospital, where the practicing family physician is likely to see this problem, than from the university hospital. The hypothesis of this study was that patterns of bacteremia would be different between the two types of hospitals. Two hundred four patient episodes of culture-proven bacteremia from two analogous community hospitals were reviewed. Bacteremia was discovered in 2.6 of 1,000 patients, which is lower than reports from university hospitals. Of the 213 organisms isolated, slightly more were gram-negative than gram-positive, whereas many tertiary care centers report a preponderance of gram-negative organisms. About 20 percent of the episodes of bacteremia ended in death, a rate lower than in many tertiary care centers, and slightly more patients died of gram-negative than gram-positive bacteremia. The most common organisms in descending order were the streptococci and Escherichia coli followed by Staphylococcus aureus, Klebsiella pneumoniae, Proteus species, and Streptococcus pneumoniae. The most common sources of bacteremia were, in decreasing order, urinary tract, source unknown, heart valve, and lung. The most common underlying disorders were, in decreasing order, malignancy, diabetes mellitus, complicated urinary tract infection, valvular heart disease, and postoperative infection. Correctness of treatment of bacteremia appeared to increase survival.
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PMID:A two-center review of bacteremia in the community hospital. 354 87

In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Staphylococcus aureus meningitis: a broad-based epidemiologic study. 382 85


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