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 277,896 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

The clinical and radiological features of pneumococcal pneumonia were studied in 94 hospitalized patients. Fifty-seven (61%) had a bronchopneumonic pattern on roentgenogram, and 37 (39%), a lobar pattern. Eighty-two (87%) of the patients in both roentgenographic classifications had one or more underlying disease states. There was no difference in the frequency of heart disease, diabetes, chronic pulmonary disease, or malignancy between the two categories. Sputum Gram's stains were also similar in both patterns. Twenty (54%) of the 37 patients with the lobar pattern were bacteremic compared with only five (9%) of the 57 patients with the bronchopneumonic pattern; all five patients with bronchopneumonia and bacteremia had an associated malignancy. Although a lobar pattern is usually emphasized in the diagnosis of pneumococcal pneumonia, this study showed that the majority of patients hospitalized with pneumococcal pneumonia had a roentgenographic bronchopneumonic pattern rather than the classic lobar pattern. Thus, patients with the bronchopneumonic pneumococcal pneumonia pattern may be underdiagnosed. The implications are important both for treatment and for epidemiologic data used in the selection of pneumococcal types for prophylactic vaccines.
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PMID:Pneumococcal pneumonia in hospitalized patients. Clinical and radiological presentations. 684 6

Eleven cases of bacteremia in diabetic patients with infected lower extremities at Rancho Los Amigos Hospital (RLAH) were observed over a 34-mo period. The yearly incidence was 0.6% of admissions to the Ortho-Diabetes service. Aerobic bacteria were recovered in six cases and anaerobic bacteria in five. Bacteroides fragilis was isolated four times, Staphylococcus aureus three times, and nonfragilis Bacteroides sp., Escherichia coli, group B streptococcus, and viridans streptococcus were each seen once. Ten of the 11 patients were febrile at the time of bacteremia. Clinical, laboratory, radiologic, and ultrasonographic parameters were comparable in patients with aerobic and anaerobic bacteremia, and between bacteremic patients and nonbacteremic controls. Fever, however, was significantly more frequent in bacteremic patients. Foul-smelling lesions were seen in two of the five patients with anaerobic bacteremia, and in none of the patients with aerobic bacteremia. Postoperative B. fragilis bacteremia was observed to be transient and resolved without definitive therapy in one patient. Appropriate antibiotic therapy in 10 patients together with surgical intervention in eight cases resulted in resolution of the infection in the remaining patients.
Diabetes Care
PMID:Bacteremia in diabetic patients with infected lower extremities. 692 18

Clinical features and specific aspects of treatment were evaluated in 612 patients with gram-negative bacteremia observed over a 10 year period. Coagulation abnormalities or thrombocytopenia were observed in 64 per cent of the patients. Evidence of disseminated intravascular coagulation (DIC) was found in approximately 10 per cent of them but was of sufficient severity to be associated with subcutaneous or visceral bleeding in 3 per cent of them. The frequency of coagulation abnormalities, other than DIC, was greater in patients with more severe underlying disease but DIC occurred with similar frequency irrespective of the severity of underyling host disease. Coagulation abnormalities of all types were associated with increased fatality rates. Hypothermia was noted in 13 per cent of the patients at the onset of bacteremia but was transient and was not associated with increased fatality. Failure to mount a febrile response greater than 99.6 degrees F within the first 24 hours of bacteremia was associated with a significant increase in fatality rates. Prior corticosteroid therapy diminished the febrile response to bacteremia. Age, underlying host disease, granulocytopenia, congestive heart failure, diabetes mellitus, renal insufficiency, nosocomial infections, and antecedent treatment with antibiotics, corticosteroids, and antimetabolites significantly increased fatality rates. Appropriate antibiotic treatment reduced the fatality rate of those with bacteremia by approximately one-half among patients in each category of severity of underlying host disease. In addition, it was shown that early appropriate antibiotic therapy also reduced the frequency with which shock developed by one half. Even after development of shock, appropriate antibiotic therapy significantly reduced fatality rates. The use of combinations of antibiotics could not be demonstrated to significantly improve survival rates. Minimal differences in therapeutic efficacy could be demonstrated between individual antibiotics and various combinations of antimicrobials. Shock occurred in approximately 40 per cent of the patients and its frequency was not influenced by the species of etiologic agent. Contrary to previous reports, corticosteroid therapy in patients with shock did not enhance survival and treatment with an average of 4.0 g/day of hydrocortisone or its equivalents was associated with a significant increase in fatality rates.
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PMID:Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. 698 71

The presentation and course of Staphylococcus aureus bacteremia in 27 diabetic patients (18 insulin-dependent) were compared with those in 34 nondiabetic patients. The groups were comparable in age, proportion with pre-existing cardiac valvular disease, community-acquired bacteremia, fever, and leukocytosis. Endocarditis (vegetation or new regurgitant murmur) was present in eight (30 percent) diabetics and four (12 percent) nondiabetics (p = 0.16). A primary focus of infection was present in 67 percent of diabetics and 65 percent of nondiabetics. Among those with a focus, six of 18 diabetics and none of 22 nondiabetics had endocarditis (p less than 0.005). Fifteen of 54 (28 percent) patients who received appropriate antibiotic therapy died. After stratificaton for underlying illness, there was no mortality difference between those with and without endocarditis (three endocarditis deaths versus 1.78 expected), or between those with and without diabetes (four diabetic deaths versus 4.8 expected). Diabetics with staphylococcal bacteremia were more likely than nondiabetics to have endocarditis in the presence of a primary focus. They had no increase in mortality.
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PMID:Staphylococcus aureus bacteremia in diabetic patients. Endocarditis and mortality. 713 2

Fourteen patients with necrotizing fasciitis seen over a 5 year period at a public hospital are reviewed. Middleaged men predominated. The disease followed such diverse initiating causes as self-injection with heroin, boil, ischiorectal abscess, perforated occult colonic cancer and trivial abrasions. In a few cases there was no evidence of an initiating lesion. Necrotizing fasciitis affected the arms, legs, trunk and neck. Bacteriologic analysis showed that the disease is usually caused by gram-negative bacilli and hemolytic streptococci, alone or in combination. Morbidity and mortality rates in the present series were influenced by associated clinical conditions such as old age, diabetes mellitus, carcinoma and gram-negative bacteremia.
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PMID:Necrotizing fasciitis. 728 33

In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994). Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS). Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03). Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04). Nine (41%) patients with GBSB were i.v. drug abusers; nevertheless, none of the subjects with GBSB were i.v. drug abusers (p < 0.001). The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02). Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia. In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis.
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PMID:[Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults]. 756

Fifty-nine episodes of bacteremia due to Aeromonas species occurred within a 5-year period in one medical center in southern Taiwan. Underlying diseases in the 58 patients included hepatic cirrhosis (36%) and cancer (24%). Patients with aeromonas bacteremia more often had underlying hepatic cirrhosis than did those with bacteremia due to other gram-negative bacilli. Males (67%) outnumbered females. The cases appeared to cluster in the summer and fall months. Thirty-two percent were polymicrobial infections; often the Aeromonas pathogens were accompanied by other gram-negative bacilli. Aeromonas hydrophila was the most common species isolated (69%). In addition to fever, hypotension and jaundice were the common clinical manifestations of aeromonas sepsis. In cirrhotic patients, spontaneous bacterial peritonitis, altered mental status, and jaundice were most common, and aeromonas bacteremia in such patients was monomicrobial and community-acquired more often than in noncirrhotic patients. In vitro aeromonads were generally susceptible to aminoglycosides, cefuroxime, the third-generation cephalosporins, and quinolones. The overall crude fatality rate was 36%. Predictors of fatal outcome for cirrhotic patients included spontaneous bacterial peritonitis, hypotension on admission, diabetes mellitus, and high Pugh scores.
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PMID:Aeromonas bacteremia: review of 59 episodes. 762 14

Streptococcus pyogenes bacteremia occurred in 104 patients over a 6-year period, during which time the annual incidence remained constant. The clinical and epidemiologic characteristics are described for 90 of these patients. Of the 90 patients, 90% had community-acquired infection, and 77% had an underlying illness predisposing them to infection. Skin infection was the cause of bacteremia in 61% of the cases. Septic shock developed in 13 patients. The overall mortality rate was 15%. An increased likelihood of death was associated with septic shock and diabetes mellitus.
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PMID:Group A streptococcus bacteremia at the Hadassah Medical Center in Jerusalem. 762 31

The importance of group B streptococcus (GBS) as a cause of serious infectious disease among adults is not widely appreciated. In adults, the modes of acquisition and transmission are unknown. Since most hospital-based studies of GBS bacteremia in adults consist of small numbers of patients, the clinical spectrum of disease is not well described. Our retrospective study reviews the clinical features, antimicrobial therapy, and risk factors for mortality of 32 adult patients (18 women and 14 men) with GBS bacteremia and compares the proportion of isolates from the different beta-hemolytic streptococci sero-groups. We found that 39% of isolates from adult blood cultures were group B, a frequency nearly identical to that of group A streptococcal bacteremia. Most (66%) adult patients were more than 50 years old. Primary bacteremia was the most frequent clinical diagnosis, occurring in 7 (22%) of 32 patients. Nonhematologic cancer was the most frequently associated condition (25%). Nineteen percent of the patients had diabetes mellitus. The overall mortality rate was 31% and was significantly associated with increasing age. Our results are compared to those obtained by a review of all 5 previous comparable studies and demonstrate that GBS bacteremia is a serious infection in adults with increased mortality related to advancing age.
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PMID:Group B streptococcal bacteremia in adults. Five years' experience and a review of the literature. 762 53


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