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Expert Review of Anti-infective Therapy 2015The diagnosis of bacteremia in children is important and it can be clinically challenging to recognize the signs and symptoms. The reported rates of bacteremia are... (Review)
Review
The diagnosis of bacteremia in children is important and it can be clinically challenging to recognize the signs and symptoms. The reported rates of bacteremia are higher in young children but with the increasing vaccine coverage, there has been a decrease in bacteremia due to the three vaccine preventable bacteria (Streptococcus pneumoniae, Haemophilus influenzae group b and Neisseria meningitidis). Notably, there have been increases in healthcare-associated bacteremias with a rise in Staphylococcus aureus and Gram negative bacteremias. This review provides a brief overview of the clinical diagnosis of bacteremia in children, focusing on the epidemiology, clinical characteristics, risk factors, antibiotic treatment, outcomes and preventative measures to reduce the incidence of bacteremia and improve morbidity and mortality.
Topics: Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Humans; Treatment Outcome
PubMed: 26143645
DOI: 10.1586/14787210.2015.1063418 -
Clinical Infectious Diseases : An... Dec 1996The results of early studies showed that anaerobes account for 20% of all bacteremias; more-recent data suggest that these organisms account for approximately 4%... (Review)
Review
The results of early studies showed that anaerobes account for 20% of all bacteremias; more-recent data suggest that these organisms account for approximately 4% (0.5%-9%) of bacteremias ( or approximately one case per 1,000 admissions), with variation by geographic location, hospital patient demographics, and especially, patient age. Elderly persons seem to be at increased risk for developing anaerobic bacteremia while young children (2-5 years of age) are at the least risk. Bacteroides fragilis is the most common blood isolate recovered from patients with anaerobic bacteremia; this organism and species of the B. fragilis group account for approximately 55% of anaerobic bacteremias. B. fragilis bacteremia is associated with a mortality of 19%, with a mortality risk of 3.2; a 16-day increase in hospital stay; and often, intra-abdominal disease. Associated risks for mortality include chronic liver disease and congestive heart failure. There is value in performing separate anaerobic blood cultures; clinicians at each institution should determine the prevalence of anaerobic bacteremia and use this information to guide blood-culture practices.
Topics: Age Distribution; Bacteremia; Bacteria, Anaerobic; Bacteriological Techniques; Bacteroides Infections; Bacteroides fragilis; Humans; Risk Factors
PubMed: 8953114
DOI: 10.1093/clinids/23.supplement_1.s97 -
Supportive Care in Cancer : Official... Jan 1993In the 1960s, almost all patients who developed gram-negative bacteremia during granulocytopenia died; death occurred before blood culture results were available in... (Review)
Review
In the 1960s, almost all patients who developed gram-negative bacteremia during granulocytopenia died; death occurred before blood culture results were available in about 50% of cases; many patients received antibiotics that were, at best, suboptimal and frequently inactive against the invading pathogen. In the early 1970s epidemiological studies demonstrated that more than 50% of gram-negative bacteremias were caused by hospital-acquired strains which colonized along the alimentary canal and caused infection in a limited number of locations, especially the pharynx, lungs, colon, and perianum. Surveillance culture studies have demonstrated that among acquired gram-negative bacilli, Pseudomonas aeruginosa will almost invariably proceed to bacteremia if the patient becomes profoundly neutropenic, with Escherichia coli and Klebsiella pneumoniae leading to bacteremia in only a moderate number of patients and other gram-negative bacilli rarely progressing to bacteremia despite colonization. Hence, the leading causes of bacteremia in the granulocytopenic patient are E. coli, K. pneumoniae and P. aeruginosa. Further investigations demonstrated that gram-negative bacilli were acquired from hands, food, and water, thus leading to approaches to infection prevention which included careful handwashing, low-microbial-content diet, and attention to water sources, including ice machines. Another basic approach to infection prevention has been to suppress gram-negative bacilli colonizing the alimentary canal with oral nonabsorbable antibiotics or, more recently and more effectively, with agents such as the fluoroquinolones which, unlike previous regimens, do not concurrently suppress the anaerobic flora, hence maintaining colonization resistance. The third basic approach to infection prevention is to improve the host defense factors, principally by a more rapid return of circulating granulocytes with the use of colony-stimulating factors such as granulocyte/macrophage colony-stimulating factor or granulocyte colony-stimulating factor. As to therapy, the fundamental approach with presumed gram-negative bacteremia is the prompt institution of empiric antibiotic therapy when fever first develops in the setting of granulocytopenia. There is a short "window of opportunity" after which no therapy will be effective. Combinations of antibiotics such as a beta-lactam and an aminoglycoside are used for multiple reasons: to afford coverage in the event the pathogen, proves resistant to one of the agents, to afford a synergistic activity thus improving and prolonging the serum bactericidal activity, and to reduce the development of resistance. However, patients can be divided into two risk groups: those with granulocytopenia and a regenerating bone marrow and those with an aplastic marrow who will have persistent, profound (< 100 microliters) granulocytopenia.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Agranulocytosis; Animals; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Neoplasms; Survival Rate
PubMed: 8143100
DOI: 10.1007/BF00326634 -
Journal of General Internal Medicine Feb 1993Bacteremia has a high mortality rate in all elderly populations, but especially nursing home residents and the hospitalized elderly. Elderly patients with bacteremia may... (Review)
Review
Bacteremia has a high mortality rate in all elderly populations, but especially nursing home residents and the hospitalized elderly. Elderly patients with bacteremia may present in a nonspecific fashion with incontinence, with falls, or afebrile. Mortality is greater in patients whose bacteremia originates outside the genitourinary tract or who are bacteremic with gram-positive organisms. Early appropriate treatment has been found to reduce mortality in some studies, especially in patients over 85 years old or with gram-positive bacteremias. Gram-negative bacteremias are more common than those caused by gram-positive organisms in most studies. E. coli is the most common gram-negative isolate, followed in most studies by either Proteus or Klebsiella. Staphylococcus aureus is the most common gram-positive isolate; enterococcus and pneumococcus are also frequently isolated. Bacteremia in the elderly may present in a subtle fashion. Appropriate antibiotic therapy may reduce mortality and should include antibiotic coverage for S. aureus and gram-negative bacilli, as well as for anaerobes if pressure ulcers are suspected as the source. Clinicians who care for the elderly should be aware of the possible presentations of bacteremia and the appropriate treatment in all clinical settings.
Topics: Aged; Bacteremia; Gram-Negative Bacterial Infections; Humans; Risk Factors; Survival Rate
PubMed: 8441082
DOI: 10.1007/BF02599992 -
Revista Medica Del Instituto Mexicano... 2010Acinetobacter baumannii has emerged as an important nosocomial pathogen. It is difficult to control and treat. The most seriously ill patients and those previously... (Review)
Review
Acinetobacter baumannii has emerged as an important nosocomial pathogen. It is difficult to control and treat. The most seriously ill patients and those previously infected are more likely than others to be infected or colonized by A. baumannii. The epidemiology of A. baumannii infection is complex, with the coexistence of epidemic and endemic infections. The A. baumannii are the species isolated in 90% of the nosocomial infections and in 92% of the nosocomial bacteremias. The intensive care units presented the greater number of nosocomial bacteremias by A. baumannii. The most common sources of A. baumannii are respiratory tract, surgical wound, catheter, urinary tract and others. The most frequently clinical manifestation is sepsis and a fulminating course is observed when the patient presents septic shock. Progressive resistance of A. baumannii to antimicrobial limits the therapeutic options. The patients with A. baumannii multidrug-resistant present an excessive rate of attributed mortality, length of stay and costs.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Bacteremia; Humans
PubMed: 21184718
DOI: No ID Found -
Clinical Infectious Diseases : An... Dec 1993Enterococcus avium, formerly "group Q streptococcus," has rarely been reported as a pathogen in humans. To determine the clinical significance of this organism, we... (Review)
Review
Enterococcus avium, formerly "group Q streptococcus," has rarely been reported as a pathogen in humans. To determine the clinical significance of this organism, we reviewed the records of all patients whose blood cultures were positive for E. avium who were seen at our institution from 1986 through 1991 and identified nine cases of bacteremia due to E. avium. All isolates were believed to be clinically significant. Five of nine cases developed in patients with significant gastrointestinal illnesses. The remaining clinical scenarios included intravenous catheter sepsis and factitious disorders. E. avium bacteremias were polymicrobial in seven cases; in six cases, the coisolates were gastrointestinal organisms. These observations suggest that E. avium bacteremia most often originated from a gastrointestinal tract source. We conclude that, though rare, E. avium can be pathogenic in humans and that E. avium bacteremia is associated with gastrointestinal abnormalities.
Topics: Adult; Aged; Bacteremia; Catheters, Indwelling; Enterococcus; Female; Gastrointestinal Diseases; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged
PubMed: 8110922
DOI: 10.1093/clinids/17.6.1006 -
Clinical Microbiology and Infection :... Mar 2021Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists. (Review)
Review
BACKGROUND
Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists.
OBJECTIVES
The aim was to summarize the more relevant features of EB and to provide a practical state-of-the-art on the topics that more directly affect its management.
SOURCES
Pubmed articles from inception to 31 May 2020.
CONTENT
The following topics are covered: epidemiological, clinical and microbiological characteristics and factors associated with prognosis of EB; diagnosis and work-up, including the use of echocardiography to rule out endocarditis; antibiotic management with special focus on antimicrobial resistance and complicated EB; and the role of infectious disease consultation and the use of bundles in EB. In addition, three clinical vignettes are presented to illustrate the practical application of the guidance provided, and major gaps in the current evidence supporting EB management are discussed.
IMPLICATIONS
EB is associated with large burdens of morbidity and mortality, particularly among fragile and immunosuppressed patients presenting complicated bacteraemia due to multidrug-resistant enterococci. Most cases of EB are caused by Enterococcus faecalis, followed by E. faecium. EB often presents as polymicrobial bacteraemia. Rapidly identifying patients at risk of EB is crucial for timely application of diagnostic techniques and empiric therapy. Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization-time of flight mass spectrometry, especially if used together with infectious disease consultation within bundles, appear to improve management and prognosis of EB. Echocardiography is also key in the work-up of EB and should probably be more extensively used, although its exact indications in EB are still debated. Multidisciplinary approaches are warranted due to the complexity and severity of EB.
Topics: Bacteremia; Enterococcus; Gram-Positive Bacterial Infections; Humans
PubMed: 33152537
DOI: 10.1016/j.cmi.2020.10.029 -
Clinical Microbiology Reviews Jan 2009The human gingival niche is a unique microbial habitat. In this habitat, biofilm organisms exist in harmony, attached to either enamel or cemental surfaces of the tooth... (Review)
Review
The human gingival niche is a unique microbial habitat. In this habitat, biofilm organisms exist in harmony, attached to either enamel or cemental surfaces of the tooth as well as to the crevicular epithelium, subjacent to a rich vascular plexus underneath. Due to this extraordinary anatomical juxtaposition, plaque biofilm bacteria have a ready portal of ingress into the systemic circulation in both health and disease. Yet the frequency, magnitude, and etiology of bacteremias due to oral origin and the consequent end organ infections are not clear and have not recently been evaluated. In this comprehensive review, we address the available literature on triggering events, incidence, and diversity of odontogenic bacteremias. The nature of the infective agents and end organ infections (other than endocarditis) is also described, with an emphasis on the challenge of establishing the link between odontogenic infections and related systemic, focal infections.
Topics: Bacteremia; Bacteria; Endocarditis; Gingiva; Humans; Incidence; Tooth
PubMed: 19136433
DOI: 10.1128/CMR.00028-08 -
Problems in Veterinary Medicine Jun 1990Bacteremias and septicemias are diagnostic and therapeutic challenges. Disseminated bacterial infections may be associated with a number of different conditions and can... (Review)
Review
Bacteremias and septicemias are diagnostic and therapeutic challenges. Disseminated bacterial infections may be associated with a number of different conditions and can present with any of a wide variety of clinical signs. Additionally, they are often complicated by the adverse effects of an overzealous immune response in the patient. The most immediately severe and life threatening of these complications is septic shock, a frequent sequela to bacteremia characterized by endotoxin-producing gram-negative microorganisms. Infection with any of a large number of gram-positive or gram-negative aerobes or anaerobes is possible, as is mixed infection. Definitive diagnosis of bacteremia is by repeatable isolation of the pathogen(s) from culture of the patient's blood. Successful therapeutic outcome is dependent on early diagnosis and prompt treatment with a prolonged course of high doses of bactericidal antibiotics, facilitated by in vitro sensitivity testing.
Topics: Animals; Anti-Infective Agents; Bacteremia; Cat Diseases; Cats; Dog Diseases; Dogs; Sepsis
PubMed: 2134597
DOI: No ID Found -
Clinical Microbiology and Infection :... Feb 2022Staphylococcus aureus bloodstream infections are common and associated with a high mortality of 15-25%. Methicillin-resistant S. aureus (MRSA) bloodstream infection... (Review)
Review
BACKGROUND
Staphylococcus aureus bloodstream infections are common and associated with a high mortality of 15-25%. Methicillin-resistant S. aureus (MRSA) bloodstream infection accounts for 10-40% of cases, and has an even higher mortality. Despite being the 'bread and butter' of clinical infectious diseases practice, robust evidence to guide optimal management is often lacking and there is wide variation in practice.
OBJECTIVES
To provide a real-world example of a case of MRSA bacteraemia and the thought processes of the authors as key management decision points are reached.
SOURCES
The discussion is based on recent literature searches of relevant topics. In making recommendations, randomized clinical trial data have been prioritized and highlighted, and where these are not available recommendations are based on the experience and opinions of the authors.
CONTENT
For a patient with MRSA bacteraemia and a primary bone and joint infection the following points are discussed: empirical antibiotic choice for suspected S. aureus bacteraemia; directed antibiotic choice for MRSA; monitoring and dosing of vancomycin; the role of combination therapy when bacteraemia is persistent; and the duration of therapy and role of switching to oral antibiotics.
IMPLICATIONS
While broad principles of aggressive source control and appropriate choice and duration of antibiotics are important, the heterogeneity of S. aureus bacteraemia means that a tailored rather than algorithmic approach to management is often required. Further randomized controlled trials are needed to strengthen the evidence base for the management of MRSA bacteraemia.
Topics: Anti-Bacterial Agents; Bacteremia; Humans; Methicillin-Resistant Staphylococcus aureus; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus; Vancomycin
PubMed: 34757117
DOI: 10.1016/j.cmi.2021.10.014