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The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.
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PMID:Klebsiella pneumoniae bacteremia in the community hospital. 265 4

A 67-year-old woman with pneumonia and diabetes mellitus was admitted with the complaints of abdominal and back pain. Sputum culture was positive for Klebsiella pneumoniae. Computed tomographic scanning (CT) of the abdomen and spinal radiograph of the lumber column revealed a paraventebral space-occupying lesion, abdominal aortic aneurysm and destructive change of L3 and L4. Pseudoaneurysm of the abdominal aorta associated with infectious spondylitis with paravertebral abscess was suspected and confirmed by aortography. Klebsiella pneumoniae was cultured from the abscess. The patient's condition improved rapidly after drainage of the abscess and administration of LMOX and gentamicin. Infectious pseudoaneurysm of the abdominal aorta associated with infectious spondylitis has rarely been reported. These two in combination due to Klebsiella pneumoniae has not been reported to our knowledge. The pathologic changes were found easily by CT scan. When infectious aneurysm or infectious spondylitis is diagnosed alone, possible combination of these diseases should be kept in mind.
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PMID:A case of infectious pseudoaneurysm of the abdominal aorta associated with infectious spondylitis due to Klebsiella pneumoniae. 266 92

The Klebsiella pneumoniae bacillus is a rare cause of acute hematogenous osteomyelitis of long bones. Bony involvement usually develops from a bacteremia associated with a Klebsiella pulmonary or urinary tract infection. Diabetes mellitus, alcoholism, or cirrhosis are predisposing conditions to the development of this form of osteomyelitis. A case report follows in which two sites of Klebsiella osteomyelitis were demonstrated by three-phase bone imaging in a patient with both diabetes and alcoholism.
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PMID:Klebsiella pneumoniae osteomyelitis: demonstration by three-phase radionuclide bone imaging. 266 97

We report a rare case of Klebsiella pneumoniae meningitis associated with liver abscess, which was successfully treated with cefotaxime (CTX), one of the third-generation cephalosporins. A 53-year-old man was admitted to Keio University Hospital on June 13, 1988, because of a fever and a headache. On June 3, he suddenly started shivering and his temperature rose to 39 degrees C. He then began to complain of polydipsia, polyuria, and a weight loss of 4 kg a week. On June 11, he developed a severe headache. Four years prior to this incident, he had been diagnosed as having diabetes after a routine medical examination, but had neglected to undergo medical treatment. On admission, laboratory data showed leukocytosis, hyperglycemia (394 mg/dl) and ketonuria (4+). A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) containing 500/3 cells/mm8, of which about 70% were neutrophils. A diagnosis of diabetic ketoacidosis and purulent meningitis was made. A treatment with ampicillin (ABPC) and CTX, (12 g/day, each) was begun. On the third day, cultures of a blood specimen and CSF yielded both K. pneumoniae. The MICs of CTX to K. pneumoniae isolated from blood and CSF were both 0.05 microgram/ml. ABPC was discontinued, gentamicin was administered for 2 days, CTX was continued at the same dosage level and an administration of prednisolone 40 mg daily was begun.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Klebsiella pneumoniae meningitis associated with liver abscess: a case report]. 269 13

A case of emphysematous pyelonephritis, xanthogranulomatous pyelonephritis histologically, is reported. A 49-year-old female patient was referred to our department from the department of internal medicine because abdominal ultrasonography demonstrated left renal swelling with gas echo. Computed tomographic scan showed much emphysema in the left kidney. Although aggressive treatment with broad spectrum antibiotics and immunoglobulin had been performed, subfever and left lumbago continued. Thereafter, she underwent left nephrectomy, and histological findings revealed xanthogranulomatous pyelonephritis. In the Japanese literature 27 cases of emphysematous pyelonephritis have been reported. Many cases are in middle-aged females and 85% of these cases complicated with diabetes mellitus. E. coli and Klebsiella was the main causative organism. The mortality of this disease was 26%. This report is the first case combined with xanthogranulomatous pyelonephritis in Japan. We recommend adequate chemotherapy and timely surgical treatment for good results.
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PMID:[A case of emphysematous pyelonephritis combined with xanthogranulomatous pyelonephritis]. 273 41

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

A total of 222 cases of septicaemia was recorded at the University Hospital of the West Indies between June 1982 and June 1983. This gave an overall incidence of 16.1 per 1000 admissions. The 233 bacterial strains isolated comprised 100 Gram-positive and 133 Gram-negative organisms with Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus being the most frequent. Highest rates of septicaemia were recorded in patients less than 1 year and over 50 years of age. Septicaemia caused by Gram-positive organisms was predominantly a disease of children whereas that caused by Gram-negative organisms arose more often in neonates and in patients over 50 years of age. A predisposing factor was noted in 104 patients of whom 42 had neoplastic disease. The most frequently identified initial sites of infection were the respiratory tract, the gastro-intestinal tract and the meninges. Most blood stream infections were community-acquired, three quarters of all septicaemic patients being admitted to the departments of medicine or paediatrics. There were 11 cases of polymicrobial septicaemia caused predominantly by Gram-negative organisms in patients with underlying disease. Appropriate antimicrobial drugs were administered to 57% of septicaemic patients whereas 17% received superfluous antimicrobial therapy. In those patients who received inappropriate antimicrobial therapy there was a marked increase in mortality. Forty of 61 deaths were attributed to septicaemia. Mortality from septicaemia caused by Gram-negative organisms was 21% compared with 13% for that caused by Gram-positive organisms. The organisms associated with the highest case fatality rates were Escherichia coli, 53%; Enterobacter sp., 27%; and beta-haemolytic streptococci 24%. There were no deaths from septicaemia caused by Haemophilus influenzae, Salmonella sp. or Serratia sp. The highest mortality rates were associated with neoplastic disease, diabetes, polymicrobial septicaemia, urinary tract infections and old age.
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PMID:Bacteraemia at the University Hospital of the West Indies--a report of 222 cases. 389 69

Risk factors for the development of nosocomial infection, i.e., diabetes, immunosuppressive therapy, etc., are reviewed. In most cases, the patient's own fecal flora is the primary reservoir for potentially infecting pathogens, such as Escherichia coli, Pseudomonas, Klebsiella, Enterobacter, Proteus, Serratia, and enterococcus. Hospitalized patients are likely to have antibiotic-related changes in fecal flora. Abnormal urethral flora in men, as well as high rates of vaginal and urethral colonization in women, increase the risk of infection associated with urinary catheterization or instrumentation. The costs of nosocomial urinary tract infections, both in economic and health terms, are briefly discussed. After a review of the causes and consequences of bacterial resistance to antibiotics, the issue of perioperative prophylaxis is addressed. It is concluded that the most important aspects of effective perioperative prophylaxis are achievement of suitable drug-tissue levels at the time of surgery and a limited period of postoperative antibiotic administration. The problem and probable causes of cross contamination are described. Recommendations for reducing nosocomial infections are offered.
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PMID:Nosocomial infection of urinary tract: changing pathogens, changing patterns. 401 97

Four patients with pyogenic hepatic abscesses are reported. There were three females and one male with an age range of 36-75 years. In all the cases, diabetes mellitus was associated. Confirmation of the abscesses was obtained by liver scanning or ultrasonography, or both. In one patient, the clinical course was complicated by sympathetic pericardial effusion with right heart failure. Two patients had percutaneous transhepatic drainage of the abscesses under fluoroscopy. All four patients eventually required laparotomy and open drainage of the abscesses. Diabetic control was achieved with insulin therapy. The common causative organism in all instances was the Klebsiella species. Three patients recovered. The remaining one developed hypotension post-operatively and died of brain-stem infarction and the hepato-renal syndrome.
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PMID:Pyogenic hepatic abscess and diabetes mellitus--a probable association. 403 83


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