Staphylococcal bacteremia in cancer patients: Risk factors and outcome in 134 episodes prior to and after introduction of quinolones into infection prevention in neutropenia

A total of 134 episodes of staphylococcal bacteremia (SBE) appearing among 9987 admissions, and 979 episodes of bacteremia in cancer patients within 5 years, were analyzed for risk factors, clinical course and outcome; 64 were monomicrobial and 70 polymicrobial. The most frequent risk factors were acute leukemia, catheter insertion, long-lasting neutropenia, and prior prophylaxis with quinolones. There was no significant difference between polymicrobial and monomicrobial SBE in risk factors. The two groups differed only in the source of bacteremia (gastrointestinal and respiratory-tract infections were more common in monomicrobial SBE) and etiology —Staphylococcus aureus appeared more frequently in monomicrobial than in polymicrobial bacteremia (20.3% compared to 4.3%,P<0.05). More complications (14.3%) such as abscesses, endocarditis, etc. appeared in the group of polymicrobial SBE (P < 0.05). No difference was observed in clinical course and outcome between monomicrobial and polymicrobial SBE. The incidence of SBE has increased since 1991, when quinolones were first used in prophylaxis in afebrile neutropenia at our center; however, the infection-associated mortality in monomicrobial SBE was low (4.3%).     

Incidence,clinical features,risk factors and outcome of bacteremia due to vancomycin-resistant and vancomycin-sensitiveEnterococcus species analyzed over a 7-year period in a single cancer institution

The aim of this study was to retrospectively compare the incidence, risk factors, and outcome in patients seen over a 7-year period at the National Cancer Institute in the Slovak Republic, with vancomycin-sensitive or vancomycin-resistant enterococcal bacteremia. The total incidence of enterococcal bacteremia at the National Cancer Institute increased from 5.1% in 1991 to 11.1% in 1993 and then decreased to 4.3% in 1995. Analysis of the 77 episodes of enterococcal bacteremia from 66 patients showed that 69 episodes from 60 patients were due to vancomycin-sensitiveEnterococcus faecalis (group 1) and 8 episodes from 8 patients were due to vancomycin-resistantEnterococcus faecium (group 2). The features most frequently associated with enterococcal bacteremia were the insertion of a central venous catheter, neutropenia lasting more than 10 days, previous therapy with cephalosporins or vancomycin, previous prophylaxis with quinolones, and the incidence of superinfections. There was no difference in the clinical course or outcome between the 2 study groups. Previous therapy with aminoglycosides, cephalosporins, vancomycin or imipenem, neutropenia less than 10 days in length, malignancies other than leukemia or solid tumors, and the incidence of breakthrough bacteremia significantly correlated with patients with vancomycin-resistantE. faecium rather than patients with vancomycin-sensitiveE. faecalis. The overall mortality was similar in both groups and averaged 32.5% for all enterococcal bacteremic patients. In this study, the major risk factors associated with cancer patients for developing vancomycin-resistant enterococcal bacteremia were previous therapy with aminoglycosides, cephalosporins or vancomycin, superinfections with other organisms and the incidence of breakthrough bacteremia.     

血液净化临时性中心静脉导管相关性菌血症的分析

目的了解上海交通大学附属第六人民医院肾脏风湿科血液净化患者临时性导管相关性菌血症的发生率和影响因素。方法采用回顾性分析方法分析上海交通大学附属第六人民医院肾脏风湿科445例次临时性置管患者的年龄、性别、置管时间、置管方式和菌血症的关系,同时分析致病菌的构成比和耐药性。结果我院445例次临时导管中,导管相关性菌血症的感染率是5.79%,按导管日计算为1.19例次/1000导管日;置管方式与感染无统计学意义（P=0.89）,留置时间长短与感染的关系有统计学意义（P〈0.05）;金葡菌（20.80%）、屎肠球菌（16.60%）、华纳葡萄球菌（8.30%）、肺炎克雷伯菌（8.30%）是常见致病菌。结论年龄、性别、置管方式不是导管相关菌血症的危险因素;留置时间的长短和感染率成正线性相关,临时导管留置时间大于两周者发生导管相关菌血症的风险显著增大。     

Early and late onset bacteremia have different risk factors in trauma patients

Objective The aim of this study was to identify risk factors and to describe epidemiological patterns for early—(EOB) and late—onset bacteremias (LOB) after trauma.Design A prospective study conducted on 141 consecutive trauma patients.Setting A general intensive care unit (ICU) of a university hospital.Patients All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severtity of trauma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma.Results Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (x ²=4.1,P=0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1).Conclusions Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.     

Evaluation of bacteremias in a Turkish University hospital: 3-year outcomes

In this retrospective study, the investigators examined blood cultures from patients that had been diagnosed with bacteremias over a 3-y period. The study was conduced at Kocatepe University Hospital (Middle Anatolia, Turkey). Blood samples that arrived at the university's microbiology laboratory between 2002 and 2005 were evaluated retrospectively. These samples were classified as contamination, false positivity, community-acquired bacteremia (CAB), or hospital-acquired bacteremia (HAB). Patient age and sex, foci of bacteremia, present comorbidities, predisposing factors, pathogens, and mortality rates were evaluated. A total of 1783 blood cultures that had been drawn from 1441 patients during this 3-y period were examined retrospectively. Of 354 positive isolates, 61 (17.2%) were CABs and 293 (82.8%) were HABs. In HABs, the most commonly isolated microorganisms were Staphylococcus aureus (37.5%), coagulase-negative staphylococci (29.7%), and Escherichia coli (10.2%); in CABs, the most commonly isolated microorganisms were S aureus (29.5%), Brucella spp (26.2%), and E coli (24.6%). Crude mortality rates were determined to be 15.2% for HABs and 12.7% for CABs. This study yielded data on the most common foci of bacteremia, microbiologic factors, and the epidemiology associated with HABs and CABs. It is hoped that these data will enhance empirical antibiotic therapeutic approaches, thereby preventing delays in treatment and decreasing mortality rates associated with bacteremias.     

Recurrent vascular catheter-related bacteremia caused by <Emphasis Type="Italic">Delftia acidovorans</Emphasis> with different antimicrobial susceptibility profiles

An 11-year-old girl with metastatic neuroblastoma developed recurrent bacteremia during sustained neutropenia after autologous peripheral blood transplantation. All febrile episodes of bacteremia were caused by single Delftia acidovorans strain revealed by ERIC-PCR. This strain became resistant to broad-spectrum penicillins and cephalosporins through antibiotic treatments. Removal of the indwelling vascular catheter resulted in resolution of the infection. So far as we know, this is the first report of vascular catheter-related D. acidovorans bacteremia in Japan.     

Clinical significance of Staphylococcus saprophyticus identified on blood culture in a tertiary care hospital

Staphylococcus saprophyticus is a well-known cause of acute uncomplicated urinary tract infection in young women. However, the clinical significance of this organism isolated from blood culture has not been determined. We assessed the clinical significance and characteristics of S. saprophyticus identified on blood culture. A total of 24 patients were identified, and 7 patients (29.2%) were considered to have clinically significant bacteremia. Of the 7 patients with clinically significant bacteremia, hematologic malignancy was the most common underlying illness (5 patients), and tunneled-central venous catheter was the most common portal of entry (4 patients). In no case did S. saprophyticus bacteremia originate from the urinary tract. One patient died during hospitalization. However, the death was not directly related to bacteremia. In conclusion, our data suggest that bacteremia caused by S. saprophyticus is most commonly associated with tunneled-central venous catheter in patients with hematologic malignancies and may be associated with a lower risk of mortality.     

Bacteremia in adult diabetic patients

OBJECTIVE: To compare the microbiology, sources, complications, and outcome of bacteremia in diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: A prospective study was conducted of all episodes of bacteremia in hospitalized diabetic and nondiabetic patients. The study consisted of patients greater than or equal to 18 yr of age with bacteremia detected within a 19-mo interval. RESULTS: We compared 124 episodes of bacteremia in 119 diabetic patients to 508 episodes in 480 nondiabetic patients. Diabetic patients were older than nondiabetic patients (median age 74 vs. 68 yr, P = 0.0001). In patients with an indwelling urinary catheter and bacteremic urinary tract infection, the percentage of Klebsiella in diabetic patients was 60% (6 of 10) and in nondiabetic patients was 17% (4 of 23, P = 0.04). In patients without an obvious source of bacteremia, the percentage of staphylococcal isolates in diabetic patients was 29% (10 of 35) and in nondiabetic patients was 14% (24 of 176, P = 0.04). Staphylococci were a common cause of bacteremic infections of the extremities in diabetic patients (12 of 19, 63%) and nondiabetic patients (20 of 50, 40%). Septic shock was the only complication that was more common in diabetic patients. The mortality in diabetic and nondiabetic patients was 28 and 29%, respectively. CONCLUSIONS: Our results represent elderly patients with non-insulin-dependent diabetes mellitus. In this group, empirical treatment for suspected bacteremic urinary tract infection in patients with a urinary catheter should include coverage for Klebsiella. Empiric treatment for suspected bacteremia of unknown origin or caused by infection of the extremities should include an antistaphylococcal drug. The prognosis of bacteremia in diabetic and nondiabetic patients was similar.     

Clinical characteristics and outcomes of bacteremia caused by Acinetobacter species other than A. baumannii: comparison with A. baumannii bacteremia

Previous reports have suggested that bacteremia caused by Acinetobacter species other than A. baumannii is frequently associated with intravascular catheters, and that A. baumannii is less virulent than non-baumannii Acinetobacter. To validate these observations, 28 patients with bacteremia caused by Acinetobacter species other than A. baumannii (cases) were compared with 112 randomly selected patients with A. baumannii bacteremia (controls). Only 1/28 (3.6%) case episodes and 13/112 (11.6%) control episodes of bacteremia were definitely catheter-related (P = 0.301). Even if probable catheter-related episodes were included, the frequency did not differ significantly between cases and controls (46.4% vs 39.3%; P = 0.491). No significant differences between cases and controls were noted in crude mortality (17.9% vs 32.4%; P = 0.131) or bacteremia-related mortality (14.3% vs 12.6%; P = 0.760). In conclusion, we found that the portals of entry and the mortality of bacteremia associated with Acinetobacter species other than A. baumannii and with A. baumannii were similar.     

Who Needs a Blood Culture? A Prospectively Derived and Validated Prediction Rule

The study objective was to derive and validate a clinical decision rule for obtaining blood cultures in Emergency Department (ED) patients with suspected infection. This was a prospective, observational cohort study of consecutive adult ED patients with blood cultures obtained. The study ran from February 1, 2000 through February 1, 2001. Patients were randomly assigned to derivation (2/3) or validation (1/3) sets. The outcome was "true bacteremia." Features of the history, co-morbid illness, physical examination, and laboratory testing were used to create a clinical decision rule. Among 3901 patients, 3730 (96%) were enrolled with 305 (8.2%) episodes of true bacteremia. A decision rule was created with "major criteria" defined as: temperature > 39.5 degrees C (103.0 degrees F), indwelling vascular catheter, or clinical suspicion of endocarditis. "Minor criteria" were: temperature 38.3-39.4 degrees C (101-102.9 degrees F), age > 65 years, chills, vomiting, hypotension (systolic blood pressure < 90 mm Hg), neutrophil% > 80, white blood cell count > 18 k, bands > 5%, platelets < 150 k, and creatinine > 2.0. A blood culture is indicated by the rule if at least one major criterion or two minor criteria are present. Otherwise, patients are classified as "low risk" and cultures may be omitted. Only 4 (0.6%) low-risk patients in the derivation set and 3 (0.9%) low-risk patients in the validation set had positive cultures. The sensitivity was 98% (95% confidence interval [CI] 96-100%) (derivation) and 97% (95% CI 94-100%) (validation). We developed and validated a promising clinical decision rule for predicting bacteremia in patients with suspected infection.     

Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case-controlled study

The aim of this study was to assess whether multiresistant gram-negative bacteremias (MRGNB) were associated with specific risk factors for higher mortality than sensitive gram-negative bacteremias. Two groups of subjects: (51 cases and 102 controls) were matched for sex, age, underlying disease, and neutropenia. There were no significant differences in the incidence of cytotoxic chemotherapy administered, vascular catheter insertion, catheter as source of bacteremia, and etiology of bacteremia. The proportion of Klebsiella-Enterobacter, Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia was similar in the two groups. Prior surgery (21.6% vs 7.9%, P < 0.05) was significantly associated with sensitive gram-negative bacteremia. Previous prophylaxis with ofloxacin (45.1% vs 24.5%; P < 0.05) and prior therapy with broad-spectrum antibiotics (41.2% vs 27.5%; P < 0.05), such as first and second generation cephalosporins (19.6% vs 7.8%; P < 0.05), third generation cephalosporins (41.2% vs 13.7%; P < 0.01), aminoglycosides (39.2% vs 9.8%; P < 0.01), ofloxacin (11.8% vs 2.0%; P < 0.005), and imipenem (19.6% vs 2.0%; P < 0.001) were significantly more frequently observed among cases than controls. Cases (patients with bacteremia due to multiresistant gram-negative bacteremias) were also significantly more frequently infected with bacteria resistant to ceftazidime (68.6% vs 17.6%; P < 0.001), amikacin (52.9% vs 7.8%; P < 0.001), imipenem (50.1% vs 23.5%; P < 0.05), ciprofloxacin (32.1% vs 5.9%; P < 0.001), and piperacillin (41.2% vs 7.8%; P < 0.01). With regard to outcome, attributable mortality was similar (15.7% vs 13.8%; not significant) in the two groups; however, cure rates were lower among cases (patients infected with MRGNB) because crude mortality was higher in cases (35.3% vs 13.8%; P < 0.01) than in controls. Received: January 20, 1998 / Accepted: March 30, 1999     

Comparison of arterial and venous blood samples for the diagnosis of bacteremia in critically ill patients

We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were positive in 42 (19%) of the episodes, but there were great discrepancies between the results obtained by the two methods. In only eight cases did both methods give the same microorganism. In eight other episodes, the two arterial cultures were positive while the venous sample was negative, probably indicating a continuous contamination of the catheter system. Pseudomonas aeruginosa and Staphylococcus epidermidis were the two most common microbes. The frequency of positive arterial catheter blood cultures did not increase with the length of catheter use. We conclude that an arterial catheter is not a reliable sampling site for blood cultures and does not replace the conventional venipuncture method.     

Risk Factors for Mortality of Bacteremic Patients in the Emergency Department

Objectives: Patients with bacteremia have a high mortality and generally require urgent treatment. The authors conducted a study to describe bacteremic patients in emergency departments (EDs) and to identify risk factors for mortality. Methods: Bacteremic patients in EDs were identified retrospectively at a university hospital from January 2007 to December 2007. Demographic characteristics, underlying illness, clinical conditions, microbiology, and the source of bacteremia were collected and analyzed for their association with 28-day mortality. Results: During the study period, 621 cases (50.2% male) were included, with a mean (±SD) age of 62.8 (±17.4) years. The most common underlying disease was diabetes mellitus (39.3%). Escherichia coli (39.2%) was the most frequently isolated pathogen. The most common source of bacteremia was urinary tract infection (41.2%), followed by primary bacteremia (13.2%). The overall 28-day mortality rate was 12.6%. Multivariate stepwise logistic regression analysis showed age > 60 years (odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.29 to 4.92, p = 0.007), malignancy (OR = 2.66, 95% CI = 1.44 to 4.91, p = 0.002), liver cirrhosis (OR = 2.08, 95% CI = 1.02 to 4.26, p = 0.044), alcohol use (OR = 5.73, 95% CI = 2.10 to 15.63, p = 0.001), polymicrobial bacteremia (OR = 3.99, 95% CI = 1.75 to 9.10, p = 0.001), anemia (OR = 2.33, 95% CI = 1.34 to 4.03, p = 0.003), and sepsis (OR = 1.94, 95% CI = 1.16 to 3.37, p = 0.019) were independent risk factors for 28-day mortality. Conclusions: Bacteremic patients in the ED have a high mortality, particularly with these risk factors. It is important for physicians to recognize the factors that potentially contribute to mortality of bacteremic patients in the ED.     

Retrospective analysis of bacteremia because of Enterobacter cloacae compared with Escherichia coli bacteremia

A total of 52 patients of Enterobacter cloacae bacteremia from a University hospital during the period from January 2000 to June 2005 were analysed and compared with a reference group comprising 52 patients of Escherichia coli bacteremia. Overall, E. cloacae ranked the tenth in all pathogens of bacteremia accounting for 2.8% of the total patients. Although the incidence of E. cloacae bacteremia was low, the attributable mortality rate till achieved 13.5%. Most patients (86.5%) with E. cloacae bacteremia were hospital-acquired. The overwhelming majority of patients (92.3%) were men, while almost half of the patients (48.1%) were from the Department of Urological Surgery with underlying diseases such as urinal obstruction, kidney transplantation and kidney tumours. Possible risks factors associated with E. cloacae bacteremia included immunocompromised status, long-term hospitalisation and invasive procedures or surgeries. E. cloacae bacteremia significantly differed from E. coli bacteremia in a number of clinical aspects, including underlying diseases, portal of entry, infection type, risks factors, laboratory findings and appropriateness of empirical antibiotic therapy. Besides the high prevalence of resistance to cephalosporins, most E. cloacae blood isolates were also resistant to ciprofloxacin (resistance rate, 67.3%), gentamicin (73.1%) and tobramycin (73.1%). Based on the findings of the present study, E. cloacae is probably an important pathogen of bacteremia occurring in male patients with underlying urinal system illnesses.     

Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital.

BACKGROUND: Group B streptococcal bacteremia in nonpregnant adults continues to be a significant infection. METHODS: We reviewed medical records of nonpregnant adult patients with group B streptococcal bacteremia from 1995 to 1999 and compared the findings with data from a similar study in our institution between 1980 and 1984. RESULTS: There were 36 episodes of group B streptococcal bacteremia. The mean age was 70 years. Most of the cases (94%) were community-acquired. The most common underlying disease was diabetes mellitus (49%). The most common sources of group B streptococcal bacteremia were pneumonia and soft tissue infections. The overall mortality rate was 16.7%. CONCLUSIONS: Group B streptococcal bacteremia is still found mainly in the elderly, with significant underlying disease, particularly diabetes mellitus. The spectrum of infection has included lymphadenitis, ascending cholangitis, mastitis, prostatitis, and toxic shock syndrome. The mortality has decreased significantly during the past 15 years (16.7% vs 67.9%).     

Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients

A total of 1051 bacteremic episodes (782 patients) were prospectively recorded in 10 cancer centers (9 French, 1 Belgian), with: patient's age (mean 53, range 1–89 years), underlying cancer, neutropenia (<1000 neutrophils/l; 233), signs and symptoms, type of i.v. line (percutaneous central: 534; peripheral: 228; central implanted: 304), treatment, blood culture system, number of positive blood culture bottles/total obtained, time to growth. Of all episodes, 23.2% occurred within 48 h of admission. The patients were receiving systemic antibiotics at sampling (on AB) in 34.6% of cases. The 1147 pathogens isolated (86 polymicrobial) were: E. coli (10.7%), Klebsiella-Enterobacter-Serratia (6.1%), other enterobacteriaceae (2.2%), Pseudomonas aeruginosa (4.8%), other nonfermenters (4.7%), coagulase-negative staphylococci (CNS, 40.8%), Staphylococcus aureus (9.9%), streptococci (5.4%), enterococci (2.2%), anaerobes (3.4%), yeasts (3.5%), and other bacteria (6.9%). The CDC (Centers for Disease Control) criteria (1988) were used to assess significance: group 1: pathogenic species (616 episodes; 59%); group 2: clinical signs and isolation of a contaminant species (47; 4.5%); group 3: as in group 2 with an i.v. line and empiric antibiotic treatment (181 episodes including 176 CNS; 17%); group 4: non-significant (207 episodes including 203 CNS; 20%). Groups 1–3, in which the episodes were considered to be significant (844 episodes; 80%) were compared with non-significant episodes (Fisher). Significant differences (P0.05) were seen in time to growth (median growth within 24 h vs 48 h), fever (86% vs 54%), chills (40% vs 3%), hypotension (10% vs 2%), septic shock (9% vs 1%), polymicrobial etiology (10% vs 0.5%), and initiation of empiric antibiotic treatment (71% vs 4%). Bacteremic episodes of CDC groups 1,3 and 4 were further studied in episodes with a single isolate as a doubtful clinical significance (482 episodes) and episodes with 2 bottles positive of probable clinical significance (569 episodes; 54%). In group 1 (218 doubtful, 398 probably significant episodes) significant differences were seen in chills (36% vs 52%), shock (7% vs 13%), polymicrobial (8% vs 17%), initiation of empiric antibiotic treatment (60% vs 72%); in group 3 (87 doubtful, 94 probably significant) in time to growth delay; in group 4 (177 doubtful, 30 probably significant) in proportion with implanted catheter (26% vs 52%), fever (62% vs 10%), and time to growth. This study confirms the predominant role of Gram-positive cocci in bacteremia occurring in cancer patients.M. Viot and M. Schneider, Centre Antoine-Lacassagne, Nice; V. Bussy, Centre Jean-Godinot, Reims; C. Lion, CHRU, Nancy; C. Minello, Centre George-François-Leclercq, Diion; A. Lobera, Fondation Bergognié, Bordeaux; F. Boineau, CHU, Bordeaux; M. Roussel-Delvallez, CHU, Lille; J. Beal and D. Lefèbvre, Centre Oscar-Lambret, Lille; J. Pusel, Centre Paul-Strauss, Strasbourg; J. L. Théard, Centre René-Gauducheau, Nantes; D. Coullioud, Centre Léon-Bérard, Lyon, France; P. Van der Auwera and J. Klastersky, Institut Jules Bordet, Brussels, Belgium     

Staphylococcus aureus bacteremia: a prospective study

During a 22-month period, 47 patients with 49 consecutive episodes of Staphylococcus aureus bacteremia were identified and observed prospectively for the development of endocarditis and metastatic infection. Eighteen (37%) of the episodes were community-acquired and 31 (63%) were nosocomial. The mean patient age was 55 years, and all but nine patients had one or more underlying diseases. A primary focus was identified for 38 episodes (78%) most often an intravenous catheter, and 21 episodes (43%) were associated with a removable focus of infection. In this group, no patient had endocarditis after a mean duration of 20 days of therapy. Overall, two of 47 patients had endocarditis by clinical criteria; one was a drug abuser and one had no known heart disease. Forty-five of 49 episodes were treated with a single antimicrobial agent. There were 12 (24%) deaths in this series, seven (14.2%) directly due to staphylococcal infection. In this prospective study we found a low but definite risk of endocarditis associated with S aureus bacteremia. The mortality was similar to that in other recently published studies. All deaths occurred within two weeks of initiating therapy, indicating the potential importance of host factors in the outcome.     

菌血症患者病原菌耐药情况和临床特征分析

目的了解佛山市中医院菌血症患者的临床特征和病原菌耐药情况,探讨菌血症的相关因素,为临床预防、治疗菌血症、合理使用抗菌药物提供科学依据。方法对佛山市中医院2010年7月至2011年7月菌血症患者的临床资料进行回顾性分析,以Excel及SPSS统计分析病原菌种类和药物敏感情况。结果收集1 231例血培养标本,共分离病原菌174株,革兰阴性(G-)杆菌105株(60.34%),革兰阳性(G+)球菌59株(33.91%),真菌10株(5.75%);G-杆菌以大肠埃希菌和肺炎克雷伯菌为主,对亚胺培南和阿米卡星高度敏感,对氨苄西林高度耐药;G+球菌以溶血葡萄球菌和金黄色葡萄球菌为主,对万古霉素、替考拉宁、利奈唑胺、呋喃妥因、喹奴普汀-达福普汀、米诺环素全敏感,对青霉素高度耐药。医院获得性感染率39.0%,社区获得性感染率61.0%;有基础疾病者81.8%;科室主要分布于肿瘤科、重症监护病房。经过抗生素治疗,治愈及好转占87.0%、死亡占7.8%、未愈占5.2%。住院期间进行过手术或侵入性操作、插管占45.5%;临床上97.4%有发热,常伴寒战症状。结论应根据药敏分析结果选用最佳抗生素治疗菌血症患者,缩短治疗时间,减少细菌耐药性发生,提高菌血症的救治成功率;菌血症患者多伴有基础疾病,临床常见发热、寒战等症状。减少手术、侵入性操作、插管,合理使用广谱抗菌药物可以减少医院菌血症的发生率。     

Serious Bacterial Infections in Febrile Outpatient Pediatric Heart Transplant Recipients

Objectives: The purpose of this study was to describe the incidence of serious bacterial infections (SBIs) in febrile outpatient pediatric heart transplant recipients and to assess the utility of using white blood cell (WBC) indices to identify patients at low risk for bacteremia. Methods: A retrospective study was conducted on all heart transplant recipients followed at a single children’s hospital. All outpatient visits from January 1, 1995, to June 1, 2007, in which fever was evaluated were reviewed. Patients with history of a primary immunodeficiency, receiving concurrent chemotherapy, or having had a stem cell or small bowel transplant were excluded. Demographic, historical, physical examination, laboratory, and radiographic data were then recorded. Results: Sixty‐nine patients had 238 individual episodes of fever evaluation; of these, 217 (91.2%) had blood cultures drawn with results available in their initial evaluation. There were six (2.8%) true‐positive blood cultures and eight (3.7%) false‐positive cultures. Chest radiography was done in 185 evaluations (77.8%), and 44 episodes of pneumonia (23.8%) were diagnosed. Of 112 urine cultures done, one (0.9%) was positive. Neither of two lumbar punctures performed were positive. In non–ill‐appearing children without indwelling central lines or focal bacterial infections (pneumonia, cellulitis), the incidence of bacteremia was 1.2%. In children with a focal bacterial infection, the rate of bacteremia was 6.3%. WBC indices were not significantly different between bacteremic and nonbacteremic patients. A band‐to‐neutrophil ratio (BNR) of ≥0.25 and a published guideline for identifying low‐risk infants using WBC indices identified all bacteremic patients, each with a sensitivity of 100% (95% confidence interval [CI] = 48% to 100% and 54% to 100%, respectively). Conclusions: The incidence of bacteremia was low in febrile, outpatient pediatric heart transplant patients, especially in those who were not ill‐appearing and did not have a focus of serious infection. Two different low‐risk criteria performed well in identifying the bacteremic patients, although given the low number of true‐positive cultures, the CIs for the sensitivities of these tests were extremely wide, and neither test could be reliably used at present. A prospective multicenter study is required to confirm the low incidence of bacteremia and low‐risk criteria in this population.     

凝固酶阴性葡萄球菌菌血症临床感染特征及耐药性分析

目的 分析凝固酶阴性葡萄球菌(CNS)菌血症患者临床资料及菌株耐药性,为临床诊断与治疗提供依据.方法 对该院2009年11月至2011年10月56例CNS菌血症患者临床资料进行回顾性统计分析.结果 CNS患者均有发热和白细胞升高、植入各种留置导管、先期使用过抗菌药物、血培养阳性报警时间小于48 h;56株CNS中,82.5%为甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS),对万古霉素、替考拉宁、利福平较为敏感;临床治疗有效率57.1%、死亡率10.7%.结论 CNS已是菌血症的重要病原菌,正确鉴定CNS是否为病原菌是临床诊断的关键,万古霉素仍是治疗MRCNS菌血症首选药物.