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Endoscopic variceal sclerotherapy, though a safe and effective therapy for esophageal varices, is not devoid of local and distant complications. We report a patient with postnecrotic cirrhosis and diabetes mellitus who developed a splenic abscess while on a sclerotherapy program. The abscess may have been a consequence of retrograde thrombosis of the portal venous system or of bacteremia following sclerotherapy.
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PMID:Splenic abscess--a possible complication of endoscopic variceal sclerotherapy. 834 Jan 43

In a prospective, randomized, blinded study, 826 patients undergoing clean neurosurgical procedures received single intravenous doses of ceftizoxime (2 g) (n = 422) or a combination of vancomycin (1 g) and gentamicin (80 mg) (n = 404) 1 hour before an incision was made. Patients with infected or contaminated wounds and those receiving shunts or other implants were excluded. Primary wound infections occurred within 30 days in five patients in each group and were most common after spinal surgery and procedures through previous incisions. Secondary infections (pneumonias, urinary tract infections, and intravenous line-related bacteremia) occurred in 24 patients in the ceftizoxime group and 25 in the vancomycin/gentamicin group. The infection rates after transsphenoidal procedures (n = 129) were remarkably low in both groups. Ceftizoxime caused no adverse drug reactions, but six patients in the vancomycin/gentamicin group had clinically significant infusion-related hypotension or flushing. Placement of a temporary external drain, use of an operating microscope, preoperative steroids, and diabetes were not associated with increased infection rates. Analysis of routinely encountered ventricular cerebrospinal fluid and simultaneously obtained peripheral blood showed low but detectable levels of all three antibiotics within 2 hours; only ceftizoxime, however, achieved cerebrospinal fluid levels sufficient to inhibit the staphylococcus and Gram-negative bacilli most often associated with postneurosurgical infections. We conclude that ceftizoxime is as effective as vancomycin and gentamicin in neurosurgical prophylaxis but is less toxic and penetrates cerebrospinal fluid better.
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PMID:Ceftizoxime versus vancomycin and gentamicin in neurosurgical prophylaxis: a randomized, prospective, blinded clinical study. 841 95

In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. Enterobacteriaceae dominated as causative agents (57%), following by Gram-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia was found in 8% of the episodes. The incidence of Enterobacteriaceae bacteremia culminated in the middle (1978-82) of the period (4.7/1,000 admissions) and decreased during the last decade. Gram-positive bacteremia increased throughout the period (from 1.8 to 2.9; p < 0.001), due mainly to increasing incidences of bacteremia caused by non-hemolytic streptococci, Streptococcus pneumoniae and coagulase-negative staphylococci. Bacteroides fragilis accounted for a rising incidence of anaerobic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were available for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with indwelling catheters, mainly bladder catheters (28%) and i.v. lines (7%). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently malignancies (20%) and diabetes mellitus (7%). The mortality rate related to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the first 2 days after the first positive blood culture was obtained. Logistic regression analysis defined 7 variables that independently influenced the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antibiotic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bacteremia at a Danish university hospital during a twenty-five-year period (1968-1992). 853 49

Endovascular infection of atherosclerotic aorta is a rare event in the setting of aged patients with gram negative bacteremia of the salmonella group. Until the beginning of the 60s this meant an ominous diagnosis with an almost unavoidable fatal prognosis. Presently, this trend has been reverted, mostly due to an earlier diagnosis, the development of more sophisticated imaging techniques, the correct use of broad spectrum bactericidal antibiotics and prompt surgical management. Paradoxically, the incidence of arterial infections has increased in recent years, specially in old people with atherosclerotic abdominal aortic aneurysms, in whom infective endocarditis could not be demonstrated. We describe the case of a 65 year old man, with a history of longstanding non-insulin-dependent diabetes, presenting with protracted fever, weight loss and thigh pain. Blood cultures and serologic studies as well as several echocardiograms yielded negative results. An abdominal CT scan showed an infrarenal aortic aneurysm raising the clinical suspicion of arterial infection of abdominal aorta. The patient underwent surgery because of highly presumptive diagnosis of complicated aortic aneurysm. The resection was followed by an in situ graft. There was no evidence of disruption or gross collection. Samples of the aortic wall and perianeurysmatic fluid grew Salmonella enteritides. We describe the main etiopathogenic and clinic features of the entity highlighting the high sensitivity and specificity of the CT scan in the identification and characterization of infected aortic aneurysm. Certain features may firmly suggest this diagnosis without using preoperative aortography.
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PMID:-Prolonged fever syndrome and infection of abdominal aortic aneurysm due to Salmonella enteritidis. 872 76

To determine recent trends in the incidence and severity, group A streptococcal (GAS) bacteremia was studied over the last 14 years (1981-1994). There were 116 events of GAS bacteremia, representing 1.7% of all bacteremic episodes, without an increase in recent years. A total of 108 patients were available for study. Underlying conditions were found in 95 patients (88%), including mainly malignant diseases, chronic obstructive pulmonary disease, congestive heart failure and diabetes mellitus. A source of the bacteremia was noted in 71 patients (66%), with skin and soft tissue infection being the major portal of entry. All isolates were susceptible to penicillin. Overall mortality was 21%. Mortality had not increased in recent years, but depended significantly on several clinical factors: increased age; admission temperature; source of bacteremia (highest for GAS bacteremia without an identified source); and underlying conditions (highest for diabetes mellitus and chronic pulmonary disease, absent for patients with no underlying disease). This study shows that neither the incidence nor the severity of GAS bacteremia has increased in recent years. Severity is significantly affected by the source of bacteremia and the presence of underlying conditions.
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PMID:Incidence and severity of group A streptococcal bacteremia in a medical center in Israel, 1981-1994. 879 79

Lactobacillus bacteremia in the absence of endocarditis is a rare entity, and the clinical relevance of such bacteremia remains unclear. The clinical courses of lactobacillus bacteremia without endocarditis in 43 previously described patients and 12 new patients were reviewed. Bacteremia with Lactobacillus alone occurred in 34 (62%) of the patients, and 12 (22%) of the patients had bacteremia with other organisms, including Lactobacillus. Lactobacillus was isolated from another site in 18 (33%) of these patients. Intravenous catheter infections were not noted in these patients. Underlying conditions included cancer (6 patients), organ transplantation (9), diabetes mellitus (4), and recent surgery (12). Fever occurred in all patients, and eight (15%) of the patients experienced a sepsis syndrome. The mortality rate was 14%; however, only three deaths were attributed soley to lactobacillus sepsis. Lactobacillus bacteremia is an uncommon condition that usually occurs in patients with severe underlying illnesses and is frequently seen as a part of a polymicrobial infection. Blood cultures positive for Lactobacillus represent true infection and not contamination. Although resistance to commonly used antibiotics is common, the mortality rate associated with this bacteremia appears to be low.
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PMID:Lactobacillus bacteremia: description of the clinical course in adult patients without endocarditis. 890 43

A previously healthy 40-year-old man experienced the sudden 'stroke-like' onset of homonymous hemianopsia due to a bacterial brain abscess. Clinical features and initial computed tomography (CT) suggested a stroke. Subsequent CT and magnetic resonance (MR) demonstrated a cerebral abscess, proven at surgery. It is extremely rare that a healthy individual without various risk factors, such as congenital heart disease, immunologic deficiency, diabetes mellitus, or pregnancy, presents with the above symptoms. The exact mechanism of this sudden 'stroke-like' onset in a patient with a bacterial brain abscess is unknown. One possibility is that paroxysmal septic emboli led to abscess formation within or near areas of embolic infarction. Another possibility is that a primary cerebral infarction was associated with secondary bacteremia. Surgical drainage revealed a bacterial (Streptococcus) abscess, but no identifiable source of infection.
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PMID:Sudden "stroke-like' onset of homonymous hemianopsia due to bacterial brain abscess. 898 24

High rates of acinetobacter bacteremia were observed in a large teaching hospital in Hong Kong. A retrospective study of 94 acinetobacter bacteremic episodes in patients in 1993-94 revealed 70 episodes of significant bacteremia. 53% of the patients were over 60 years with a male to female ratio of 1.5:1. Cases were most rare during the fourth quarter. The intensive care unit was the commonest location of acquisition of bacteremia. Most infections were hospital acquired. Intravascular catheters, urinary catheters, antibiotic therapy and respiratory tract manipulations were common risk factors. Lower respiratory tract infections and catheter-related sepsis were predominant foci of bacteremia. One-third of the patients received appropriate antibiotics within 48 hours after bacteremia onset. Mortality attributable to acinetobacter infection was 27%. Prognosis of underlying diseases, location in intensive care unit, lower respiratory tract infection as foci of infection as well as diabetes mellitus were associated with mortality.
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PMID:A retrospective study of clinical characteristics of acinetobacter bacteremia. 906 49

Forty-three patients with Klebsiella oxytoca bacteremia were seen between July 1980 and June 1996 at National Taiwan University Hospital (Taipei, Taiwan). We retrospectively analyzed the clinical features of these patients and the antimicrobial susceptibilities of the 43 isolates recovered from them. Twenty-seven patients (63%) had community-acquired bacteremia, and 16 patients (37%) had polymicrobial bacteremia. The clinical syndromes included hepatobiliary infections (58% of patients), primary bacteremia (23%), intravascular device-associated infections (7%), urinary tract infections (5%), skin and soft-tissue infections (5%), and peritonitis (2%). Most of these patients (93%) had underlying diseases including hepatobiliary diseases (53%), neoplastic diseases (42%), and diabetes mellitus (16%). Eight patients (19%) had septic shock, and two (5%) had disseminated intravascular coagulation. Four patients (9%) died of K. oxytoca bacteremia. All isolates were susceptible to ampicillin/sulbactam, cefmetazole, imipenem, aminoglycosides, and quinolones, and 86% of the isolates were susceptible to cefazolin.
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PMID:Bacteremia due to Klebsiella oxytoca: clinical features of patients and antimicrobial susceptibilities of the isolates. 919 86

To understand group B streptococcal infections other than peripartum events in adults and to provide a regional antimicrobial therapy guide, we conducted a retrospective analysis of invasive diseases caused by group B streptococcus (GBS) in 33 nonpregnant adults treated in a medical center in southern Taiwan, from January 1993 to July 1994. Antimicrobial susceptibility tests were performed using the agar dilution method. The incidence of the disease was 1.6 per 1,000 nonpregnant adult admissions, and the mean age of patients was 58 years (range 17-86 years). Primary bacteremia (13) and soft-tissue infections (11) were the most common manifestations. Nearly all the patients had underlying disease(s) and/or condition(s); the three most common were diabetes mellitus (13), malignancy (5), and liver cirrhosis (5). There were eight nosocomial infections and six patients died. Of 32 GBS strains tested, 27 were susceptible to penicillin G and the rest were intermediately susceptible. All strains were uniformly susceptible to cephalothin, cefotaxime, ofloxacin, and vancomycin; two strains were susceptible to gentamicin and nearly half were intermediately susceptible. Our findings imply a requirement for higher doses of penicillin or combination with an aminoglycoside for treatment of GBS infection. First-generation cephalosporins may be an alternative for the treatment of GBS infections in Taiwan.
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PMID:Clinical characteristics and antimicrobial susceptibility of invasive group B streptococcal infections in nonpregnant adults in Taiwan. 929 Feb 73


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