Septicaemia in an Austrian neonatal intensive care unit: a 7-year analysis

The results of blood cultures and clinical data of 101 neonates with 110 episodes of septicaemia during a 7-y study period were reviewed. The overall incidence of culture-proven sepsis within the study period was 6.0 per 100 neonatal intensive care unit admissions and the mortality rate was 14%. Three groups of pathogens accounted for 70% of all isolates: coagulase-negative staphylococci (27%), aerobic Gram-negative rods (24%) and Enterococcusfaecalis (19%). Group B streptococcus was the major pathogen of very early-onset septicaemia (within 24 h of birth), whereas late-onset infections were most commonly caused by coagulase-negative staphylococci. Birthweight <1500g, gestational age <30 weeks of gestation and early onset of symptoms within the first week of life were associated with poor prognosis. In addition, the case fatality rate of episodes caused by Gram-negative organisms was significantly higher than that of Gram-positive bacteraemia.     

Angioleiomyoma of the Common Bile Duct

ABSTRACT An 80-year-old woman with angioleiomyoma in the common bile duct is described. Apart from weakness and jaundice, the patient had no signs or symptoms until after endoscopic retrograde cholangiopancreatography, when cholangitis and septicaemia due to Pseudomonas aeruginosa developed. X-ray during endoscopy revealed a tumour obstructing the common bile duct and was assumed to be malignant. Because the patient was so old and her general condition had deteriorated, no treatment was given. Autopsy revealed a benign angioleiomyoma of the common bile duct and suppurative cholangitis, the latter obviously caused by the endoscopy.     

Six year trend of neonatal septicaemia in a large Malaysian maternity hospital

Abstract A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaeia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.     

Bacterial contamination of single-donor blood components

SUMMARY. An analysis was performed of the microbiological laboratory quality control data for the past 9 years (1985–1993). Bacterial contamination was detected in 100 of 25,171 tested blood components. Single-donor platelet concentrates had a contamination incidence of 25 in 5889 (0.42%); whole blood samples were contaminated at a rate of 1 in 2973 (0.03%) and red cell concentrates at a rate of 73 in 15, 317 (0.48%); of 992 samples of fresh frozen plasma only 1 was contaminated (0.1%). Gram-positive staphylococci comprised 75% of cases and Gram-negative rods 10%. This frequency of laboratory-detected bacterial contamination contrasts with the low rate of transfusion-associated septicaemic events.     

Bacterial infection of peripheral artery cannulae in newborn infants

ABSTRACT. The incidence of bacterial colonization of peripheral artery cannulae in 58 sick newborn infants was documented using a semi-quantitative culture technique. Of the 86 cannulae inserted, a positive "high-density" semi-quantitative culture not related to distant bacteraemia and indicative of local infection was found in nine cannulae (10%) and "low-density" colonization was found in one cannula (1%). One of the 58 infants died from cannual-related septicaemia and meningitis due to Klebsiella pneumoniae. Bacterial colonization was significantly more common in cannulae which had been present for more than seven days compared with cannulae present for seven days or less (P<0.05).     

Blood cultures in paediatric patients: a study of clinical impact

PURPOSE: Blood cultures form a critical part of evaluation of patients with suspected sepsis. The present study was undertaken to study the risk factors, duration of incubation for obtaining positive cultures and the clinical impact of the culture report. METHODS: A total of 220 samples from 107 pediatric patients presenting with suspected bacteraemia were processed aerobically. RESULTS: Cultures were positive in 18.7% of the samples. Most of the positive cultures were obtained after 24 hours of incubation of the broth and no isolates were obtained beyond day 4 of incubation. Therapy was modified in 54.23% of the patients after receipt of culture report. CONCLUSIONS: Incubation beyond four days (unless with specific indication like enteric fever) may be unnecessary for issuing a negative culture report. Repeated isolation of doubtful pathogens confirms true bacteraemia. Early culture report increases therapeutic compliance.     

Membrane-related effects underlying the biological activity of the anthraquinones emodin and barbaloin

Commercial plant extracts containing anthraquinones are being increasingly used for cosmetics, food and pharmaceuticals due to their wide therapeutic and pharmacological properties. In this work, the interaction with model membranes of two representative 1,8-dihydroxyanthraquinones, barbaloin (Aloe) and emodin (Rheum, Polygonum), has been studied in order to explain their effects in biological membranes. Emodin showed a higher affinity for phospholipid membranes than barbaloin did, and was more effective in weakening hydrophobic interactions between hydrocarbon chains in phospholipid bilayers. Whereas emodin induced the formation of hexagonal-H(II) phase, barbaloin stabilized lamellar structures. Barbaloin promoted the formation of gel-fluid intermediate structures in phosphatidylglycerol membranes at physiological pH and ionic strength values. It is proposed that emodin's chromophore group is located at the upper half of the membrane, whereas barbaloin's one is in a deeper position but having its glucopyranosyl moiety near the phospholipid/water interface. Moreover, membrane disruption by emodin or barbaloin showed specificity for the two major phospholipids present in bacterial membranes, phosphatidylethanolamine and phosphatidylglycerol. In order to relate their strong effects on membranes to their biological activity, the capacity of these compounds to inhibit the infectivity of the viral haemorrhagic septicaemia rhabdovirus (VHSV), a negative RNA enveloped virus, or the growth of Escherichia coli was tested. Anthraquinone-loaded liposomes showed a strong antimicrobial activity whereas these compounds in their free form did not. Both anthraquinones showed antiviral activity but only emodin was a virucidal agent. In conclusion, a molecular mechanism based on the effect of these compounds on the structure of biological membranes is proposed to account for their multiple biological activities. Anthraquinone-loaded liposomes may suppose an alternative for antimicrobial, pharmaceutical or cosmetic applications.     

TREATMENT OF SEPTICAEMIA IN THE NEWBORN INFANT: CHOICE OF INITIAL ANTIMICROBIAL DRUGS AND THE ROLE OF EXCHANGE TRANSFUSION1

Abstract. The therapeutic success of antibiotics used at the beginning of treatment and the effect of exchange transfusion in cases of septicaemia were tested in 22 newborn infants. The clinical course of these patients was compared with the outcome of 11 newborn infants who received antibiotic treatment without exchange transfusion. The following results were obtained: 1) All 6 patients initially receiving antibiotics, which were ineffective in vitro, died. In this group of patients the incidence of septic organ involvements (meningitis, ventriculitis, peritonitis) was significantly increased, 2) Following exchange transfusion, an impressive clinical improvement was consistently observed. 3) In patients who had initially received effective antibiotics and exchange transfusion, the lethality was significantly lower than in patients without exchange transfusion. 4) Our bacteriological findings show that continuous monitoring of cultures from blood, CSF and stool is necessary to choose the most effective antibiotic in the prevailing nosocomical circumstances.     

Meningococcal conjunctivitis

Background: Primary meningococcal conjunctivitis is a rare condition that can have devastating ocular and systemic complications. Methods: Review of the case records. Conclusions: Appropriate Gram stain and cultures should be obtained in cases of hyperacute conjunctivitis, especially in young patients, and systemic antibiotics should be initiated promptly where Gram-negative diplococci are found and prophylaxis for close contacts considered in Neisseria meningitidis conjunctivitis.     

Monitoring of hearing during treatment of leukaemia with special reference to the use of amikacin

Abstract. Thirty-nine patients with leukaemia were followed audiometrically during treatment with broad-spectrum antibiotics. Amikacin was given during neutropenic febrile episodes. Five patients reported a deterioration of the hearing function after termination of amikacin treatment. Significant hearing threshold loss occurred in 20 patients (51%). The hearing threshold changes were small in general, except for two patients who exhibited bilateral hearing threshold changes in the frequency range 0.5–8 kHz. Using multiple linear regression analysis 22% of the changes in hearing thresholds was estimated to be related to old age, an increased trough concentration of amikacin and an impaired pretreatment hearing state. Factors found not to influence the hearing thresholds were maximum peak concentration of amikacin, cumulative duration of therapy, pretreatment renal dysfunction and concomitant use of vancomycin. It is concluded that administration of amikacin for repeated treatment courses is associated with a low incidence of serious changes in hearing function.