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During a three-year period eight patients with blood cultures positive for Stomatococcus mucilaginosus were identified at two university hospitals. One patient without any signs of infection had a central venous catheter that was colonized with this organism, two patients had transient bacteremia without definite relationship to underlying disease, whereas the remaining five patients suffered from clinically significant infections. Of these last five patients, one had undergone prior head and neck surgery and four had hematologic malignancy with mild to severe neutropenia; two of the latter patients developed the infection subsequent to dental surgery. Besides neutropenia and mucosal damage in the oropharynx, quinolone antibacterial prophylaxis may have been an additional risk factor for the development of S. mucilaginosus bacteremia in these patients. A thorough review of the literature revealed that in addition to our findings, endocarditis and foreign body infections are further typical clinical manifestations. Although the overall antibiotic susceptibility pattern of S. mucilaginosus resembles that of streptococci, it is suggested that penicillin G may not be the drug of choice for initial therapy of particularly severe infections. S. mucilaginosus can be easily differentiated from other gram-positive bacteria when certain key criteria (e.g. adherence to agar surfaces, poor growth on Mueller-Hinton agar, presence of a capsule) as well as an array of biochemical tests, including commercially available identification systems, are applied. Our own and published data emphasize that both microbiologists and clinicians should be increasingly aware of this opportunistic pathogen.
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PMID:Bacteremia caused by Stomatococcus mucilaginosus: report of seven cases and review of the literature. 152 87

We report a retrospective, clinicopathologic study of 139 patients who died during treatment of a severe burn. Fifty-three percent of the patients had central nervous system (CNS) complications-infections, cerebral infarcts and hemorrhages, metabolic encephalopathies, central pontine myelinolysis, and cerebral trauma. Children and adults were equally affected. Sixteen percent of the patients had a CNS infection. Candida species, Staphylococcus aureus and Pseudomonas aeruginosa caused almost 80% of them. S. aureus and candida caused cerebral microabscesses and septic infarcts. P. aeruginosa caused meningitis and infarcts due to meningitis. CNS infections arose as a result of spread from a systemic source. The major risk factors for CNS infection were an extensive burn, S. aureus endocarditis, and a burn wound infection due to candida or P. aeruginosa. Patients with burns of less than 30% of the surface area of their body, those without a systemic infection, and those in the first week after their burn were at low risk. Eighteen percent of the patients had cerebral infarcts. In almost half the patients, the infarcts were caused by septic arterial occlusions or other complications of the burn, viz, disseminated intravascular coagulation (DIC) and septic shock. In only one-third of the patients were infarcts due to atherosclerosis, atrial fibrillation, or other causes prevalent in the general population. Intracranial hemorrhages were only one-fifth as frequent as infarcts and were due to DIC and thrombocytopenia, caused by bacteremia. Diagnosis during life was difficult, because the neurologic picture of focal cerebral lesions and meningitis was indistinguishable from that of metabolic encephalopathies, and because many patients had more than 1 neurologic complication. However, our results suggest that a clinical approach that includes analysis of risk factors for CNS infection, cerebral imaging, examination of cerebrospinal fluid, and tests for DIC can lead to a neurologic and microbiologic diagnosis in most patients.
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PMID:Central nervous system complications of thermal burns. A postmortem study of 139 patients. 152 3

The treatment plan for the pediatric cardiac patient must include the following: 1. A complete medical history that will elicit adequate information with respect to the patient's possible heart condition. 2. Consultation with the family physician, pediatrician and/or cardiologist to learn the specific nature of the defect, specific past history, the child's ability to tolerate stress and anxiety, current medication and any specific recommendations for patient management. 3. Antibiotic prophylaxis, in an effort to prevent endocarditis, for all dental procedures that are likely to result in gingival bleeding, including routine professional cleaning. Application of chlorhexidine may be used as an adjunct to antibiotic prophylaxis, particularly in patients who are at high risk and/or with poor dental hygiene. 4. Prompt and vigorous treatment of all infections, with extraction to be considered as the preferred treatment for endodontically involved primary teeth. 5. A frank and open discussion with the parents and patient, detailing the importance of strict oral hygiene and regular dental care for both the oral and general health of the patient. As important as appropriate antibiotic prophylaxis is to the patient's continued health, it must be stated in summation that the dentist's efforts to foster optimal oral health are perhaps even more significant. Dental manipulation is in no way essential to the genesis of bacteremia, and it must be assumed that frequent showers of organisms are the rule in individuals who neglect their mouths. Perhaps the dentist performs the greatest service for this group when he or she succeeds in significantly modifying their oral hygiene behavior, thus preventing inadvertent septic "suicide".
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PMID:Dental care for the pediatric cardiac patient. 153 30

Twenty-seven episodes of bacteremia caused by Staphylococcus warneri were identified at Long Island Jewish Medical Center in New York between 1984 and 1989. Fourteen of these were thought to represent true bacteremias and 13 to represent contaminants. Of the 14 true bacteremias, 5 were in pediatric and 9 were in adult patients. Eight of 14 patients (57%) had catheter-related bacteremia and 5 of 14 had bacteremia of unknown source. There was one case of fulminant native valve S. warneri endocarditis. All cases of catheter-related bacteremia, except one, were nosocomially acquired, and 75% of these patients had an underlying immunosuppressive condition. Only 40% of patients with bacteremias of unknown source were immunocompromised, and S. warneri appeared to be noninvasive in this group. Interestingly, all five of the pediatric isolates were oxacillin susceptible, although four of five were resistant to penicillin, despite the fact these patients were hospitalized an average of 29 days. In contrast, seven of nine adult isolates were resistant to both oxacillin and penicillin. The only case of native valve S. warneri endocarditis occurred in a patient who had no known underlying valvular heart disease, but had an underlying immunosuppressive condition. Identification to species level of coagulase-negative staphylococci may lead to appreciation of the importance of bacteria such as S. warneri as human pathogens.
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PMID:Clinical significance of Staphylococcus warneri bacteremia. 150 May 40

We retrospectively analyzed epidemiologic information associated with 22 cultures of Neisseria elongata subsp. nitroreducens (formerly CDC group M-6) submitted to the Microbial Diseases Laboratory, California Department of Health Services, Berkeley, over a 16-year period. The most common illnesses noted with this bacterium were endocarditis, bacteremia, and osteomyelitis. Risk factors associated with N. elongata subsp. nitroreducens infection included dental manipulations and/or a previous history of endocarditis, valve damage, or rheumatic heart disease.
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PMID:Association of an important Neisseria species, Neisseria elongata subsp. nitroreducens, with bacteremia, endocarditis, and osteomyelitis. 155 90

Endocarditis due to Escherichia coli is rare. The case of a 79-year-old woman with E. coli bacteremia and multiple hemorrhagic cerebral infarcts is reported. A two-dimensional echocardiogram showed no evidence of a vegetation. While she was receiving antimicrobial therapy, bacteremia, hematuria, conjunctival petechiae, and a mitral regurgitant murmur occurred. The patient died, and at autopsy a large (2.2 x 2.0 x 0.7 cm) necrotic vegetation on the anterior leaflet of the mitral valve and several hemorrhagic infarcts of the brain were noted. An in vitro study with use of pooled human serum was performed and demonstrated that the patient's infecting strain of E. coli was serum resistant, in contrast to a serum-sensitive control strain of E. coli that was isolated from the cultures of blood from a patient with pyelonephritis. Including our case, 19 well-described cases of E. coli endocarditis from 1945 to 1990 have been reported. E. coli can cause endocarditis of both sides of the heart. More cases of endocarditis of host valves than of prosthetic valves have been documented.
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PMID:Mitral valve endocarditis caused by a serum-resistant strain of Escherichia coli. 155 38

This report reviews 45 episodes of group A streptococcal bacteremia during 1980-1989 in a large hospital; 24 episodes occurred in the first 5 years of study (1980-1984) and 21 in the last 5 years (1985-1989). Four episodes were nosocomial. The remaining 41 episodes were community acquired; of these episodes, 12 occurred in patients who were transferred from nursing homes. There was a definite seasonal predominance (84%) during November-June. All but three patients had chronic underlying conditions. The major portals of entry were the skin and lungs, and the main types of infection were primary septicemia, cellulitis and soft-tissue infection, pneumonia, and infective endocarditis. The overall mortality rate was 24%; 20% of the deaths were due to infection. Factors that adversely influenced mortality were septic shock (P less than .02), less than 10,000/mm3 leukocytes (P less than .05); less than 80% segmented polymorphonuclear leukocytes and band forms (P less than .02), and hyperbilirubinemia (P less than .01). Neither prevalence nor severity of group A streptococcal bacteremia increased during the last 5 years of study.
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PMID:Group A streptococcal bacteremia in a community teaching hospital--1980-1989. 157 44

Over the last two decades, the optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia has become the subject of controversy. A review of the literature revealed an occasional association between relapse of the infection and a short course of therapy (less than 10 days of iv antibiotic therapy). From records kept between 1983 and 1989 at the University of Florida's affiliated hospitals, we identified 55 patients with catheter-related S. aureus bacteremia. Nine patients (16%) developed acute early complications (e.g., endocarditis or osteomyelitis) while receiving antibiotics. The results of multivariate analysis showed that an early complicated course was characterized by fever and/or bacteremia that persisted for greater than 3 days after catheter removal (P = .02). The remaining 46 patients were followed up for at least 3 months. During follow-up, three of the 18 patients treated for less than 10 days with iv antibiotics developed relapsing septicemia, whereas none of the 28 patients treated for a longer period developed this condition (P = .05). Fever and/or bacteremia that persists for greater than 3 days after catheter removal and initiation of antibiotic therapy suggests an acutely complicated course requiring prolonged treatment. The duration of iv antibiotic therapy in uncomplicated cases should not be less than 10 days but need not be greater than 2 weeks.
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PMID:Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review. 162 83

Group-C beta-hemolytic streptococci (GCBHS) is an uncommon cause of bacteremia. In a 5-year period, GCBHS accounted for 0.28% of positive blood cultures and 0.35% of bacteremias documented at our hospital. The incidence of GCBHS bacteremia was 0.05 episodes per 1000 admissions. We were able to analyze clinical data of 10 of the 13 patients with GCBHS bacteremias. All but one were adults with significant underlying diseases, and seven episodes were community acquired. The skin was the portal of entry in only one case. Clinical syndromes included primary bacteremia (four cases), pneumonia (two cases), endocarditis (two cases), and meningitis, intraabdominal infection, and metastatic suppurative pericarditis (one episode each). Of 13 isolates, 12 were identified to species level: six, Streptococcus equisimilis; three S. equi; two S. dysgalactiae; and one S. zooepidemicus. Resistance to penicillin was detected in one isolate and none of our isolates displayed penicillin tolerance, Four patients died (40%) despite appropriate antimicrobial therapy.
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PMID:Group-C beta-hemolytic streptococcal bacteremia. 157 40

Streptococcus salivarius is a normal inhabitant of the oral cavity. When isolated from blood cultures, this viridans streptococcus is often disregarded as a contaminant. Viridans streptococci, although a common cause of endocarditis, are rarely associated with bacterial meningitis and account for less than 1% of all cases of purulent meningitis. We report a case of bacteremia and meningitis due to S. salivarius that occurred in a patient who underwent upper gastrointestinal endoscopy and cauterization for control of gastric bleeding. Although bacteremia following gastrointestinal procedures has been well documented, its incidence is low (ranging from 2% to 10%), and its course is usually transient without major clinical sequelae. This case is unique with respect to the pathogen isolated, the length of bacteremia, and the meningitis that subsequently developed following a gastroesophageal procedure.
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PMID:Streptococcus salivarius bacteremia and meningitis following upper gastrointestinal endoscopy and cauterization for gastric bleeding. 157 92


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