Sepsis

Gastroenterology, 1991 Dec, 101(6), 1642 - 8
A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices; Ho H et al.; Reported incidences of bacteremia after endoscopy with esophageal variceal sclerotherapy are conflicting . A prospective controlled study was conducted to determine the frequency of bacteremia after emergency endoscopy with esophageal variceal sclerotherapy compared with frequency after elective esophageal variceal sclerotherapy and after emergency endoscopy in patients with upper gastrointestinal bleeding from nonvariceal sources . A total of 126 endoscopies were studied in 72 patients . Groups consisted of (a) emergency endoscopy without esophageal variceal sclerotherapy, 37 sessions with 36 patients; (b) elective esophageal variceal sclerotherapy, 33 sessions with 14 patients; and (c) emergency esophageal variceal sclerotherapy, 56 sessions with 36 patients . Blood cultures were obtained before and 5 and 30 minutes after endoscopy . There was a higher frequency of preendoscopic bacteremia in emergency esophageal variceal sclerotherapy (13%) than in emergency endoscopy alone (0%) (P = 0.02) . Clinically significant bacteremia in emergency esophageal variceal sclerotherapy was observed in 7 of 56 (13%) sessions, compared with 0 of 33 in elective esophageal variceal sclerotherapy (P = 0.03) and 1 of 36 (3%) in emergency endoscopy alone (P = 0.45) . Of these cases, 3 (5.4%) were potentially caused by emergency esophageal variceal sclerotherapy, but not clinically significant postendoscopic bacteremia was attributable to the procedure in the other groups.

J Clin Gastroenterol, 1991 Dec, 13(6), 694 - 6
Endogenous septic endophthalmitis in severe acute hepatitis with septicemia; Chiu KW et al.; Endogenous bacterial endophthalmitis occurred in a hepatitis B virus carrier during an episode of severe hepatitis complicated by anaerobic septicemia and possible spontaneous bacterial peritonitis . This may well represent another complication of severe hepatitis with anaerobic bacteremia.

Inflammation, 1991 Dec, 15(6), 447 - 56
Scavengers of reactive oxygen intermediates do not mediate the depression of macrophage hydrogen peroxide production caused by erythrocyte phagocytosis; Schwacha MG et al.; Our previous studies have shown that a phagocytic challenge with IgG-coated erythrocytes (EIgG) depressed macrophage triggered H2O2 production in vitro, and in vivo there was a decrease in the survival rate following bacteremia . The phagocytosis of an equal number of IgG-coated erythrocyte ghosts had none of these effects, indicating that the contents of the erythrocytes are important for these effects . The present study evaluated the role of the scavengers of reactive oxygen intermediates within erythrocytes in the depression of H2O2 production triggered with phorbol myristate acetate following a phagocytic challenge with EIgG . Elicited rat peritoneal macrophages (PM) were challenged with EIgG prepared from normal E or E with inactivated catalase, depleted glutathione, hemoglobin converted to methemoglobin, or fixed with formaldehyde . The depression of triggered H2O2 production was similar when equal numbers of normal EIgG and EIgG with inactivated scavengers were phagocytized . When the phagocytic challenge with normal EIgG was carried out in the presence of cytochalasin B, no depression of triggered H2O2 production was observed . Cytochalasin B partially blocked the phagocytosis of EIgG, so that with larger doses of EIgG there was sufficient ingestion of EIgG to depress H2O2 production in untreated PM . These results indicate that the scavengers of reactive oxygen intermediates present in erythrocytes are neither required nor sufficient to depress H2O2 production by macrophages.

Am Surg, 1991 Dec, 57(12), 775 - 9
Early diagnosis and treatment of sinusitis in the critically ill trauma patient; Kulber DA et al.; Sinusitis is an important cause of sepsis in the critically ill patient and may be difficult to diagnose . Four patients admitted to the surgical intensive care unit with closed head trauma were found to have sinusitis as the cause of persistent bacteremia . All patients received pharmacologic doses of corticosteroids for treatment of head injury and had prolonged nasotracheal and/or nasogastric intubation . A bedside procedure was used for diagnosis and management . Under local anesthesia, a 16-gauge angiocatheter was inserted under the inferior turbinate and into the maxillary sinus . After purulent fluid was aspirated, the sinuses were irrigated with normal saline . All four patients defervesced within 24 to 48 hours of this procedure, and facial x rays demonstrated clearing of the maxillary sinus . It was concluded that: 1) Sinusitis is a complication of closed head trauma in critically ill patients and should be included in the differential diagnosis when persistent bacteremia occurs; 2) The use of corticosteroids in the treatment of head injury may increase the risk of sinus infection; 3) Facial x rays showing air-fluid levels and/or opacification are a valuable screening test for paranasal sinusitis; and 4) bedside aspiration of the maxillary sinus is an effective diagnostic and therapeutic technique for management of sinusitis in the critically ill.

Am J Surg, 1991 Dec, 162(6), 620 - 2; discussion 622-3
Effects of electrocautery on midline laparotomy wound infection; Kumagai SG et al.; This study compared the healing of midline fascial incisions made with either scalpel or electrocautery and inoculated with Escherichia coli in 57 Sprague-Dawley rats . At 7 days, tensile strength was significantly less when incisions were made with electrocautery than with a scalpel . Additionally, would strength was inversely related to the concentration of the inoculum of E coli . The use of electrocautery was also associated with more frequent bacteremia at 48 hours and higher mortality at 7 days . Our results suggest that the technique used to incise the abdominal fascia influences subsequent wound healing, particularly in contaminated wounds.

Ann Emerg Med, 1991 Dec, 20(12), 1355 - 65
The management of HIV-related illness in the emergency department; Talan DA et al.; As the AIDS epidemic progresses, the number of ED patients with HIV-related illness will continue to increase . As reviewed in this article, much of the existing clinical research in HIV-related illness has an impact on the diagnostic and management issues that arise in the ED . Many of the patterns of disease, subtleties of diagnosis, and therapies unique to AIDS patients have already been greatly elucidated . However, as the recognition of this disease goes into only its second decade, many questions remain . Further studies are needed, for example, to improve physician assessment of HIV risk, to further identify discriminators of PCP and bacteremia, and to optimize strategies for disposition and outpatient management . In the future, in the areas of research and clinical care, emergency medicine will play an increasing important role in the front-line attack on this modern epidemic.

J Lab Clin Med, 1991 Nov, 118(5), 471 - 5
A predictive model for the clearance of soluble phospholipase A2 during septic shock; Vadas P et al.; Circulating phospholipase A2 (PLA2) has been recognized as a mediator of cardiovascular collapse in septic shock . Proximal mediators of endotoxemia, including tumor necrosis factor and interleukin 1, induce PLA2 synthesis and release, but the factors regulating PLA2 elimination are unknown . Similarly, the kinetics of PLA2 clearance during recovery from septic shock have not been examined . An autoregressive mathematical model was developed to describe the rate of PLA2 clearance during the recovery phase of septic shock . This model (which estimates that the current day's PLA2 level is 77% of the previous day's level), accounted for 89% of the variability seen in the data . The estimated circulating half-life of soluble PLA2 in septic shock in man was 32 hours . Since elevation in serum PLA2 activity is closely associated with bacteremia or endotoxemia, a significant deviation from predicted PLA2 values may denote impending relapse.

Chin Med J (Engl), 1991 Nov, 104(11), 897 - 903
Bacterial translocation and multiple system organ failure in bowel ischemia and reperfusion; Sheng ZY et al.; Portal circulation was reduced to 50-60% for one hour by partial occlusion of the superior mesenteric artery for the purpose of studying the relationship between reperfusion injury, bacterial translocation and multiple system organ failure . Forty dogs were divided randomly into four groups, and 1 x 10(10)/kg E . coli O111B4 were fed to each animal 12 hours before operation . Group I constituted the controls, in which sham operations were performed . The experimental procedure was completed in all the animals of the other three groups . Rubia yunnanensis, an anti-oxidant, was given to group III . Amikacin was given to group IV . The results showed that group II was characterized by bacteremia, hypoxemia, and hypotension as compared with group I . The levels of superoxide dismutase (SOD) in the whole blood were markedly lowered and malondialdehyde (MDA) values significantly elevated in group II after reperfusion compared with group I . Plasma levels of anaphylatoxin C5a and B2 (TXB2) were significantly raised in group II beginning with the reperfusion when compared with groups I, III and IV . Pathological changes in the intestine, liver and lung were remarkable only in group II, including acute necrosis of the intestinal mucosa, granulocyte infiltration, hemorrhage and edema of the lung, degenerative changes of myocardial and hepatic cells, and bacterial invasion of the blood, liver and lung . These results suggested that bowel ischemia and reperfusion may promote gut barrier failure and bacterial translocation, then contribute to the development to multiple system organ failure (MSOF) by allowing bacteria or endotoxin normally contained within the gut to reach the portal and systemic circulations where it fuels the septic process . Oxygen free radicals, anaphylatoxin and thromboxane may be potential factors in the development of gut barrier failure and MSOF.

Rev Infect Dis, 1991 Nov-Dec, 13(6), 1120 - 5
Catheter-related infections caused by the Mycobacterium fortuitum complex: 15 cases and review; Raad II et al.; Fifteen cancer patients have developed catheter-related infections caused by the Mycobacterium fortuitum complex (M . fortuitum and Mycobacterium chelonae) at M . D . Anderson Cancer Center since 1978 . Eleven patients had bacteremia and four had catheter site infections . Nine infections were caused by M . fortuitum and six by M . chelonae . All four bacteremic patients whose catheters were initially removed and who were treated with antibiotics recovered, whereas for all of the seven bacteremic patients whose catheters remained in place, the infection relapsed or treatment failed . Six (86%) of the latter group ultimately responded to additional antibiotic therapy when the catheter was removed . Successful treatment of local catheter infections was accomplished by catheter removal alone or in combination with antibiotic therapy . Fourteen additional cases have been reported, and eight (57%) of these patients also had underlying cancer . Patients with septicemia or an infection at the catheter insertion site responded to catheter removal and appropriate antibiotics . Patients with infection in the catheter tunnel (tunnel infection) responded only after surgical excision of the tissue surrounding the infected tunnel . M . fortuitum complex is a cause of catheter-related bacteremia in patients with cancer . Appropriate treatment consists of antibiotic therapy and catheter removal . Tunnel infections usually also require surgical excision.

Rev Infect Dis, 1991 Nov-Dec, 13(6), 1089 - 92
Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS; Clark RA et al.; Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis . More recently, M . tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients . We describe 13 adult HIV-infected patients in whom hematogenous M . tuberculosis dissemination was evident . Although for most patients whose bone marrow aspirate cultures yielded M . tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M . tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates . Most patients with M . tuberculosis bacteremia had other risk factors for M . tuberculosis, and many had a rapid death, suggesting acute fulminant infection . Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M . tuberculosis.

Rev Infect Dis, 1991 Nov-Dec, 13(6), 1048 - 52
Infections due to Stomatococcus mucilaginosus: 10 cases and review; Ascher DP et al.; We describe 10 new cases of bacteremia due to Stomatococcus mucilaginosus and review eight other cases that have been described in the literature . The most common clinical presentations were endocarditis, catheter-related infection, and septicemia . Commonly associated risk factors were intravenous drug abuse, cardiac valve disease, the presence of foreign bodies (especially indwelling vascular catheters), and immunocompromised states . S . mucilaginosus bacteremia is readily treatable with antibiotics . This organism is of low virulence, but appears to be an emerging pathogen . Infection due to S . mucilaginosus is likely to be underreported because the organism may be easily misidentified and information on it is not included in the databases of many automated microbiologic identification systems.

J Clin Microbiol, 1991 Nov, 29(11), 2675 - 7
Enteroinvasive Escherichia coli: a cause of bacteremia in patients with AIDS; Bessesen MT et al.; A strain of enteroinvasive Escherichia coli was isolated from the blood of a patient with advanced human immunodeficiency virus disease on repeated occasions, associated with severe diarrheal illness . The isolate was killed in vitro by control sera but not by sera collected from the patient before or after his bacterial illnesses.

J Am Vet Med Assoc, 1991 Nov 1, 199(9), 1170 - 3
Escherichia coli bacteremia associated with hypertrophic osteodystrophy in a dog; Schulz KS et al.; Escherichia coli bacteremia was detected in a dog that had hypertrophic osteodystrophy . The dog improved after treatment with cephalothin sodium, iv fluid therapy, and cage rest . The cause of hypertrophic dystrophy has not been determined, although an infectious cause has been suggested . Dogs that are suspected of having hypertrophic osteodystrophy should be monitored closely for evidence of septicemia, and the administration of prophylactic antibiotics may be advisable.

Schweiz Rundsch Med Prax, 1991 Sep 24, 80(39), 1030 - 3
{Septic syndrome with a pulmonary focus}; Bielecki JW; After acute pharyngitis a 21 year old patient developed signs of severe bacteremia with a well demarcated infiltrate in the left lung . The typical course and a prompt response to antibiotic therapy with Imipenem (Tienam) led to the diagnosis of Lemierre's syndrome (post-anginal sepsis)--in spite of negative blood cultures . The patient recovered quickly, a chest radiogram after two weeks showing but pleural scarring and restitution ad integrum after four weeks.

Am J Med, 1991 Sep 16, 91(3B), 95S - 100S
Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters; Graham DR et al.; Rates of bacteremia among hospitalized patients with central venous catheters range up to 21% . Few data exist for home intravenous therapy (IVT) . We studied 300 patients from two hospital-based home IVT services in 29 months . Diagnoses included 92 cases of osteomyelitis, 33 of pneumonia, 35 of malnutrition, 26 of chronic pain, and 114 of other diseases . Peripheral IVT was given to 97 patients . Mean age was 39.4 years (range, 0.3-98) . Hickman, Infuse-A-Port, Broviac, Arrow triple lumen, Hohn, and peripherally inserted central catheters (PICC) were used for a mean of 44 days . Six bacteremias (one death) (2%, 4.6/10,000 catheter days), two subclavian thromboses, 13 catheter site infections, and one additional death occurred . PICC experience included 76 patients, mean age 46 years (range, 4-76), primarily with infections, chronic pain, or dehydration . Mean duration of therapy was 24 days (0-67) and was completed in 51 patients; others completed therapy with standard peripheral catheters a mean of 6 days later . Complications included 17 obstructions by clot, 11 cases of phlebitis, six catheter fractures, five punctures, two accidental removals, and one infiltration . Liquid silicone repaired holes; urokinase opened clots . Successful completion of therapy was more common in the second year, 88% versus 57% . Despite more complications, patients, home IVT nurses, and physicians preferred PICCs . We conclude that home IVT is safe via many means of access, with fewer infections than with hospital care . Such infections may be termed "nosohusial."

Cancer, 1991 Sep 15, 68(6), 1230 - 7
A phase II trial of high-dose cisplatin and dacarbazine . Lack of efficacy of high-dose, cisplatin-based therapy for metastatic melanoma; Steffens TA et al.; Cisplatin and dacarbazine are used widely in the treatment of metastatic melanoma . To evaluate high-dose cisplatin and dacarbazine, 32 patients with metastatic melanoma were treated with cisplatin 50 mg/m2 and dacarbazine 350 mg/m2 daily for three days repeated at 28-day intervals . Their median age was 43.5 years (range, 25 to 73 years), and their median Karnofsky performance status was 80% (range, 70% to 100%) . Measurable and evaluable disease sites (number of patients) included lymph nodes (22), lung (17), soft tissue (16), liver (13), bone (seven), spleen (four), adrenal gland (three), skin (three), and other sites (five) . Patients received a median of two cycles of therapy (range, one to eight cycles) . Thirty patients were evaluable for response . No complete responses were observed . Five patients had a partial response (17%; 95% confidence interval, 3% to 30%) for 16+, 12+, 7, 6.5, and 3 months . Responding sites of disease included lymph nodes (five of 22), lung (three of 17), and soft tissue (two of 16) . Hematologic toxicity (Grade greater than or equal to 3) included neutropenia (16 of 32 patients, 30 of 90 cycles), thrombocytopenia (eight of 32 patients, 12 of 90 cycles), and anemia (five patients) . Nine episodes of neutropenia and fever were seen in four patients; two had bacteremia . Nonhematologic toxicity (Grade greater than or equal to 3) included hypotension (two patients), nausea and vomiting (four), neuropathy (two), ototoxicity (four), and hypomagnesemia (nine) . The low objective response rate and severe toxicity of this regimen preclude its standard use in patients with metastatic melanoma . A review of cisplatin-based therapy in metastatic melanoma suggests that there is no dose-response relationship . The use of high-dose cisplatin (greater than 100 mg/m2) in the treatment of metastatic melanoma is not recommended.

Hosp Pract (Off Ed), 1991 Sep, 26 Suppl 5, 43 - 7; discussion 62-3
Ceftriaxone in treatment of serious infections . Septicemia; Foster MT Jr; Ceftriaxone is generally recognized as safe and effective when used as a single drug in the therapy of septicemia and other serious infections involving bacteremia in both adults and children . An advantage of ceftriaxone over other third-generation cephalosporins is its long serum half-life, which allows the drug to be given every 12 hours in children or less frequently in adults.

Rev Infect Dis, 1991 Sep-Oct, 13(5), 803 - 14
Mediastinitis complicating cardiac operations: evidence of postoperative causation; Ehrenkranz NJ et al.; An excess rate of mediastinitis complicating cardiac operations occurred in one of two hospitals served by the same surgeons . The rates were 4% at hospital A and 0.48% at hospital B for the same period (P = .002) . At hospital A five patients who underwent a thoracic reoperation experienced postoperative pneumonia or bacteremia prior to onset of mediastinitis; these infections were caused by the same bacterial species . This circumstance provided a unique opportunity for comparing infection control practices, in which one hospital served as a control for interventional changes . At hospital A regular and temporary critical care nursing personnel, who took care of both infected and uninfected patients, did not antisepticize their hands before manipulation of percutaneous catheters . After cohorts of nurses were formed and antisepsis of the hands with alcohol was strictly enforced (no diminution in the number of temporary personnel was instituted), the frequency of mediastinitis decreased significantly among patients who underwent reoperations at hospital A (P = .002), but no concurrent change was noted at hospital B . Preventable postoperative remote-site infection may lead to mediastinitis.

Infect Dis Clin North Am, 1991 Sep, 5(3), 523 - 38
Moraxella (Branhamella) catarrhalis; Verghese A et al.; Moraxella (Branhamella) catarrhalis is now a well-recognized pathogen in lower respiratory tract infections, particularly in the setting of chronic lung disease . The ability to produce beta-lactamase, which now characterizes most clinical strains, appears to be a recently acquired trait . The most common clinical syndrome caused by this organism is exacerbation of chronic bronchitis; this syndrome has been well described in Europe, Japan, and the United States, particularly from centers with a large elderly population with chronic lung disease . The syndrome of pneumonia is less common, and suppurative complications and bacteremia are rare.

J Natl Med Assoc, 1991 Sep, 83(9), 819 - 22
Spleen function in children with sickle B+ thalassemia; Barrios NJ et al.; Splenic function in patients with sickle B+ (SB+) thalassemia has been poorly documented . We evaluated the clinical course and splenic function in 12 children with SB+ thalassemia with simultaneous technetium sulfur colloid spleen scans and determination of pitted erythrocytes by direct interference contrast microscopy (DICM) . All patients displayed normal uptake of radiocolloid . Mean percentage of pitted erythrocytes was 2.2% compared to 0.06% in 10 normal eusplenic controls and 13.8% in 10 sickle cell patients . In this group of children, who were carefully monitored for 136 patient years, there was no episode of bacteremia/sepsis, and a low prevalence of vaso-occlusive episodes . The slight increase in percentage of pitted erythrocytes of SB+ thalassemia patients does not seem to herald any clinically relevant loss of splenic function . SB+ thalassemia children younger than 10 years of age who do not seem to present a higher risk of invasive bacterial infections than eusplenic children, should receive conservative treatment for isolated febrile episodes and should not be submitted to prophylactic penicillin.

Arch Surg, 1991 Sep, 126(9), 1087 - 93
Intravascular plastic catheters . How they potentiate tumor necrosis factor release and exacerbate complications associated with sepsis; Martin LF et al.; We tested the hypothesis that long-term intravascular cannulation exacerbates the harmful effects of an infectious challenge . Four groups of rats were initially studied: rats without intravascular catheters or infection (group 1), rats without catheters with a polymicrobial infection (group 2), rats with catheters but no infection (group 3), and rats with catheters and infection (group 4) . Infected animals had an increased mortality and generated a significantly increased tumor necrosis factor response compared with noninfected animals . Animals with catheters and infection generated far less cardiac output than animals from the other three groups . No histologic changes differentiated the four groups . Therefore, the presence of a sterile intravascular catheter significantly increases cardiac dysfunction and mortality rates in rats with chronic bacteremia . These results suggest that intravascular plastic catheters potentiate the destructive cascade of events produced by the host in response to bacteremia.

Am Fam Physician, 1991 Sep, 44(3), 878 - 88
Serious soft tissue infections of the head and neck; Herr RD et al.; The head and neck contain a number of spaces that can be invaded by organisms of the mouth or by spread of cervical osteomyelitis . Infection in these spaces may progress from superficial infection to cellulitis to the formation of an abscess requiring immediate drainage . Spread of infection between spaces depends on anatomic location . Most patients require hospitalization and intravenous antibiotic therapy . Because a deep space infection may be occult, a high index of suspicion is required for diagnosis . Early recognition is necessary to avoid tissue damage, bacteremia or airway compromise . The possibility of deep space infection should be considered in any patient who does not respond to the usual treatment of an abscessed tooth or tonsillitis . This type of infection also should be considered in a toxic patient who has a fever of unknown origin, with or without blood cultures that show anaerobic organisms . Computed tomography or magnetic resonance imaging is usually necessary to locate the infection and to detect suppuration that will be amenable to surgical exploration and drainage.

Rev Infect Dis, 1991 Sep-Oct, 13 Suppl 10, S821 - 41
Prophylactic antibiotics in gynecologic and obstetric surgery; Hemsell DL; Preventing infections at operative sites has long been a goal of gynecologic and obstetric surgeons . These infections constitute the leading cause of morbidity after both elective and emergent surgical procedures . Serious sequelae such as bacteremia, septic shock, phlegmon, pelvic abscess, septic pelvic thrombophlebitis, wound abscess, and fascial dehiscence may complicate primary infections, with devastating results . Early attempts to prevent postoperative infections concentrated on aseptic techniques and the modification of surgical skills . Soon after the introduction of antibiotics into clinical medicine, surgeons began to administer these drugs to clinically uninfected women to prevent operative-site infection; that practice has been documented and assessed in a large volume of literature . This article reviews the chronologic development of prospective data in the areas of benign gynecology, obstetrics, gynecologic oncology, and infertility and makes recommendations regarding antibiotic prophylaxis of infections associated with surgical procedures.

J Infect Dis, 1991 Aug, 164(2), 383 - 8
Plasma neutrophil-activating peptide-1/interleukin-8 and neutrophil elastase in a primate bacteremia model; Redl H et al.; A hyperdynamic sepsis model was set up in seven adult baboons to evaluate neutrophil-activating peptide-1/interleukin (IL)-8 (NAP-1/IL-8), IL-1 beta, IL-6, tumor necrosis factor-alpha (TNF alpha), and IFN-gamma in plasma . By continuous intravenous administration of 10(10) cfu/kg live Escherichia coli over 8 h with additional infusion therapy (less than or equal to 50 ml/kg/h), endotoxin plasma levels of 2.7-22.3 ng/ml were observed . In plasma the kinetics of NAP-1/IL-8 and IL-6 were similar to those of IL-1 at the end of the experiment (8 h) (peak median values, 34, 4197, and 230 ng/ml, respectively) . Differences were greatest for IL-6 . Monocyte activation during sepsis was confirmed by elevated plasma neopterin levels (91-139 mumol/mmol of creatine) . Granulocyte activation was evident from both incipient neutropenia and the massive release of neutrophil elastase into the plasma as measured by a new immunoassay (peak level, 374 ng/ml) . Thus, in primate bacteremia, early TNF release is followed by a concomitant increase of NAP-1/IL-8 with plasma kinetics similar to those of IL-6 and IL-1 and accompanied by massive activation of neutrophils.

Pediatr Emerg Care, 1991 Aug, 7(4), 215 - 8
Extreme leukocytosis in patients presenting to a pediatric emergency department; Mazur LJ et al.; We determined the frequency and clinical significance of white blood cell (WBC) counts greater than or equal to 25,000/microliters in children presenting to an emergency department (ED) and defined a degree of leukocytosis which might be considered extreme in this setting . Records of all patients seen in the ED between February 1985 and December 1986 with WBC counts greater than or equal to 25,000/microliters were identified . Each patient was paired with the chronologically nearest patient with a WBC count between 15,000 and 25,000/microliters . Of the total WBCs obtained, 5.8% were greater than or equal to 25,000/microliters; only 1% were greater than or equal to 35,000/microliters . Eighteen percent of patients with counts greater than or equal to 25,000/microliters had a serious disease, and 6% had bacteremia . Twenty-six percent of patients with counts greater than or equal to 35,000/microliters had a serious disease, and 10% had bacteremia . On the basis of infrequency and severity of illness, we suggest that, in children presenting to a pediatric emergency department, WBC counts greater than or equal to 35,000/microliters be considered extreme leukocytosis.

Exp Lung Res, 1991 Jul-Aug, 17(4), 803 - 19
Rabbit alveolar macrophages stimulated with endotoxin and lung fragments from endotoxemic rabbits produce a leukocyte infiltration-inducing factor that lacks IL-1, TNF alpha, or chemotactic activity; Issekutz AC et al.; We reported previously that rabbit pleural and peritoneal macrophages (Mos) and human Mo stimulated with endotoxin (LPS) release a protein factor of 45 to 60 kd that induces local polymorphonuclear leukocyte (PMNL) infiltration upon intradermal injection in rabbits . In the case of the human Mo product, it was shown to be distinct from interleukin-1 (IL-1), tumor necrosis factors (TNF alpha), granulocyte macrophage colony stimulating factor (GMCSF), IL-6, and lower molecular weight PMNL chemotactic factors . Here, we examined resident rabbit alveolar Mos to determine if they produce a similar factor following in vitro or in vivo exposure to LPS . Following LPS exposure (0.3 to 30 ng/ml), alveolar Mos obtained from normal rabbits by bronchoalveolar lavage released PMNL recruiting activity within 3 h, as measured by the accumulation of 51Cr labeled blood PMNL at injected skin sites . Production of this activity was blocked by cycloheximide; it was heat labile and not affected by polymyxin B, which neutralized the LPS . On gel filtration chromatography, a major peak of activity was eluted at 45 to 60 kd and was free of IL-1 but partially overlapped with rabbit TNF alpha . Although active in vivo in PMNL recruitment into the tissues, these fractions did not induce PMNL migration in vitro in a filter chemotaxis assay . After sodium dodecyl sulfate (SDS), polyacrylamide gel electrophoresis (PAGE) the predominant PMNL recruiting factor (PRF) eluted from gel slices corresponded to 22 to 32 kd, suggesting that this protein is a dimer under gel filtration conditions . These gel eluates did not contain TNF alpha activity . Following iv administration of sublethal doses of LPS (3 micrograms/kg) or of antibiotic killed Escherichi coli (10(9)/kg), peripheral lung fragments from perfused lungs spontaneously produced this PRF during ex vivo culture without further LPS stimulation . Lung tissue from normal rabbits did not release PRF spontaneously . We conclude that resident alveolar Mos produce a PRF protein in response to LPS that is distinct from IL-1, TNF alpha, and chemotactic factors and that the production of a similar protein by lung cells (probably Mos) is probably induced in vivo during endotoxemia or bacteremia . This factor may contribute to PMNL accumulation in the lung during pathologic processes.

World J Surg, 1991 Jul-Aug, 15(4), 516 - 20; discussion 520-1
Open approach in pancreatic and infected pancreatic necrosis: laparostomies and preplanned revisions; Fugger R et al.; One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations . The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission) . Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis . Overall, 36 (35%) patients died, most of multiple organ failure . Survival was significantly impaired by bacterial contamination of pancreatic necrosis (p = 0.008), bacteremia (p = 0.0001) and infected bronchial secretions (p = 0.05) . The mortality rate was reduced from 53% to 28% by changing the regimen of re-explorations from on demand to regular 48 hour intervals . Despite the fact that open packing was associated with a high frequency of gastrointestinal fistulas (30%), this concept seems to be a successful and recommendable approach in the therapy of pancreatic and infected pancreatic necrosis.

Curr Probl Diagn Radiol, 1991 Jul-Aug, 20(4), 123 - 51
Recognition and prevention of barium enema complications; Williams SM et al.; The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result . Many of these can be prevented by proper equipment and careful attention to technique . When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality . Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients . Rarely the colon may burst due to excessive transmural pressure alone . However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel . Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation . Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous . Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture . The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia . Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion . The ensuing shock may be rapidly fatal . Prompt fluid replacement and laparotomy are essential . If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop . Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula . Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm . The most dramatic complication of barium enema is venous intravasation of barium . Fortunately, this is quite rare as it may be immediately lethal . Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina . Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia . Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias . Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation . Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Med Decis Making, 1991 Jul-Sep, 11(3), 159 - 68
Availability, wishful thinking, and physicians' diagnostic judgments for patients with suspected bacteremia; Poses RM et al.; A prospective cohort study was done to assess the effects of value bias and the inappropriate use of the availability heuristic on physicians' judgments of the probability of bacteremia . Subjects of the study were 227 medical inpatients in a university hospital who had blood cultures done . Estimates of the probabilities that individual patients would have positive blood cultures were collected from the house officers who ordered the cultures . Clinical data and culture results were also obtained . Based on the data the authors calculated "value variables," reflecting doctors' assessments of the risks that individual patients would die in the hospital if they were to have bacteremia . "Recalled experience variables" reflected the doctors' recollections of recent experiences with patients with bacteremia . The physicians significantly overestimated the likelihood of bacteremia for most of their patients . Their ROC curve for this diagnosis showed moderate discriminating ability (area = 0.687, SE = 0.073) . Two recalled experience variables were significantly associated with the physicians' probability estimates . The value variables were significantly inversely associated with them . These relationships were independent of several clinical variables and measures of disease severity . The physicians' intuitive diagnostic judgments were thus influenced by the availability heuristic and by wishful thinking, a form of the value bias . The availability heuristic may mislead physicians by causing them to believe that random variations in the prevalence of a nonepidemic disease represent real trends . Wishful thinking may lead physicians to underestimate the likelihood of a disease for patients most at risk for its consequences . Teaching physicians to develop better judgmental strategies may improve the quality of their judgments and hence their patient care.

Pediatr Infect Dis J, 1991 Jul, 10(7), 506 - 10
Lack of association between neutropenia and the incidence of bacteremia associated with indwelling central venous catheters in febrile pediatric cancer patients; Gorelick MH et al.; To assess the incidence of bacteremia in pediatric cancer patients with indwelling central venous catheters with fever, we reviewed the records of all 67 such patients sequentially admitted during a 10-month period at our institution . There were a total of 140 episodes of fever in these 67 patients . In 55 of the episodes (39%) patients were nonneutropenic (absolute neutrophil count, greater than 500/mm3); 85 episodes (61%) were associated with neutropenia . Twenty-four percent of all episodes of fever in nonneutropenic patients were related to bacteremia vs . 9.5% of episodes of fever in the presence of neutropenia (P less than 0.05) . When clinical evidence of an exit site infection was absent, the incidence of bacteremia in the neutropenic and nonneutropenic groups was similar (11% in the neutropenic group; 10% in the nonneutropenic group) . We conclude that bacteremia is frequently observed in febrile pediatric cancer patients with indwelling venous catheters who are not neutropenic, particularly if there is clinical evidence of an exit site infection . Thus empiric antibiotic therapy is warranted in all pediatric oncology patients with indwelling catheters who develop fever.

Rev Med Chil, 1991 Jul, 119(7), 825 - 8
{Septicemia?, Bacteremia?, Sepsis?, Septicopyemia?: the importance of conceptual unity and language in teaching}; Kraljevic R; Elaborating on the use of the terms sepsis, septicemia, bacteremia and septicopyemia, the author stresses the importance of precise concepts and correct terminology to describe clinico-pathological entities with different pathogenesis . The significance of this attitude for medical teaching is discussed.

Bone Marrow Transplant, 1991 Jul, 8(1), 27 - 33
Some but not all benefits of intravenous immunoglobulin therapy after marrow transplantation appear to correlate with IgG trough levels; Cottler-Fox M et al.; Multiple benefits of intravenous immunoglobulin (IVIG) therapy after marrow transplantation have been reported, including decreased incidence of acute graft-versus-host disease (GVHD), infection, sepsis, cytomegalovirus (CMV) pneumonitis and platelet use . To test the hypothesis that the observed beneficial effects of IVIG are related to the serum IgG levels achieved, we followed IgG levels (pre-infusion, 1 h and 24 h post-infusion) in 45 consecutive marrow transplant recipients . IVIG 500 mg/kg was given weekly for six doses starting day -8 pre-transplant, then every other week for a total of 11 doses . Forty-one patients (22 allogeneic, 17 autologous, two syngeneic) were evaluable . Patients with acute GVHD had significantly lower serum IgG trough levels (less than 1200 mg/dl) noted at day +20 post-transplant and afterwards than patients without GVHD (greater than or equal to 1200 mg/dl) . Pharmacokinetic modeling of the data indicates that IgG half-life between day -8 and day +6 may predict which recipients are at increased risk of acute GVHD . Allogeneic recipients in the group with trough levels less than 1200 mg/dl required more platelet transfusions . Although there was no significant difference in fungal infection rates or bacteremia, sepsis was noted in only two recipients (one allogeneic, one autologous), both with serum IgG trough levels less than 1200 mg/dl . In addition, three allogeneic recipients had cytomegalovirus pneumonitis, all in the group with lower IgG trough levels . Thus, while serum IgG trough levels less than 1200 mg/dl appear to be strongly associated with acute GVHD, low levels may also be associated with increased platelet utilization, with cytomegalovirus pneumonitis, and sepsis, but not with the overall incidence of infection.

Infect Control Hosp Epidemiol, 1991 Jun, 12(6), 356 - 63
Nosocomial pneumonia in a Canadian tertiary care center: a prospective surveillance study; Louie M et al.; OBJECTIVE: To determine the contribution of etiologic agents, including Legionella pneumophila and respiratory viruses to nosocomial pneumonia at a tertiary care center . DESIGN: Prospective surveillance of nosocomial pneumonia with standardized laboratory investigations . SETTING: A 1,100-bed tertiary care center . PATIENTS: All adult inpatients . RESULTS: One hundred and thirty-five Nosocomial pneumonias (5.7/1,000 discharges) were identified . Four (3.0%) were L pneumophila serogroup 1 infections (0.17/1,000 discharges) . Legionellosis occurred in non-high-risk patients, and three cases would not have been identified without active surveillance . Viral seroconversion was identified in seven (19%) of 36 cases with specimens available (0.59/1,000 discharges): five influenza B, one influenza A, and one respiratory syncytial virus . IgM serology was positive in one case each for Mycoplasma pneumoniae and Chlamydia species . No geographical clustering was observed for viral infections, and these would not have been identified without active surveillance . Mortality for all nosocomial pneumonia was 25% . Patient factors significantly associated with a poorer outcome included older age, underlying disease, low serum albumin, renal insufficiency, lower platelet count, endotracheal intubation, respiratory failure, bacteremia, and use of antacids . CONCLUSIONS: This prospective surveillance suggested that L pneumophila and viral agents were uncommon causes of nosocomial pneumonia at our institution during this surveillance period.

Am Surg, 1991 Jun, 57(6), 370 - 2
Safety of triple lumen catheters in the critically ill; Manglano R et al.; The authors performed this prospective study to determine the infection rate of triple lumen catheters (TLC) in their surgical intensive care unit (SICU) patient population . Patients who required a central venous line for the first time while in their SICU were studied . Those with preexisting catheter infections, bacteremias, and TLC reinsertions were excluded . TLC was placed through the internal jugular or the subclavian vein and all peripheral lines were removed . The distal port was used for parenteral nutrition and the other two ports were used for fluids and medications . Dressings were changed daily and blood cultures were obtained through each port of the TLC . At the time of catheter removal, blood, catheter tip, and the subcutaneous tract were cultured . Duration of catheterization was recorded . Eighty-six catheters were studied . The mean duration of catheterization was 6.2 days and the range was two to 23 days . Six of 86 (6.9%) catheter tip cultures were positive and the remaining 80 (93.1%) were negative . Two positive tips (2.3%) had negative blood cultures for two catheter infections (CIs) . The remaining four catheters (4.6%) had associated bacteremias for four catheter sepsis (CS) . The two catheter infections occurred among catheters indwelling for 10 days or less while the four cases of catheter sepsis occurred among catheters indwelling longer than 10 days . In conclusion, triple lumen catheters can be safely left in place for up to 10 days with minimal risk for bacteremia.

Arch Surg, 1991 Jun, 126(6), 773 - 7
Effect of bile on growth, peritoneal absorption, and blood clearance of Escherichia coli in E coli peritonitis; Andersson R et al.; The effect of intraperitoneal bile on growth, peritoneal absorption, and clearance of Escherichia coli was determined in E coli peritonitis in the rat . In E coli peritonitis, intraperitoneal bacterial counts gradually decreased, whereas they increased (after 2 hours) with subsequent development of bacteremia in E coli plus bile peritonitis . After an intraperitoneal injection of labeled bacteria, blood radioactivity was only initially lower in E coli plus bile peritonitis compared with E coli peritonitis . Clearance from blood was lower in E coli plus bile peritonitis than in E coli peritonitis . Organ localization was similar in E coli peritonitis and E coli plus bile peritonitis with decreased splenic, increased pulmonary, and unchanged hepatic uptakes compared with controls . Impaired peritoneal absorption of bacteria, together with impaired local host defense, is likely to enhance the noxious effect of bile in E coli peritonitis.

J Infect Dis, 1991 Jun, 163(6), 1286 - 92
Ethanol augments intracellular survival of Mycobacterium avium complex and impairs macrophage responses to cytokines; Bermudez LE et al.; Chronic ethanol ingestion predisposes to tuberculosis and bacterial pneumonia . Mycobacterium avium complex (MAC) organisms cause bacteremia in patients with AIDS . Cultured human monocyte-derived macrophages and murine Kupffer cells were exposed to 10-100 micrograms/dl ethanol; significantly greater intracellular growth of MAC strains 100 (serovar 8) and 101 (serovar 1) occurred in ethanol-treated cells than in controls (range, 58% +/- 7%-70% +/- 5%; P less than .05 for 50 and 100 micrograms/dl ethanol vs . control) . Both cell types, when treated with 10(3) units/ml recombinant tumor necrosis factor (TNF) or 10(2) units/ml granulocyte-macrophage colony-stimulating factor (GM-CSF) in the presence of 10-100 micrograms/dl ethanol, killed significantly fewer MAC than controls (49% +/- 12% decrease for GM-CSF and 57% +/- 16% for TNF; P less than .05 for all comparisons) . C57BL black mice infected intravenously with MAC strain 101 were given ethanol as 4% of total calories daily; after 21 days they had greater numbers of MAC in blood, liver, and spleen than controls . Ethanol's effects on the interaction between the host and MAC favor progressive infection.

J Pediatr Surg, 1991 Jun, 26(6), 710 - 3
Failure of duplex sonography to diagnose hepatic artery thrombosis in a high-risk group of pediatric liver transplant recipients; McDiarmid SV et al.; Excellent correlation between angiographic findings and duplex sonography has been previously reported in the diagnosis of hepatic artery thrombosis (HAT), the most common technical complication of pediatric orthotopic liver transplantation (OLT) . We now report a significant incidence of false-negative sonograms, ie, hepatic artery reported as patent but thrombosed on subsequent angiography . HAT was diagnosed in 10 of 57 pediatric OLT recipients evaluated prospectively by duplex sonography . In 5 patients HAT was diagnosed only by angiography even though arterial wave forms were observed on duplex sonography . Selective angiography demonstrated extensive collateral vessel formation arising from the superior mesenteric artery, the celiac axis, or both . The 5 patients shared very similar clinical courses marked by relapsing bacteremias with multiple enteric organisms, associated with focal infarctions of the liver . Four of the grafts had difficult arterial reconstructions and 3 of 5 had segmental bile duct dilation . We conclude that duplex sonography has proven to be a valuable screening tool in evaluating hepatic artery patency but must be correlated with angiography studies in a high-risk group of pediatric transplant patients characterized clinically by relapsing bacteremia and radiographically by false-negative duplex examinations.

Ann Intern Med, 1991 May 15, 114(10), 845 - 54
Risk factors for infusion-related phlebitis with small peripheral venous catheters . A randomized controlled trial; Maki DG et al.; OBJECTIVE: To identify risk factors for infusion-related phlebitis with peripheral intravenous catheters . DESIGN: A randomized trial of two catheter materials, with consideration of 21 potential risk factors . SETTING: A university hospital . PATIENTS: Hospitalized adults without granulocytopenia who received a peripheral intravenous catheter . INTERVENTIONS: House officers or ward nurses inserted the catheters, and each insertion was randomized to a catheter made of tetrafluoroethylene-hexafluoropropylene (FEP-Teflon) or a novel polyetherurethane without leachable additives (PEU-Vialon) . MEASUREMENTS: Research nurses scored insertion sites each day for inflammation and cultured catheters at removal . RESULTS: The Kaplan-Meier risk for phlebitis exceeded 50% by day 4 after catheterization . intravenous antibiotics (relative risk, 2.00), female sex (relative risk, 1.88), prolonged (greater than 48 hours) catheterization (relative risk, 1.79), and catheter material (PEU-Vialon: FEP-Teflon) (relative risk, 0.73) strongly predicted phlebitis in a Cox proportional hazards model (each, P less than 0.003) . The best-fit model for severe phlebitis identified the same predictors plus catheter-related infection (relative risk, 6.19), phlebitis with a previous catheter (relative risk, 1.54), and anatomic site (hand: forearm, relative risk, 0.71; wrist:forearm, relative risk, 0.60) . The low incidence of local catheter-related infection was comparable with the two catheter materials (5.4% {95% CI, 3.8% to 7.6%} and 6.9% {CI, 4.9% to 9.6%}); none of the 1054 catheters prospectively studied caused bacteremia . CONCLUSIONS: Multiple factors, including the infusate and the duration of cannulation, contribute to the development of infusion-related phlebitis . The use of peripheral intravenous catheters made of PEU-Vialon appears to pose the same risk for catheter-related infection as the use of catheters made of FEP-Teflon, and PEU-Vialon can permit longer cannulation with less risk for phlebitis . The risk for catheter-related bacteremia with FEP-Teflon and PEU-Vialon catheters is sufficiently low that it no longer seems justifiable to recommend the use of small steel needles for most peripheral intravenous therapy.

Kokyu To Junkan, 1991 May, 39(5), 497 - 500
{Pacemaker infection with superior vena cava thrombotic obstruction, followed by bacteremia: a case report}; Tange S et al.; Infection is one of the complications brought about sometimes by pacemaker implantation . This is a case report, showing superior vena cave obstruction after pacemaker implantation, followed by bacteremia after 5 years . Gallium-67 scintigraphy was the most effective method to survey the source of the infection . We performed the operation and found vegetation (1 cm x 1 cm) attaching to the pacemaker lead and an organized thrombosis in the superior vena cava . The lead and the vegetation were removed . The administration of antibiotics after the operation led to the patient's complete recovery . Post operative gallium-67 scintigraphy didn't reveal any sign of infection at the mediastinum.

Pediatr Infect Dis J, 1991 May, 10(5), 365 - 9
Multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life; Wiswell TE et al.; We present the first investigation that examines the usefulness of multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life . Two sets of blood cultures (1 aerobic and 1 anaerobic bottle/set; BACTEC, NR 6A/7A) from different sites were obtained from 460 inborn infants who were evaluated for possible sepsis . From 0.5 to 1 ml of blood was inoculated into each blood culture bottle . In 18 infants the use of multiple site blood cultures yielded important information . In 8 of these neonates bacteremia was confirmed whereas in 10 cases contamination from skin flora was documented . We could identify no instances in which the delay in antibiotic therapy while the second set of blood cultures was obtained contributed to an adverse outcome . We conclude that multiple site blood cultures are useful in the initial evaluation for suspected sepsis during the first week of life.

South Med J, 1991 May, 84(5), 594 - 6
Polymicrobial bacteremia during long-term hemodialysis; Mulloy LL et al.; A review of hospital epidemiologic data disclosed five cases of polymicrobial bacteremia on a nephrology inpatient service over a period of 30 months . All five cases occurred in patients receiving long-term hemodialysis; four of them had indwelling silicone rubber vascular access devices . Although all patients had risk factors other than uremia and dialysis predisposing to an increased likelihood of infection, no patient had either obvious skin infection at the site of the vascular access or documented visceral infection . One patient died, and the other four recovered after removal of the vascular access device and appropriate antibiotic therapy . The increased risk of polymicrobial bacteremia associated with long-term hemodialysis should be taken into account when empiric antibiotic therapy is undertaken.

Am J Orthod Dentofacial Orthop, 1991 May, 99(5), 466 - 72
Toothbrushing and transient bacteremia in patients undergoing orthodontic treatment; Schlein RA et al.; This study was made to determine whether and to what extent bacteremia occurred after toothbrushing in patients undergoing orthodontic treatment with fixed appliances . Twenty patients were selected, all with negative history of heart or hematologic disorders . These patients had not taken antibiotics or had a history of a cold in the previous 30 days . Blood samples of 20 ml were drawn before and 5 minutes after brushing . The immune status of the patients was tested by measurement of isohemagglutins and immunoglobulin levels . Blood samples were incubated in paired culture bottles containing trypticase soy broth (TSB) with an agar paddle and Columbia broth . All samples taken before brushing were negative for bacteria . Five of the 20 patients (25% of the sample) had positive blood tests after brushing . Both anaerobic and aerobic bacteria were identified from the blood samples . Those patients who were found to have a bacteremia did not display poor oral hygiene.

Pediatrics, 1991 May, 87(5), 670 - 4
Temperature and total white blood cell count as indicators of bacteremia; Jaffe DM et al.; This study was designed to quantify more precisely the accuracy of magnitude of rectal temperature and total white blood cell (WBC) count as indicators of bacteremia in children with an obvious focal bacterial infection . A total of 955 children, aged 3 to 36 months, who had rectal temperature greater than or equal to 39.0 degrees C and were seeking care at either of two urban pediatric emergency departments had blood drawn for culture; 885 had blood drawn for WBC count . Twenty-seven had bacteremia . Various combinations of temperature and WBC count were selected to construct receiver-operating-characteristic curves by plotting sensitivity vs false-positive rate (1 - specificity) . The receiver-operating-characteristic curve of WBC count provided significantly better diagnostic information than the curve for temperature increments above 39.0 degrees C . Each increment of 0.5 degrees C led to large decrements in sensitivity and false-positive rates . At a WBC count cutoff of 10,000/mm3, the sensitivity was 92% while the false-positive rate was 57% . Using this cutoff point, the clinician could have avoided performing 368 of 955 blood cultures and missed only 2 of 26 children with bacteremia . Receiver-operating-characteristic curves combining WBC count and temperature increments above 39.0 degrees C provided no better diagnostic information than that of WBC count at a temperature cutoff of 39.0 degrees C . It is concluded that increments in temperature above 39.0 degrees C provided additional diagnostic specificity for bacteremia only at the expense of unacceptable decreases in sensitivity . Total WBC count provided better information . A WBC count cutoff of 10,000/mm3 increased specificity with minimal decrease in sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr, 1991 May, 118(5), 659 - 66
Breast-feeding and health in the 1980s: a global epidemiologic review; Cunningham AS et al.; PIP: In view of the significant and articulate minority view among pediatricians that breast feeding is not "worth the bother" in developed countries, this review of the literature delves into the evidence from both developed and developing countries for the advantages of breastfeeding, both in infants and for long-term health . Infants in developed settings experience twice the hospitalization rate and more severe illness from lower respiratory tract infection, primarily respiratory syncytial virus . In developing countries the mortality risk is 4-fold . for otitis media, the relative risks were 3.3-4.3 for Finnish infants . Bacterial meningitis and/or bacteremia had a 4-fold risk for hospitalization in a Connecticut study, and a 3-fold relative risk in 2 developing country studies . Human milk was the best preventative for bacteremia and necrotizing enterocolitis in prematures in British neonatal units . A 20-fold reduction in neonatal deaths occurred in Philippine study of breastfeeding, especially in low birth weight babies . Diarrhea causes the most infant mortality in developing nations, where bottle-feeding raises rates 14-fold . In the U.S . estimated relative risks is 3.7 for diarrheal mortality . Sudden infant death is about 1/5 less common in U.S . breast fed babies than in bottle fed . There is evidence for better long-term health after breast feeding in disorders such as celiac disease, Crohn disease, ulcerative colitis, insulin-dependent diabetes mellitus, thyroid disease, malignant lymphoma, chronic liver disease, atopic dermatitis, and food allergies . The design of good studies of protection conferred by breast feeding, and the possible modes of action of breast milk are discussed .

Rev Infect Dis, 1991 May-Jun, 13(3), 428 - 9
Bacteremia and septic arthritis caused by Moraxella catarrhalis; Melendez PR et al.; Moraxella catarrhalis was isolated from blood from a 41-year-old man who had a 24-hour history of increasing pain in and swelling of the left knee . No history of trauma, arthropathy, fever, chills, cough, or chest pain was noted . What is believed to be the first case of bacteremia caused by M . catarrhalis that was associated with septic arthritis is described in this report . The case presented suggests the pathophysiology of this rare condition . One previous case of septic arthritis caused by M . catarrhalis without documented bacteremia has been reported.

Rev Infect Dis, 1991 May-Jun, 13 Suppl 6, S535 - 41
Pneumococcal vaccine trials in Papua New Guinea: relationships between epidemiology of pneumococcal infection and efficacy of vaccine; Riley ID et al.; Field trials in Papua New Guinea have shown that pneumococcal capsular polysaccharide vaccine protects children less than 2 years of age from death due to acute lower respiratory infections (ALRI) . The vaccine appears to reduce mortality by preventing bacteremia . Evidence suggests that highly invasive "adult" pneumococcal serotypes are comparatively more important as a cause of ALRI in developing countries where ALRI-related mortality is higher than in North America . Capsular polysaccharide vaccines are more likely to be immunogenic for these serotypes than for the "pediatric" serotypes . The evaluation of pneumococcal vaccines in areas where mortality is high should have the highest priority . For such trials investigators should, at minimum, define epidemiologic circumstances in terms of (1) the invasive serotypes of pneumococci, (2) the protective levels of antibody, (3) the antibody response to vaccination, and (4) the general immune status of the population.

J Infect Dis, 1991 May, 163(5), 1001 - 7
Herpes simplex virus hepatitis after solid organ transplantation in adults; Kusne S et al.; Twelve patients developed herpes simplex (HSV) hepatitis a median of 18 days after solid organ transplantation . This is earlier than cytomegalovirus hepatitis, which usually occurs 30-40 days after transplantation . Eight recipients (67%) died, and in seven, the diagnosis was made at autopsy or less than 48 h before death . Clinical manifestations associated with mortality were hypotension, disseminated intravascular coagulation (DIC), metabolic acidosis, gastrointestinal bleeding, and bacteremia . Laboratory abnormalities at diagnosis associated with mortality were high creatinine, low platelet counts, prolonged partial thromboplastin time, and a high percentage of band forms on the blood smear . Disseminated HSV disease was noted in four of six patients who had an autopsy and included involvement of lungs in three and the gastrointestinal tract in three . Five recipients developed DIC and all died . Pathologically, HSV hepatitis has two forms, focal and diffuse . All three patients with diffuse liver pathology died . However, three of seven with focal liver pathology survived with antiviral therapy, which suggests that early diagnosis and treatment may be lifesaving . None of these patients had received prophylactic acyclovir . It is possible that acyclovir prophylaxis may be able to prevent this disease.

Vet Pathol, 1991 May, 28(3), 183 - 91
Ultrastructural studies of the lung of turkeys (Meleagris gallopavo) inoculated intratracheally with Escherichia coli; Ackermann MR et al.; To test the hypothesis that walls of air capillaries are a site for Escherichia coli to pass the air-blood barrier, fimbriated and nonfimbriated strains of E . coli were inoculated intratracheally into 18-day-old turkeys . Venous blood was cultured, and turkeys were necropsied from 0.5 to 8 hours post-inoculation . Lungs were processed for histopathology and electron microscopy . E . coli 078 was identified ultrastructurally using rabbit anti-lipopolysaccharide antibody and protein A-colloidal gold . All birds developed bacteremia; there was no significant difference between groups given fimbriated or nonfimbriated bacteria . Bacteria adhered to the plasma membrane of air capillary epithelial cells and were seen within vacuoles of portions of these cells that lined the fornices of air capillaries . Bacteria were also seen in the basement membrane at the basal surface of air capillary epithelial cells and, rarely, in vacuoles of subjacent endothelial cells . Infected granular and non-granular cells that lined air atria were necrotic 4 hours post-inoculation . Bacteria were within the overlying trilaminar substance and between reticular fibers of the interstitial stroma and pleura at 30 minutes post-infection and thereafter . Thus, the pulmonary air capillaries are a site for entrance of E . coli into the pulmonary blood capillaries, but fimbriae play little or no role in passage across the air-blood barrier.

N Engl J Med, 1991 Apr 11, 324(15), 1026 - 31
Detection of circulating candida enolase by immunoassay in patients with cancer and invasive candidiasis; Walsh TJ et al.; BACKGROUND . Invasive candidiasis is a major nosocomial infection that is difficult to diagnose . Few biochemically defined markers of invasive candidiasis are known . Initial findings suggested that the presence of candida enolase in the blood may be a novel marker for invasive candidiasis . METHODS . We tested 170 patients at high risk for invasive candidiasis for candida enolase antigenemia . All the patients had cancer and neutropenia . We detected antigen using a double-sandwich liposomal immunoassay for candida enolase in serially collected serum samples . Invasive candidiasis was proved by finding candida species in deep nonmucosal tissue, blood cultures, or both . Antigen testing was performed with the investigator blinded to tissue or culture diagnosis . RESULTS . Among 24 patients with proved invasive candidiasis, 149 serum samples were tested for enolase antigenemia; 80 were positive and 69 negative (sensitivity per sample, 54 percent) . Multiple sampling improved the detection of antigenemia, which was found in 11 of 13 proved cases of deep tissue infection (85 percent) and in 7 of 11 proved cases of fungemia (64 percent) . Specificity was 96 percent as measured against control groups including patients with mucosal colonization, bacteremia, and other deep mycoses . Antigenemia was detected in the absence of fungemia in 5 cases of deep tissue candidiasis, but was not detected in 6 cases of fungemia alone . CONCLUSIONS . Candida enolase antigenemia is a novel marker for invasive candidiasis . It may be a useful indicator of deep infection in patients with cancer and neutropenia and may complement the diagnostic usefulness of blood cultures.

Pediatr Infect Dis J, 1991 Apr, 10(4), 290 - 4
Sensitivity and specificity of daily tracheal aspirate cultures in predicting organisms causing bacteremia in ventilated neonates; Lau YL et al.; The sensitivity of daily tracheal aspirates in predicting neonatal bacteremia was ascertained from 48 of 354 ventilated neonates who became septic during a 4-year period . Fourteen babies (designated Group A) had a positive blood culture on the first day of life; 28 infants (Group B) and 6 infants (Group C) had bacteremia beyond the first day . Group C infants became septic as a result of intraabdominal pathology . Pathogens isolated from blood were correlated with those from preceding daily tracheal aspirates . The overall sensitivity of tracheal cultures in predicting results of blood cultures was 81% (Group A, 71%; Group B, 93%; Group C, 50%) . The specificity of daily tracheal aspirates was ascertained from 28 of 50 ventilated infants who were nonseptic and had negative blood cultures during a 6-month period . Only 18 had consistently sterile tracheal aspirates (specificity, 64%) . The mean number of days of intubation was 6.6 for the 10 false positive and 3.6 for the 18 true negative . Because of low positive predictive value (0.26) the role of daily tracheal aspirate culture is limited to providing early information regarding potential pathogens when sepsis occurs rather than to identify babies who are going to become septic.

Arch Surg, 1991 Apr, 126(4), 524 - 5
Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan; Kaiser CW et al.; For 4 days before surgical repair of a diverticulitic colovesical fistula and for 6 days after, a 63-year-old man was treated with 2 g of intravenous cefotetan disodium every 12 hours for associated urosepsis with bacteremia . Postoperatively, the patient followed a diet of intravenous nutrition only . Uneventful convalescence was interrupted by signs of sudden major blood loss, accompanied by prolonged prothrombin time . After stabilization with packed red blood cells, fresh plasma, crystalloids, and parenteral vitamin K, laparotomy revealed a huge intra-abdominal clot, which was evacuated . This case illustrates the risk of unexpected hypoprothrombinemia and hemorrhage in a cefotetan-treated surgical patient who demonstrated none of the usual comorbid conditions generally described in patients with antibiotic-induced hypoprothrombinemia . Like cefamandole nafate, cefoperazone sodium, moxalactam disodium, and other cephalosporins containing the methylthiotetrazole side chain, cefotetan appears to pose an unusual risk of major bleeding.

Zhonghua Wai Ke Za Zhi, 1991 Apr, 29(4), 217 - 9, 269
{The effect of bile duct pressure on cholangiovenous reflux . A clinical study}; Yoshimoto H; The measurement of the filling pressure of the bile duct during the process of endoscopic retrograde catheter cholangiography, and the determination of blood culture and blood iodine before and after cholangiography were carried out to probe into the effect of bile duct pressure on cholangiovenous reflux . In 32 cases, 2 had positive blood culture after cholangiography, with a bile duct pressure being 2.98 kPa and 3.72 kPa respectively . Nineteen cases with a pressure below 2.94 kPa showed negative blood culture . In 10 cases with a bile duct filling pressure below 2.16 kPa, no increase in blood iodine was noted whereas, blood iodine level was increased in 5 out of 9 cases (55.6%) with a bile duct filling pressure between 2.16-2.94 kPa, and in 9 out of 13 cases 69.2% with the pressure greater than 2.94 kPa . We believed that during direct cholangiography, the bile duct pressure should be lower than 2.94 kPa in order to prevent the complication of bacteremia . For patients hypersensitive to iodine, the bile duct pressure should be lower than 2.16 kPa.

Endoscopy, 1991 Mar, 23(2), 67 - 72
Bacteremia following operative endoscopy of the upper gastrointestinal tract; Sontheimer J et al.; The rate of bactaeremia following surgical endoscopy of the upper gastrointestinal tract is reported with up to 50% depending on the therapeutic measure performed . In a prospective study we examined 160 patients treated by surgical endoscopy of the upper digestive tract . The rate of bactaeremia showed a significant difference with 12.5% after diagnostic and 28.96% after surgical endoscopy . Our results recommend a single shot antibiotic prophylaxis depending on the endoscopic measure performed and the patient's individual risk.

Rev Infect Dis, 1991 Mar-Apr, 13(2), 233 - 6
Infections with Chryseomonas luteola (CDC group Ve-1) and Flavimonas oryzihabitans (CDC group Ve-2) in neurosurgical patients; Kostman JR et al.; During a 20-month period at Temple University Hospital, three cases of infection with bacteria of the Ve group--Chryseomonas luteola (CDC group Ve-1) and Flavimonas oryzihabitans (CDC group Ve-2)--were seen in neurosurgical patients . Two of the patients, including one with what is thought to be the first reported case of meningitis due to C . luteola, had complications caused by prosthetic material . A review of the literature revealed 14 well-described cases of infection with C . luteola or F . oryzihabitans, the majority of which were cases of bacteremia or peritonitis in patients undergoing dialysis . The presence of foreign material and the use of corticosteroids may predispose to and influence the course of disease . As prosthetic material becomes even more widely used, the incidence of infection with bacteria of the Ve group will likely increase and the manifestations of the infections will probably become more varied.

Changgeng Yi Xue Za Zhi, 1991 Mar, 14(1), 22 - 7
{The clinic diagnostic value of the rigid sigmoidoscopy}; You YT et al.; Rigid sigmoidoscopy is beneficial as it detects rectal or distal sigmoidal lesions very efficiently and precisely . But it also has some complications, e . g . rectal injury, rectal perforation or transient bacteremia . In this prospective study, 800 cases were collected and divided into two groups . In group I, 400 O.P.D . symptomatic cases were chosen randomly and in group II 400 cases registered for routine physical examination were picked up . The positive detection rate was 7% in group I versus 2% in group II . The lesions detected in group I are 15 cases of cancer, 7 cases of polyp, 4 cases of irradiation proctitis, 2 cases of ulcerative colitis and 1 case of pseudomembranous colitis . Only 8 polyps are found in group II . The routine sigmoidoscopy is mandatory for symptomatic patients but it is not cost-effective for routine check-ups . The stool occult blood is the best screening test for detecting colorectal lesions . For routine physical examination, stool occult blood test is safe and easy to perform . If the stool occult blood test is positive, then further examinations will be necessary.

Infect Control Hosp Epidemiol, 1991 Mar, 12(3), 150 - 6
Risk factors for nosocomial bacteremia in a large Spanish teaching hospital: a case-control study; Trilla A et al.; OBJECTIVE: Identify independent risk factors associated with the development of nosocomial bacteremia . DESIGN: Exploratory, unmatched, case-control study . SETTING: A 970-bed Spanish university hospital . PATIENTS: All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases . All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls . RESULTS: The incidence of bacteremia in the study population was 6.9/1000 admissions/year . One hundred eighty cases and 180 controls were analyzed . Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); "high-risk surgery" (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit . CONCLUSIONS: Although five variables are not modifiable, the remaining two relate to the use and duration of devices . Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization . If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.

Am J Med Sci, 1991 Mar, 301(3), 165 - 72
Empiric antibiotic selection by physicians: evaluation of reasoning strategies; Yu VL et al.; The objectives of the study were to evaluate the appropriateness of empiric antibiotic selection by housestaff treating medical patients with bacteremia . The design was a prospective, observational study at a university-affiliated hospital . Seventy-eight patients with bacteremia were evaluated . A clinical grade of acceptable or not acceptable was assigned to each antibiotic prescription by a consensus panel . The consensus panel found that 34.6% of antibiotic prescriptions were unacceptable (clinical grade) . At least one flaw in the chain of reasoning was found in 56.4% of the 78 cases evaluated . Assessment of the clinical setting was correct in 94.9% of the cases; the portal of entry was identified in 91%; adequate knowledge of the bacterial flora at the suspected site of infection was found in 69%; the diagnostic workup was appropriate in 81%, and the correct antibiotic susceptibility patterns were given in 72% . A correct chain of reasoning was more likely to result in an acceptable clinical grade than flawed reasoning (p less than 0.005) . However, an appropriate antibiotic selection was made by some physicians despite flawed reasoning, and inappropriate antibiotic selection occurred in a few cases despite fautless reasoning . In 3.8% of cases, unexpected organisms appeared in blood culture . Prescription of broad spectrum antibiotics may then be learned response . If so, educational efforts that emphasize narrow, rather than broad spectrum prescribing may be inadequate to change physician prescribing habits.

South Med J, 1991 Mar, 84(3), 409 - 10
Stomatococcus mucilaginosus catheter-related infection in an adolescent with osteosarcoma; Ascher DP et al.; Ours is apparently the first reported pediatric case of Stomatococcus mucilaginosus bacteremia . It is the second reported case of S mucilaginosus catheter-associated infection, but the first case successfully treated without removing the central venous catheter . This unusual organism should be added to the list of opportunistic pathogens that can be isolated from immunocompromised pediatric patients.

Crit Care Med, 1991 Mar, 19(3), 399 - 404
Pulmonary artery occlusion-left atrial pressure gradient: an important factor in determining pulmonary venous vascular resistance in acute pulmonary failure; Fretschner R et al.; OBJECTIVE: To determine whether pulmonary artery occlusion pressure (PAOP) accurately reflects left atrial pressure (LAP) in acute pulmonary failure . DESIGN: Sham-controlled laboratory investigation on Goettingen minipigs . INTERVENTIONS: Induction of acute respiratory failure by a 4-hr infusion of live Escherichia coli bacteria in 11 animals; two animals served as the control group . Anesthesia was obtained with methohexital/piritramide and pancuronium bromide . MEASUREMENTS AND MAIN RESULTS: Cardiac output and pressures were measured by means of femoral artery, pulmonary artery, and left atrial catheters . Arterial-alveolar Po2 ratio was calculated to evaluate pulmonary function . Measurements were obtained before and after 1 and 2 hr of the E . coli infusion . Statistical significance was tested with analysis of variance . E . coli infusion caused the hypodynamic shock and respiratory failure . The PAOP-LAP gradient was -0.3 +/- 1.6 mm Hg before bacteremia and increased significantly (p less than .001) to 2.9 +/- 1.8 and 3.4 +/- 2.0 mm Hg after 1 and 2 hr of bacteremia, respectively . No significant changes occurred in the sham group . CONCLUSIONS: A PAOP-LAP gradient may develop during acute respiratory failure . Therefore, pulmonary venous vascular resistance may be underestimated if its determination is based on PAOP . An increase in bronchial to pulmonary blood flow and pulmonary venoconstriction are discussed as hypothetical causes of a PAOP-LAP gradient during acute respiratory failure.

Radiology, 1991 Mar, 178(3), 721 - 6
Fungal pulmonary infections after bone marrow transplantation: evaluation with radiography and CT; Mori M et al.; The authors reviewed 55 pairs of chest radiographs and computed tomographic (CT) studies obtained in 33 febrile bone marrow transplant (BMT) recipients . The images were read separately, without knowledge of the clinical diagnosis . Twenty-one episodes of fungal infection were documented . One chest radiograph showed a pneumonia-like opacity, and 17 showed nodular opacities, five with cavitation . In 20 of 21 episodes, CT showed nodules with cavitation (n = 7), halo (n = 4), hazy margin (n = 5), air bronchogram (n = 2), cluster of fluffy nodules (n = 1), or sharp margin (n = 1) . In none of the nine bacteremic episodes, however, were there opacities on chest radiographs or CT studies . CT studies demonstrating complicated nodules in febrile BMT patients strongly suggest a fungal infection, whereas negative CT studies suggest bacteremia or non-filamentous fungal infection of nonpulmonary origin . CT appears to add useful information to radiographic analysis during the assessment of febrile episodes in BMT patients, especially when invasive diagnostic procedures pose a high risk.

JPEN J Parenter Enteral Nutr, 1991 Mar-Apr, 15(2), 152 - 8
Effects of a fish oil diet on pigs' cardiopulmonary response to bacteremia; Murray MJ et al.; Since an omega 3 fatty acid (FA) diet may have beneficial effects in inflammatory processes, we tested the hypothesis that the physiologic response to sepsis could be modified by altering the eicosanoid precursor pool via an omega 3 FA diet . Two groups (n = 8) of pigs were prefed for 8 days either an omega 3 FA or an omega 6 FA diet (Weaner Pig Feed with either menhaden or corn oil to produce a eucaloric feed with 15% fat) and then injected with live Escherichia coli . The omega 3 FA diet increased the concentration of eicosapentainoic acid (EPA, 20:5 omega 3) in plasma lipids, and increased the ratio of EPA to arachidonic acid (AA, 20:4 omega 6) in platelets from 1:20 to 1:1 over the 8 days . Following the injection of bacteria, there was a fall in PaO2 and blood pressure that was attenuated (p less than 0.05) by the omega 3 FA diet . The omega 3 FA diet, compared to the omega 6 FA diet, also attenuated the rise in thromboxane B2 (3.0 +/- 1.1 vs 12.9 +/- 5.7 ng/mL) and 6 keto-PGF1 alpha (0.8 +/- 0.5 vs 1.7 +/- 1.1 ng/mL) associated with bacteremia . We conclude that dietary omega 3 FA attenuated the physiologic response to sepsis, possibly by modifying arachidonic acid metabolism.

An Med Interna, 1991 Mar, 8(3), 131 - 2
{Arthritis, endophthalmitis and endocarditis caused by Escherichia coli}; Molina Boix M et al.; A female diabetic patient of 66 years old with acute pyelonephritis, caused by escherichia coli, was further complicated by bacteremia and a rare septic metastasis such as arthritis of the knee and coxa-femoral, unilateral purulent endophthalmitis with a loss of sight and aortic endocarditis which required a surgical change of valves, the posterior evolution being favourable.

Enferm Infecc Microbiol Clin, 1991 Mar, 9(3), 159 - 61
{Bacteremia after fibrobronchoscopy . Prospective study}; Pedro-Botet ML et al.; We prospectively evaluated in 88 inpatients the incidence of fever and bacteremia after fiberoptic bronchoscopy and its predisposing variables . Fever was present in 27% of cases and no bacteremia could be demonstrated neither associated nor intercurrent . Chronic Hepatic Disease, endobronchial pathology and bronchial biopsy practice were predisposing factors for fever development in the univariant analysis.

Pediatr Infect Dis J, 1991 Feb, 10(2), 117 - 21
Interleukin 6 activity in infants and children with bacterial meningitis . The Collaborative Study on Meningitis; Rusconi F et al.; Concentrations of interleukin 6 (IL-6) in cerebrospinal fluid (CSF) and serum of infants and children with bacterial meningitis were determined and correlations were sought with other indices of inflammation and with outcome . Forty-two patients ages 1 month to 15 years (mean, 2.5 years) were studied . IL-6 activity was detectable (greater than 50 units/ml) in 30 of 36 CSF samples collected at admission from patients with meningitis and in 1 of 23 controls with fever and normal CSF findings . Mean values were 36,000 units/ml (range, 151-156,000) . IL-6 activity in CSF persisted during the first 5 days of illness . IL-6 concentrations at admission were not associated with clinical findings, CSF leukocyte, protein and glucose concentrations, serum C-reactive protein concentration and neurologic complications or sequelae . IL-6 was also detected in the serum of 3 of 14 patients with meningitis and in 0 of 7 controls with no infectious disease . The presence of IL-6 was not associated with bacteremia or with duration of fever before admission . The presence of IL-6 in the CSF of pediatric patients with bacterial meningitis is in accordance with available data on other cytokines and suggests their role as mediators of meningeal inflammation.

Circ Shock, 1991 Feb, 33(2), 84 - 91
Endotoxin and cytokine profile in plasma of baboons challenged with lethal and sublethal Escherichia coli; Creasey AA et al.; This descriptive study compares the inflammatory, coagulant, and hemodynamic responses of the baboon to a 2-hr infusion of lethal and sublethal concentrations of Escherichia coli (40 and 4.0 billion organisms per kilogram, respectively) . The response to lethal E . coli challenge occurred in three stages: an inflammatory stage marked by a fall in white blood cell count (0-2 hr), a coagulant stage marked by a fall in fibrinogen concentration (2-6 hr), and a hypoxic cell injury stage marked by a rise in SGPT/BUN and by a gradual cardiovascular collapse, and death (6-24 hr) . The inflammatory, or first stage coincided with the appearance in plasma of tumor necrosis factor (TNF) and interleukin-1 beta (IL-1 beta), which peaked at 120 and 240-300 min, respectively; a slow but continuous appearance and rise of interleukin-6 (IL-6); and the appearance of endotoxin reaching a maximum at 120 min . This contrasted markedly with the response to sublethal E . coli, in which only one of the three stages was observed (inflammatory) and only minor amounts of the cytokines or endotoxin appeared in the plasma . This study describes the cytokine and endotoxin profiles and the bacteremia in the primate under experimental conditions . It shows for the first time the extreme qualitative differences in their response to lethal and sublethal concentrations of E . coli . It raises the possibility that lethality is associated with an override of the tissue threshold for processing these mediators, as marked by their appearance in plasma in response to lethal E . coli infusion.

Pediatr Emerg Care, 1991 Feb, 7(1), 4 - 11
Peripheral white blood cell counts and bacterial meningitis: implications regarding diagnostic efficacy in febrile children; Lembo RM et al.; In order to investigate the clinical value of peripheral white blood cell variables for the diagnosis of bacterial meningitis among young, febrile children, we compared total peripheral white counts, total segmented neutrophil counts, total band counts, and the ratio of immature-to-total neutrophils (I:T ratio) among 46 children with bacterial meningitis, 130 children with aseptic meningitis, and 56 febrile children with culture confirmed extrameningeal bacterial infection . Children with bacterial meningitis were comparable to those with aseptic meningitis with respect to median total white blood cell counts and median total segmented neutrophil counts but had a significantly higher median total band count (1760/microliters vs 378/microliters, P = 0.0001) and a significantly higher median I:T ratio (0.40 vs 0.09, P less than 0.001) . In contrast, children with bacterial meningitis were comparable to those with an extrameningeal bacterial infection with respect to median total band count but had a significantly lower median total peripheral white count (10,650/microliters vs 15,300/microliters, P = 0.0013), a lower median total segmented neutrophil count (4511/microliters vs 6796/microliters, P = 0.023), and a significantly higher median I:T ratio (0.40 vs 0.15, P less than 0.001) . Children with meningitis who were bacteremic at presentation had a significantly lower total white cell count (P = 0.001) and significantly higher I:T ratio (P = 0.005) when compared with children who had an extrameningeal infection and concurrent bacteremia at presentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer, 1991 Feb 1, 67(3), 716 - 21
The role of infection in the morbidity and mortality of patients with head and neck cancer undergoing multimodality therapy; Hussain M et al.; Cancer of the head and neck is a common cancer worldwide . The majority of patients present with locally advanced disease . Recently a great deal of improvement has been made in multimodality therapy of this disease, warranting more careful consideration of factors affecting quality of life, disease course, and treatment . Infection is clearly a factor . Analysis of 662 hospital admissions of 169 head and neck cancer patients was performed . A definite infection was documented in 86 febrile episodes, pneumonia contributed to 40%, bacteremia to 13%, skin and soft tissue infection to 12%, and tracheobronchitis to 10% . Among the evaluated risk factors, foreign bodies, specifically intravenous (IV) cannulae and gastrostomy tubes, race, performance status, alcohol intake, and nutritional status were statistically significant variables that predicted for or were associated with infection . Infection contributed to 44% of the deaths.

JAMA, 1991 Jan 16, 265(3), 365 - 9
Contaminant blood cultures and resource utilization . The true consequences of false-positive results; Bates DW et al.; To determine whether contaminant blood cultures increase resource utilization, we studied charge and length of stay data for episodes in which blood cultures were obtained from hospitalized adults . Compared with 1097 negative episodes, 94 false-positive episodes were associated with increased subsequent length of stay (median, 12.5 vs 8 days) and subsequent total charges (median, $13,116 vs $8731), pharmacy charges (median, $1456 vs $798), and laboratory charges (median, $2057 vs $1426) . In multivariate analyses, contaminants were independently correlated with 20% and 39% increases in total subsequent laboratory charges and intravenous antibiotic charges, respectively . Thus, the true costs of contaminants may greatly exceed those of the test itself . Identifying patients at very low risk of bacteremia and attention to sterile technique may reduce costs by decreasing the frequency of contaminants.

J Pediatr, 1991 Jan, 118(1), 11 - 20
Management of infants at risk for occult bacteremia: a decision analysis; Downs SM et al.; Because febrile infants with no obvious source of bacterial infection may have bacteremia, and because bacteremia is difficult to diagnose on clinical grounds, we used decision analysis to evaluate whether such infants should be treated with antibiotics, tested further, or sent home . Using a simple decision tree, we found that the decision to give empiric antibiotic treatment is the decision of choice . The difference in quality-adjusted life expectancy between the "best" and "worst" decisions was only 11 days . However, this difference translated to prevention of death or permanent disability in 60 cases per 100,000 febrile children . Further, empiric treatment remained the best management alternative unless the probability of bacteremia was less than 1.4% (less than any published prevalence), or the efficacy of treatment was less than 21% . Our analysis demonstrated that a test with far greater sensitivity than leukocyte count or other tests currently in use is needed to justify testing rather than treating empirically . Further, an enormous patient population would be needed to find a difference of both clinical and statistical significance between treated and untreated patients in a controlled trial . In the absence of such trials, we recommend blood culture and empiric antibiotic treatment of all infants at risk for occult bacteremia.

J Med Vet Mycol, 1991, 29(5), 343 - 5
Concurrent bloodstream infection with Histoplasma capsulatum and Mycobacterium tuberculosis; Tucker RM et al.; An immunosuppressed patient is the first to be reported with both histoplasmal fungemia and tuberculous bacteremia, emphasizing the need to consider polymicrobial infection in such patients and the utility of lysis-centrifugation and radiometric blood culture techniques.

J Pediatr, 1991 Jan, 118(1), 21 - 9
Strategies for diagnosis and treatment of children at risk for occult bacteremia: clinical effectiveness and cost-effectiveness; Lieu TA et al.; Decision analysis was used to evaluate the probable health benefits, complications, and costs of six management strategies for febrile children at risk for occult bacteremia . The strategy that combined blood culture with empiric oral antibiotic treatment for all patients was predicted to prevent the highest number of major infections and to have the lowest cost per major infection prevented . The strategy that combined a leukocyte count and blood culture for all patients, followed by empiric antibiotic treatment for those with leukocyte count greater than or equal to 10,000/mm3, had almost equal cost and clinical effectiveness and avoided many antibiotic complications . Culture of blood specimens from all patients and no empiric treatment constituted the third most clinically effective intervention but was the least cost-effective in this model . Giving a 2-day oral course of amoxicillin without testing had the lowest average cost per febrile patient but was the least clinically effective intervention . However, the low degree of effectiveness of empiric treatment alone was based on the assumption that oral amoxicillin therapy was only 20% effective in preventing major infections after bacteremia . At higher estimates of effectiveness, treatment alone became a more viable strategy . We conclude that approaches which combine blood culture with empiric antibiotic treatment are the most clinically effective and the most cost-effective strategies for children at risk for occult bacteremia.

Gastrointest Radiol, 1991 Summer, 16(3), 193 - 7
Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts; Teplick SK et al.; Transhepatic cholangiography (THC) was performed in 107 patients who had nondilated intrahepatic bile ducts on computed tomography (CT) or ultrasound . The cholangiogram was diagnostic in 72 patients (67%) . Thirty-one (43%) of the 72 diagnostic studies were abnormal and showed poor emptying, stones, or strictures . Twenty-three (21%) complications occurred, including two deaths . Sixteen patients experienced acute pain, requiring additional narcotics . There was one case of peritonitis and pancreatitis, and two of bacteremia . We compared our success and complication rates to those of endoscopic retrograde cholangiography (ERC) reported in the literature . We conclude that when a bile duct abnormality is clinically suspected, the incidence of pathology is sufficiently high to warrant direct visualization of the ducts in order to make an anatomic diagnosis, even if the intrahepatic ducts are not dilated . However, ERC has a better success rate and fewer complications than THC and it should be the initial invasive procedure.

Chemotherapy, 1991, 37 Suppl 2, 53 - 7
Overall clinical utility of the intramuscular preparation of imipenem/cilastatin; MacGregor RR; Imipenem is the broadest-spectrum antibiotic currently available but requires frequent intravenous dosing for efficacy . A recently formulated finely milled preparation can be given intramuscularly in small volumes and demonstrates kinetics favorable for 12-hourly intramuscular administration . The intramuscular imipenem formulation has been proven to be effective for mild to moderate infections of many body sites, as demonstrated by other papers in this symposium . The advantages of intramuscular administration include: less frequent dosing, avoidance of the complications of intravenous administration (phlebitis, bacteremia, fluid overload, nursing time), ability to use the drug in settings where intravenous administration is either undesirable or impossible and, surprising to medical personnel, greater patient satisfaction.

Qual Assur Util Rev, 1991 Winter, 6(4), 132 - 7
Solitary blood cultures as a quality assurance indicator; Schifman RB et al.; For patients with suspected bacteremia, at least two separate blood cultures are recommended to achieve maximum sensitivity and to properly interpret results . Since a single blood collection may signify an improper procedure with serious consequences if the diagnosis of blood stream infection is missed, we investigated this problem with studies at three teaching hospitals (A, B, and C) and by a survey of 38 other hospitals . The incidence of solitary blood cultures ranged from 1 to 99% (median 26%) at the surveyed institutions . Among the cases investigated at hospitals B and C, between 10 and 30% of solitary blood cultures were not clinically indicated, while most of the others were caused by the physician not knowing that one culture was insufficient or by failure to complete the diagnostic plan . Focused concurrent intervention at hospital B was associated with reductions in solitary blood cultures from 40.0 to 24.6% (p = 0.045) and a decline in those not indicated from 38.1 to 12.5% (p = 0.192) . Global educational efforts at hospital A were associated with a decrease in solitary blood culture rates from 52 to 37% (p = 0.016) . These results show that blood culture practice varies widely among institutions in spite of consensus recommendations for proper specimen collections . We estimate that, nationwide, up to 18,000 etiologic diagnoses of bacteremia are missed annually because of this problem . Monitoring institutional solitary blood cultures is recommended as a test utilization indicator and as the basis for improving blood culture practice.

Dtsch Stomatol, 1991, 41(11), 427 - 8
{Prophylaxis of the bacterial endocarditis in dental surgery}; Wiltfang J et al.; Bacterial endocarditis is a disease with high morbidity and lethality . Bacteremia following diagnostic or therapeutic procedures in oral surgery may cause bacterial endocarditis . Patients with certain kinds of heart diseases are at higher risk to develop bacterial endocarditis . Especially these patients have to be protected by means of systemic and local prophylactic regimens.

Scand J Infect Dis, 1991, 23(5), 583 - 8
Laboratory diagnosis of catheter-related bacteremia; Rello J et al.; Semiquantitative culture of the external surface of catheter tips has become the currently most used method to detect catheter colonisation and catheter-related bacteremia; however, this method may fail to detect significant colonisation of the internal lumen of catheters, and several quantitative methods have been described for this purpose . Although 15 and 1000 CFU are used to define positive catheters, the sensitivity and specificity are not yet well known, and the definitive cut-off level for a positive result remains to be established . We studied prospectively 91 intravascular catheter tips removed because a catheter-related infection was suspected . The result of external and internal cultures with different cut-off levels, alone or combined, were correlated with clinical data in 22 bacteremic episodes which occurred in these patients, 12 of which were catheter-related . The semiquantitative culture of the external surface alone with a cut-off level of 25 CFU provided the best means of detecting catheter-related bacteremia . This method has 100% sensitivity and 81.1% specificity . We conclude that semiquantitative culture technique of the catheter tip alone is sufficient and this method should be employed for diagnosing catheter-related bacteremia in unselected populations.

Adv Perit Dial, 1991, 7, 63 - 7
Improved overall survival of elderly patients on peritoneal dialysis; Joglar F et al.; Clinical complications and outcome of 50 patients, age 65 or older, on dialysis during 1985-1990 were studied . There were three groups: Peritoneal Dialysis (PD-10 pts.), Hemodialysis (HD-28 pts.), and both for at least one month each (PD-HD 12 pts.) (8 HD to PD and 4 PD to HD) . Analysis included sex, age, bacteremia associated to acute vascular accesses (AVA), peritonitis (PD), other illnesses, hospital days, blood chemistries, quality of life (active, sedentary or bedridden) . The most frequent causes of death were septicemia and cardiac failure . No difference was found in age, chemistries, hemoglobin, illnesses or quality of life . The results showed a significant improved overall survival for those in the PD group (77.8%, p less than 0.05) as compared to HD or PD-HD group . Therefore, more emphasis should be placed on using PD for elderly patients.

Clin Pharm, 1990 Dec, 9(12), 939 - 47
Ampicillin-sulbactam therapy for multiple pyogenic hepatic abscesses; Zenon GJ 3rd et al.; A patient with multiple, pyogenic hepatic abscesses is described, and the pathophysiology, etiologies, clinical and laboratory manifestations, and management of the disease are reviewed . A 55-year-old man with a history of ethanol abuse and pancreatitis developed fever, chills, general malaise, and right upper quadrant abdominal pain two weeks before hospitalization . Baseline laboratory and hematology results included serum albumin concentration, 3.2 g/dL; serum alkaline phosphatase concentration, 239 mIU/mL; total serum bilirubin concentration, 1.3 mg/dL; white blood cell count, 18,400/cu mm; red blood cell count, 4.7 million/cu mm; hemoglobin, 12.5 g/dL; and hematocrit, 38.8% . Abdominal ultrasound showed echo-free cavities throughout the hepatic parenchyma; abdominal computed-tomography (CT) scan showed hepatomegaly and multiple radiolucent spaces . CT-guided needle aspiration of a hepatic mass yielded purulent material that grew Fusobacterium necrophorum under anaerobic conditions . On day 7, the patient was started on i.v . ampicillin sodium-sulbactam sodium . A CT scan two weeks later showed a reduction in the number and sizes of abscesses . The patient continued i.v . therapy for one month, then was discharged on a regimen of p.o . amoxicillin trihydrate-clavulanate potassium . Hepatic abscesses are either amebic or pyogenic; the latter usually has a higher mortality . The etiologies of pyogenic hepatic abscesses include ascending cholangitis, portal vein bacteremia, systemic bacteremia, extension from a contiguous focus of infection, and trauma . Diagnosis is difficult and relies highly on clinical suspicion . Clinical symptoms include hepatomegaly, fever, chills, and malaise . Abnormal laboratory values include leukocytosis, anemia, and hypoalbuminemia . The abscesses are frequently polymicrobial; Escherichia coli is the most commonly isolated species . CT is the best radiological technique for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr Surg, 1990 Dec, 25(12), 1264 - 5
Obstruction of the Roux limb after portoenterostomy for biliary atresia: a delayed complication; Levy J et al.; We report the case of a 5-year-old girl who underwent a Kasai portoenterostomy for extrahepatic biliary atresia . The conduit was exteriorized until 11 months of age . She was doing well, with stable portal hypertension until she suddenly developed jaundice, acholic stools, and bacteremia not responsive to a course of steroids and intravenous antibiotics . Suspecting obstruction at the site of the previously exteriorized anastomosis, a percutaneous cannulation of the conduit was performed . Catheterization of the conduit obstruction unkinked it and reestablished bile flow . She has remained anicteric with stable liver function.

J Clin Microbiol, 1990 Dec, 28(12), 2848 - 9
Kluyvera mediastinitis following open-heart surgery: a case report; Sierra-Madero J et al.; Reports of serious infections caused by Kluyvera spp . have been rare . A case of Kluyvera sp . mediastinitis and bacteremia in a man after open-heart surgery is described . The clinical significance of Kluyvera sp . isolates was debated in early descriptions of the organism . More recent reports, as well as the present case, suggest that the pathogenic potential of this organism is being increasingly recognized by clinicians and microbiologists.

Clin Chest Med, 1990 Dec, 11(4), 633 - 56
Sepsis syndrome, the adult respiratory distress syndrome, and nosocomial pneumonia . A common clinical sequence; Niederman MS et al.; Systemic sepsis and pneumonia are common predisposing factors for ARDS, which can serve as the initial manifestation of the multisystem organ failure syndrome . Primary pneumonia that necessitates ICU admission leads to ARDS in approximately 10% of patients . Systemic infection can also lead to ARDS, but when bacteremia alone is present, the risk is low (probably less than 5%) . If the septic syndrome with a hemodynamic and end-organ response develops, the ARDS may follow in as many as 40% of patients . When multiple risk factors for acute lung injury are present, the risk of developing ARDS rises dramatically . The septic syndrome, acute lung injury, and multiorgan failure are closely tied to one another because bacterial cell walls can activate inflammatory mediators, such as interleukin-1 and tumor necrosis factor, which can in turn lead to the septic syndrome and inflammatory injury to the lung . Clinical features, more than serum markers, have been the best predictors of whether lung injury will follow sepsis, indicating that the mere presence of mediators alone cannot cause ARDS and that there are individual susceptibility factors in the effects of these mediators . With the advent of monoclonal antibodies and new anti-inflammatory drugs, prevention of progression from sepsis to multiorgan failure may become possible . Pneumonia is the most common infection that complicates ARDS once it is established, and the mortality rate may approach 90% . The existence of acute lung injury, its predisposing conditions, coexisting illnesses, and the therapeutic interventions used for patients with lung injury all can interfere with lung host defenses and set the stage for bacterial infection of the already-injured lung . This infection appears to add to the propagation of the multiple system organ failure that has already begun . In the future, it may become possible to prevent this infection, which would be a welcome development, because currently, we are stymied in our efforts to diagnose and treat pneumonia in the setting of acute lung injury . Preventive efforts will follow from an understanding of the pathogenesis of pneumonia and in the future may include topical antibiotics, selective digestive decontamination, and prophylactic passive immunotherapy.

Am J Surg, 1990 Dec, 160(6), 610 - 2; discussion 613
Choledochotomy for calculous disease in the elderly; Hacker KA et al.; To determine the risk of operations on the biliary tract in the elderly, we retrospectively examined 56 patients 80 years of age or older undergoing choledochotomy for calculous disease and compared their outcomes with those of a contemporary group of 257 patients undergoing similar surgery . Thirty of 56 elderly patients (54%) required urgent surgery for acute cholangitis, acute cholecystitis, or obstructive jaundice (serum bilirubin greater than 5 mg/dL), compared with 97 of 257 younger patients (38%) (p = 0.029) . Mortality in elderly patients was significantly higher (5 of 56) than in younger (6 of 257) patients (p = 0.015) . In three of the five patients who died, urgent surgery was performed for obstructive jaundice, reflecting the higher mortality experienced by jaundiced patients in the entire series (9.4%) . Biliary cultures grew organisms in 25 of 27 elderly patients (93%) . This is in contrast to findings of bactibilia in 62 of 118 patients (53%) under the age of 80 (p = 0.001) . Similarly, preoperative blood cultures were positive more often in elderly (63%) than in younger patients (26%) (p = 0.007) . Mean postoperative hospital recovery was longer in the elderly group (16.2 +/- 8.5 days) than in the younger group (12.2 +/- 9.3 days) (p = 0.002) . In conclusion, elderly patients, particularly those with obstructive jaundice, are at higher risk for complicated biliary tract disease necessitating choledochotomy . They appear to be more susceptible to bactibilia and bacteremia, and require longer hospital recovery than younger patients.

Chest . 1990 Dec;98(6):1526.
Septic pulmonary embolism complicating a central venous catheter; Cervia JS et al.; Bacteremia is a recognized complication in patients with indwelling central venous catheters . More recently pulmonary embolism in such patients has also been described . Despite abundant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients . This case illustrates such a complication.

Arch Surg, 1990 Dec, 125(12), 1573 - 6
Absorptive hyperemia restores intestinal blood flow during Escherichia coli sepsis in the rat; Gosche JR et al.; Enteral nutritional support has been found to result in better maintenance of mucosal integrity during stress than parenterally administered nutritional support . In our experiments, we employed in vivo microvascular techniques to examine the effect of mucosally applied glucose on intestinal microvascular blood flow during hyperdynamic live Escherichia coli bacteremia in the rat . We observed a significant decrease in intestinal microvascular blood flow during bacteremia when the mucosa was suffused with a nonglucose solution . Blood flow was rapidly restored to above-baseline values after glucose was added . The restoration of blood flow resulted from dilation of arterioles at all branch orders and was associated with dilation of premucosal arterioles to above-baseline diameters . Our results show that glucose-induced absorptive hyperemia restores intestinal blood flow during live E coli bacteremia . Restoration of intestinal microvascular blood flow may be a contributing factor to the improved maintenance of mucosal integrity associated with enteral feeding.

Inflammation, 1990 Dec, 14(6), 705 - 16
Effect of phagocytosis of erythrocytes and erythrocyte ghosts on macrophage phagocytic function and hydrogen peroxide production; Commins LM et al.; Our previous studies have shown that an in vivo phagocytic challenge with IgG-coated erythrocytes can depress Kupffer cell complement and Fc receptor function, as well as decrease the survival rate following endotoxemia and bacteremia . In an effort to better understand the mechanism underlying these in vivo findings, the present study evaluated the in vitro effects of a phagocytic challenge with either IgG-coated erythrocytes (EIgG) or erythrocyte ghosts (GIgG) on macrophage phagocytic and respiratory burst activity . Elicited rat peritoneal macrophage (PM) monolayers were challenged with varying doses of EIgG, then the noninternalized EIgG were lysed hypotonically and the monolayers incubated for an additional hour prior to determining phagocytic function and PMA-stimulated hydrogen peroxide production . Challenge of PM with 1 x 10(6) EIgG per well had no effect, but challenge with 1 x 10(7) or 1 x 10(8) EIgG per well caused a dose-dependent depression of phagocytic function or hydrogen peroxide production . GIgG were formed by hypotonically lysing EIgG bound to PM at 4 degrees C . The bound GIgG were phagocytized during a subsequent incubation at 37 degrees C . Challenge with GIgG depressed phagocytic function only with the highest challenge dose tested (1 x 10(8) per well) and did not depress hydrogen peroxide production . The observation that prior phagocytic challenge with EIgG depressed macrophage function to a greater extent than challenge with GIgG supports our previous in vivo observations . Furthermore, these studies suggest that the internalization of erythrocyte contents, and not phagocytosis per se, plays an important role in determining macrophage host defense function.

Ginecol Obstet Mex, 1990 Dec, 58, 338 - 45
{Septic shock in obstetrics}; Sereno Colo JA et al.; Septic shock in obstetrics is a major cause of mortality . Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection . Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy . Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output . Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis . Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF . Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure . The mortality was 25% . Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality . Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.

Rev Infect Dis, 1990 Nov-Dec, 12(6), 1060 - 99
Modern chemotherapy for brucellosis in humans; Hall WH; The most effective, least toxic chemotherapy for human brucellosis is still undecided . In vitro, the antibiotics most active against Brucella include the tetracyclines, the aminoglycosides, the aminopenicillins, some cephalosporins, trimethoprim-sulfamethoxazole, erythromycin, rifampin, and some new fluorinated quinolones . Because Brucella species are facultative intracellular parasites, the penetration of drugs into and within phagocytes and phagosomes can be problematic and can best be studied in experimental animals or tissue cultures . In humans, the effectiveness of various regimens of chemotherapy has been compared best in acute bacteremic infections by assessment of the control of symptoms, bacteremia, complications, and relapses . The standard therapy against which all other therapies have been judged is a combination of tetracycline and streptomycin, which is almost universally effective but fails to prevent relapse in 10% of cases . A combination of oral doxycycline and rifampin is convenient and currently popular; it is highly effective, with an average relapse rate of only 8.4% . Trimethoprim-sulfamethoxazole is less effective in controlling bacteremia and other manifestations: in collected series, 5.7% of cases did not respond and 12% relapsed . Drug-resistant Brucella strains are rarely a cause of therapy failure . Localized brucellosis poses special problems, often requiring surgery in addition to prolonged combined chemotherapy.

Pediatr Infect Dis J, 1990 Nov, 9(11), 815 - 8
Utility of collecting blood cultures through newly inserted intravenous catheters; Isaacman DJ et al.; We prospectively examined the utility of obtaining blood cultures through newly inserted intravenous catheters in 99 children who required both a blood culture and placement of an intravenous catheter . Two blood cultures were collected from each patient, one through a freshly inserted intravenous catheter and another through a butterfly needle at a separate venipuncture site . A standardized technique of skin preparation with povidone-iodine was used . The rate of contamination was 1.0% (95% confidence intervals, 0 to 3.0%) for each method . Ten patients had blood cultures yielding true pathogens; in five of these bacteremic children, only one of two sets of blood cultures was positive . We conclude that blood cultures can be collected through freshly placed intravenous catheters without increasing the risk of contamination . These results also raise the possibility that obtaining two blood cultures instead of a single culture may improve the detection of bacteremia in children.

J Infect Dis, 1990 Nov, 162(5), 1012 - 7
The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents; Redd SC et al.; Human immunodeficiency virus (HIV) is an important risk factor for invasive pneumococcal disease, but information on clinical course and infecting serotypes is limited . To help develop strategies to reduce the morbidity due to invasive pneumococcal disease, episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records (November 1983-November 1987) at 10 San Francisco hospitals and, for patients 20-55 years old living in San Francisco, HIV antibody status was determined by review of medical records . Pneumococcal isolates from one hospital were serotyped . Of 294 patients with pneumococcal bacteremia identified, 32 (11%) had AIDS at the time pneumococcal bacteremia was diagnosed and another 43 (15%) were HIV-infected but did not have AIDS; 12 HIV-infected patients developed AIDS after the episode of pneumococcal bacteremia . The rate of pneumococcal bacteremia in AIDS patients was estimated to be 9.4/1000 patient-years . Serotypes of 27 (82%) of 33 pneumococcal isolates from HIV-infected patients and 107 (90%) from 119 patients without known HIV infection were among the 23 serotypes included in the currently available polysaccharide vaccine . The rate of pneumococcal bacteremia is approximately 100-fold greater in AIDS patients in San Francisco than rates reported before the AIDS epidemic, but more than half the episodes of pneumococcal bacteremia in HIV-infected patients occurred in patients without AIDS . Data on pneumococcal serotypes causing invasive disease in HIV-infected patients suggest that the current pneumococcal vaccine, if effective in this population, could provide significant protection against pneumococcal disease.

Emerg Med Clin North Am, 1990 Nov, 8(4), 793 - 803
Infections in alcoholic patients; Sternbach GL; Alcoholic patients have an increased susceptibility to certain bacterial infections . Among the more important of these infections are pneumonia, tuberculosis, spontaneous peritonitis, and bacteremia . This susceptibility is caused by alteration of immune function and mechanical defenses and are the sequel of chronic alcoholism, most notably cirrhosis . In many infections, morbidity is increased in alcoholics, with the course of the illness being more severe and complications more frequent . Assessment of the alcoholic patient with suspected infection should, therefore, be thorough and treatment prompt.

Am J Emerg Med, 1990 Nov, 8(6), 542 - 5
Buccal cellulitis; Walker JS et al.; Buccal cellulitis (BC) is an innocuous appearing infection of the cheek that is found in children and has a high incidence of concomitant bacteremia . Typically, the child is younger than 12 months and has a 2 to 8 hour prodrome of coryza and fever before developing the cellulitis on the cheek . A purplish hue on the cellulitic region is highly suggestive of Hemophilus influenzae bacteremia . The differential diagnosis is reviewed . A complete blood count, blood culture, and cellulitis aspirate culture, should be obtained on all patients with BC . Meningitis may be present despite the lack of meningeal signs . A lumbar puncture should be performed on all children at risk for bacteremic BC . The vast majority of these children are bacteremic and require parenteral antibiotics . A typical case of BC is presented and its management is reviewed.

Rev Med Chil, 1990 Nov, 118(11), 1195 - 200
{The IgG antibody response in patients colonized by Helicobacter pylori}; Figueroa G et al.; The IgG antibody response specific to Helicobacter pylori was evaluated through ELISA in a group of 92 gastric patients colonized by this bacteria . 74 had gastritis and 19 gastroduodenal ulcer . Three control groups were studied in a similar way: normal adult volunteers (n = 17), adults with E coli or S typhi bacteremia (n = 30) and normal infants (n = 30) . IgG antibody response to H pylori was demonstrated in 98% of colonized patients and 0% of infants . Asymptomatic individuals and those with bacteremia had high rates of antibody response (76 and 90% respectively), although this rate and also the titers of antibody response were significantly lower than that of colonized patients (p < 0.05) . ELISA reactive sera from colonized patients and asymptomatic individuals evidenced a similar antibody pattern when tested by blotting . This profile was absent in non reactive sera, including those with high antibody titers to C jejuni . The presence of specific IgG antibodies to H pylori in the majority of colonized gastric patients and asymptomatic adults suggests that this infection is very common in our population.

Oral Surg Oral Med Oral Pathol, 1990 Nov, 70(5), 590 - 2
The prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus; Luce EB et al.; The purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with SLE, to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment . The hospital records of 112 patients with SLE were reviewed and screened for endocarditis, heart murmurs, and other valvular pathosis . Two of the 112 patients had confirmed cases of bacterial endocarditis . This prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease . The high prevalence of endocarditis in this population of patients with SLE suggests that according to present perspectives on patient management, patients with SLE should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia.

Medicine (Baltimore), 1990 Nov, 69(6), 375 - 83
Bacteremia due to Mycobacterium tuberculosis in patients with human immunodeficiency virus infection . A report of 9 cases and a review of the literature; Barber TW et al.; Mycobacterium tuberculosis bacteremia is being reported more frequently in patients with human immunodeficiency virus, type 1 (HIV-1) infection . We report 9 patients with bacteremia due to M . tuberculosis and HIV infection who were identified over a 36-month period . Of the 9 patients studied, 8 were male, 8 were black, 6 were born in Haiti, 3 were homeless, 2 were intravenous drug users, and 1 was homosexual . At the time of diagnosis, 3 patients had the acquired immunodeficiency syndrome (AIDS) and 5 patients had CD4 lymphocyte counts less than or equal to 170 cells/mm3, indicating marked immunodeficiency . All 9 patients presented with temperature greater than 38.3 degrees C, 5 (50%) had abnormal chest roentgenogram on admission, and each of the patients tested had elevations of at least 2 liver function tests . Eight patients (80%) had M . tuberculosis isolated from sputum or other body fluids and tissues . All blood isolates of M . tuberculosis were identified from Dupont Isolator tubes . Antibiotic-resistant isolates of M . tuberculosis were cultured from 3 of the 6 patients born in Haiti . One patient died before diagnosis and received no antimycobacterial therapy; 7 of the remaining 8 patients appeared to respond to treatment . Our data, and a review of the literature, suggest that bacteremia due to M . tuberculosis is becoming more frequent, and that blood cultures may be helpful in establishing or confirming a diagnosis of tuberculosis in patients with HIV-1 infection.

Ann Intern Med, 1990 Oct 1, 113(7), 495 - 500
Predicting bacteremia in hospitalized patients . A prospectively validated model; Bates DW et al.; OBJECTIVE: To develop and validate a model for the prediction of bacteremia in hospitalized patients, and to identify subgroups of patients with a very low likelihood of bacteremia in whom a positive blood culture has a low positive predictive value . DESIGN: Prospective cohort study with clinical data on 1516 episodes collected from a random sample of all patients who had blood cultures done at one institution . SETTING: Urban, tertiary care hospital . PATIENTS: Derivation set: 1007 blood culture episodes sampled from all blood cultures done on patients at Brigham and Women's Hospital between October 1988 and February 1989 . Validation set: 509 episodes, May 1989 to June 1989 . The unit of evaluation was the episode, defined as a 48-hour period beginning after a blood culture was drawn . MEASUREMENTS AND MAIN RESULTS: True- and false-positive rates of blood cultures in the derivation set as assessed by independent reviewers were 7% (74 of 1007) and 8% (81 of 1007), respectively . Independent multivariate predictors of true bacteremia were temperature of 38.3 degrees C or higher, presence of a rapidly (less than 1 month) or ultimately (less than 5 years) fatal disease; shaking chills; intravenous drug abuse; acute abdomen on examination; and major comorbidity . In the low-risk group, defined by absence of these predictors, the misclassification rate of the model in the derivation set was 1% (4 of 303), and a positive blood culture had a positive predictive value of only 14% for true bacteremia . The model also identified a high-risk subset in which 16% (41 of 264) of episodes represented true bacteremia . The model was prospectively validated in 509 additional episodes, and the misclassification rate in the low-risk group was 2% (3 of 155) . INTERVENTIONS: None . CONCLUSION: These findings provide a means of stratifying hospitalized patients according to their risk for bacteremia . If prospectively validated in other settings, this model may be helpful when deciding whether or not to do blood cultures or start antibiotic therapy and, when evaluating a positive blood culture, to determine whether or not it is a true-positive.

Can J Surg, 1990 Oct, 33(5), 415 - 22
Imipenem versus tobramycin--antianaerobe antibiotic therapy in intra-abdominal infections; Poenaru D et al.; The authors compared broad-spectrum monotherapy with imipenem to an aminoglycoside-based antibiotic regimen for the management of intra-abdominal infections . One hundred and four patients who had intra-abdominal infection were randomly allocated to receive imipenem (52) or tobramycin plus clindamycin or metronidazole (52) . Patients treated with imipenem had fewer febrile episodes and occurrences of breakthrough bacteremia, less antibiotic resistance and need for drug change; their hospital stay was shorter . The death rate from sepsis was 4% in patients who received imipenem and 13% in those who received the combined regimen (p = 0.08) . Treatment was successful in 79% of patients on imipenem versus 67% of those receiving an aminoglycoside . Patient stratification by the APACHE II system and probability of death calculation using delayed-type hypersensitivity scores predicted a similar death rate for the two treatment groups . Imipenem appears to be a safe and efficacious alternative broad-spectrum antibiotic for treating patients who are seriously ill with intra-abdominal infection.

Ann Surg, 1990 Oct, 212(4), 543 - 9; discussion 549-50
Ionized calcium, parathormone, and mortality in critically ill surgical patients; Burchard KW et al.; A prospective study measured ionized calcium and parathormone sequentially at 48- to 72-hour intervals in 25 surgical intensive care unit patients . Twelve patients (48%) died at mean day 40 and median day 26 . Levels of ionized calcium, parathormone, blood urea nitrogen, creatinine, albumin, magnesium, and phosphate for patients who lived were compared with levels for patients who died . The incidence of hypotension, renal failure (creatinine greater than or equal to 3.0), and bacteremia, as well as the amount of red cell, crystalloid, and colloid administration for the two groups was compared . Hypotension, bacteremia, red cells, crystalloid, and colloid were no different . On days 1 and 2 ionized calcium levels were significantly lower and parathormone levels significantly higher in nonsurviving patients; this difference persisted through days 3 and 4 . Blood urea nitrogen and creatinine levels increased early in nonsurviving patients but renal failure, which occurred in nine nonsurviving patients, did not develop until mean day 14, median day 18 . The phosphate level was slightly higher but still within normal range in nonsurviving patients . By days 5 and 6 ionized calcium and parathormone levels were no different in nonsurviving patients, despite there being no improvement in renal function . Magnesium and albumin levels were no different between groups . Ionized calcium levels are lower and parathormone levels higher early in nonsurviving patients . This difference is not readily explained by associated clinical conditions, including renal dysfunction . Although etiology remains unclear, low ionized calcium and elevated parathormone are early predictors of mortality in critically ill surgical patients.

Crit Care Med, 1990 Oct, 18(10), 1073 - 9
Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance; Eyer S et al.; We studied the infectious risk of different methods of managing vascular catheters during long-term use . Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site . In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source . Cultures were obtained when clinically indicated and at the time of every catheter change . Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism . A total of 112 patients met evaluation criteria . There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate . The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization . These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC . We conclude that there is no difference in infectious risk between these three methods of long-term catheter management . The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1990 Oct, 162(4), 978 - 81
Prevention of Escherichia coli K1 bacteremia in newborn mice by using topical vaginal carbohydrates; Cox F et al.; Pregnant Swiss-Webster mice were vaginally inoculated with 5 x 10(4) Escherichia coli K1 strain LH (O75:K1:H3) or C94 (O7:K1:H-) . Inhibitor solutions were applied vaginally before delivery and the incidence of bacteremia and surface colonization determined in neonates at 3 days of age . E . coli K1 strain LH resulted in bacteremia in 77% and colonization in 74% of control newborn mice . After topical maternal vaginal D-mannose treatment, bacteremia and colonization were present in 25% of neonates . Topical vaginal application of subinhibitory concentration of gentamicin reduced bacteremia to 23% of neonates . Topical methyl-alpha-D-mannoside and p-nitrophenyl-D-mannoside, however, prevented bacteremia in 100% of newborn mice . A neonatal meningitis strain of E . coli K1 (C94) caused bacteremia in 100% of neonates and was also completely inhibited by methyl-alpha-D-mannoside . This technique of vaginal treatment before delivery may have applicability to human mothers and their infants.

Gan To Kagaku Ryoho, 1990 Sep, 17(9), 1925 - 8
{Epirubicin-based combination chemotherapy in the treatment of non-Hodgkin's lymphoma: with emphasis of elderly patients}; Sampi K et al.; Twenty-four patients with non-Hodgkin's lymphoma aged 60 years and older were treated with epirubicin-based combination chemotherapy . Complete remission was obtained in nineteen (83%) of 23 patients with measurable disease . Of these complete responders seventeen patients with localized disease attained complete remission . No patients received radiation therapy after chemotherapy . The survival rate was 78% at 50 months in patients with the localized disease . The median follow-up time is 40 months, ranging from 13 to 65 months . All of the localized disease were treated in the out-patient clinic and no patients died of chemotherapy-related infectious complications . No severe infection such as either bacteremia or pneumonia occurred . It was concluded that epirubicin-based combination chemotherapy was highly effective in patients with localized non-Hodgkin's lymphoma.

Minerva Stomatol, 1990 Sep, 39(9), 745 - 50
{The prevention of bacterial endocarditis}; Garavelli M et al.; The paper examines the prevention of bacterial endocarditis in risk patients undergoing outpatient treatment . The hypothesis of possible bacteremia provoked by either diagnostic or therapeutic surgery should be carefully assessed . For this purpose antibiotic prophylaxis should be commenced, using different methods and doses according to the type of patient, in association with hygienic and behavioural norms which the specialist will recommend and monitor.

J Burn Care Rehabil, 1990 Sep-Oct, 11(5), 419 - 22
The efficacy of pediatric blood culture sets in the determination of burn bacteremia; Heggers JP et al.; A blood culture is an essential laboratory procedure necessary to confirm a septic episode . However, it is important to collect the blood sample at the appropriate time with an acceptable technique . The standard method is to collect at least 5 to 10 ml blood per culture bottle from patients with fevers . However, this volume of blood is an unrealistic amount to take from the frequently febrile pediatric patient . Alternatively, the pediatric blood culture bottle allows the collection of 1 ml blood per bottle to perform the same evaluation . We evaluated the two techniques of blood-culture collection over a 9-month period and compared the results between adult and pediatric blood culture bottles . Seventy-six patients, from November 1988 through February 1989, had blood cultures performed with the adult culture bottles, which produced a total of 1314 samples . A total of 113 patients, from March through July 1989, had blood cultures performed with the pediatric culture bottles, which produced a total of 758 samples . Percent recovery for the adult bottles versus the pediatric bottles was 13.95% versus 22.8% (p less than 0.0001) . Since the amount of blood necessary to isolate an infectious agent is critical not only for laboratory identification but also for the volume of blood of pediatric patients, these data clearly establish the efficacy of pediatric blood culture bottles and the utilization of smaller amounts of blood . Not only did this approach significantly enhance organism recovery rate, but it may well be more cost-effective because fewer cultures need to be performed to isolate the infectious organism.

Am J Kidney Dis, 1990 Sep, 16(3), 196 - 206
Patterns of complement activation in idiopathic membranoproliferative glomerulonephritis, types I, II, and III; Varade WS et al.; Complement profiles on 22 hypocomplementemic patients with membranoproliferative glomerulonephritis (MPGN) type I, on 11 with MPGN II, and on 16 with MPGN III, gave evidence that the nephritic factor of the amplification loop (NFa) is responsible for the hypocomplementemia in MPGN II and the nephritic factor of the terminal pathway (NFt) for the hypocomplementemia in MPGN III . In contrast, in MPGN I, there was evidence for three complement-activating modalities, NFa, NFt, and immune complexes . As a result, four different patterns of complement activation were seen . NFa, found in MPGN II, produces a complement profile characterized mainly by C3 depression . In addition, four of seven (57%) severely hypocomplementemic MPGN II patients (C3 less than 30 mg/dL) had slightly depressed levels of factor B, and one of seven (14%) of properdin, but in all the C5 concentration was normal . In contrast, all eight severely hypocomplementemic patients with MPGN II had depressed C5 and properdin levels, and six of eight (75%) depressed levels of C6, C7, and/or C9 . Of eight MPGN III patients with moderate hypocomplementemia, 50% had depressed C5 and properdin levels and the remainder, depressed C3 only . This spectrum of profiles is most likely produced by varying concentrations of NFt . In MPGN I, nine of 23 (39%) had a profile indicating only classical pathway activation; seven of 23 (39%), a pattern compatible with NFt alone; four of 23 (9%), evidence for both classical pathway activation and NFt; and three of 23 (13%), a pattern compatible with NFa . The unique multifactorial origin of the hypocomplementemia in MPGN I, often giving evidence of classical pathway activation, together with previously reported differences in glomerular morphology and clinical features at onset, makes it distinct from MPGN III . Depressed C8 levels were found to some extent in all hypocomplementemic states . The levels were uncommonly depressed in patients with NFa, most markedly depressed with NFt, and moderately reduced with classical pathway activation . The cause is not known . Diagnostically, profiles showing classical pathway activation and low levels of C6, C7, and/or C9 are specific for MPGN I . Those showing only classical activation are likewise diagnostic of MPGN I if systemic lupus erythematosus (SLE) and chronic bacteremia are ruled out.

Obstet Gynecol Surv, 1990 Sep, 45(9), 563 - 9
Pyomyoma associated with polymicrobial bacteremia and fatal septic shock: case report and review of the literature; Greenspoon JS et al.; case of fatal septic shock due to pyomyoma (suppurative leiomyoma of the uterus) is reported . This unusual cause of sepsis and polymicrobial bacteremia should be rapidly identified because surgical therapy is essential for cure . Nine additional cases reported since 1945 are reviewed . Pyomyoma develops in association with either recent pregnancy or in postmenopausal patients who frequently have underlying vascular disease . The triad of: 1) bacteremia or sepsis; 2) leiomyoma uteri; and 3) no other apparent source of infection should suggest the diagnosis of pyomyoma.

Am J Physiol, 1990 Sep, 259(3 Pt 2), H728 - 34
Prostaglandins mediate skeletal muscle arteriole dilation in hyperdynamic bacteremia; Cryer HG et al.; Live Escherichia coli bacteremia during the high cardiac output (hyperdynamic) phase of sepsis causes constriction of large arterioles but dilation of small arterioles in skeletal muscle . This study examines the role of dilator prostaglandins, serotonin, and histamine in these differential microvascular responses in the decerebrate rat that avoids the effects of drug anesthesia . Topical application of meclofenamate, a prostaglandin synthesis inhibitor, to the cremaster muscle 60 min after induction of E . coli bacteremia enhanced the constriction of large arterioles from 20 +/- 8 to 46 +/- 9% less than baseline and blunted the dilation of small arterioles from 39 +/- 9 to 17 +/- 7% above baseline values in the cremaster microcirculation . Induction of E . coli bacteremia after pretreatment of the cremaster with meclofenamate constricted large arterioles to 40 +/- 4% less than baseline and small arterioles to 31 +/- 4% less than baseline . This indicates that prostaglandins initiate small arteriole dilation in response to E . coli, but some other dilator factor is activated by prostaglandins to maintain small arteriole dilation during E . coli bacteremia . Topical application of cyproheptadine, an antagonist of both histamine and serotonin receptors, to the cremaster muscle did not alter the E . coli-induced constriction of large arterioles or the dilation of small arterioles in the cremaster microcirculation.

J Clin Oncol, 1990 Sep, 8(9), 1591 - 7
Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms; Schwartz C et al.; Forty-five children with oncologic or hematologic disorders requiring tunneled central venous catheters (TCVC) for the administration of immunosuppressive therapy were randomized to receive either 10 U/mL heparin (H) (24 patients) or a solution of 10 U/mL H and 25 micrograms/mL vancomycin (H-V) (21 patients) for all catheter flushes . Episodes of fever or suspected sepsis were evaluated to determine whether the addition of vancomycin to the flush solution would alter the incidence of symptomatic bacteremia attributed to luminal colonization of TCVC with vancomycin-susceptible bacteria . Patients were enrolled for 247 +/- 150 days, accounting for a total of 11,095 days of catheter use . Bacteremia attributed to luminal colonization with vancomycin-susceptible organisms occurred in five patients (six infections) receiving H alone compared with zero patients receiving H-V (P = .035) . The time to the first episode of bacteremia with vancomycin-susceptible organisms, analyzed by Kaplan-Meier survival curves, was significantly longer in patients receiving H-V (P = .04) . There were no differences in the incidence of other infections including bacteremia attributed to luminal colonization with vancomycin-resistant organisms, other bacteremias (including those arising from the catheter exit site), exit-site cellulitis, or fungal infections . No organisms resistant to vancomycin were identified . Vancomycin could not be detected in the peripheral blood of patients receiving vancomycin in the flush solution . No vancomycin-related toxicities were noted . We conclude that the use of an H-V flush solution in immunocompromised patients with TCVC can decrease the frequency of bacteremia attributed to luminal colonization with vancomycin-susceptible bacteria.

Antimicrob Agents Chemother, 1990 Sep, 34(9), 1629 - 32
Effect of rifabutin on disseminated Mycobacterium avium infections in thymectomized, CD4 T-cell-deficient mice; Furney SK et al.; Disseminated Mycobacterium avium infection is the major cause of bacteremia in patients with acquired immunodeficiency syndrome . We present here a new animal model of this disease, thymectomized C57BL/6 mice that were intravenously infused with monoclonal antibody to selectively deplete CD4+ T cells . The increased susceptibility of such animals to M . avium infection is comparable to that of C57BL/6 beige mice and thus may provide a viable alternative to the latter model . Further, using representative strains of acquired immunodeficiency syndrome-associated M . avium (serotypes 1, 4, and 8 and a rough isolate), we show that the course of such infections in thymectomized, CD4-deficient mice can be markedly restrained and in some cases the infections can be sterilized by treatment over a 120-day period with a regimen containing 40 mg of the new antimycobacterial agent rifabutin per kg (body weight).

Am J Kidney Dis, 1990 Sep, 16(3), 211 - 5
Use of a silicone dual-lumen catheter with a Dacron cuff as a long-term vascular access for hemodialysis patients; Moss AH et al.; We evaluated our experience over a 4-year period with a silicone dual-lumen catheter with a Dacron cuff (SDLCDC) to determine if the catheter represents an alternative to the polytetrafluoroethylene graft for long-term vascular access for hemodialysis patients . Records of 131 patients who used 168 catheters were reviewed for catheter function, duration of use, and occurrence and response to treatment of complications . Eighty-five percent of catheters functioned adequately until their use was no longer required or the end of the study . One-year catheter survival estimate was 65% and median survival estimate was 18.5 months . Mean blood flow rate achieved was 243 mL/min and recirculation was 7.5% . Exit-site infection occurred in 21% of patients and bacteremia in 12% . There were significantly more exit-site infections in diabetics than nondiabetics (33% v 11%, P less than 0.02) . Exit-site infections resolved with parenteral antibiotic therapy in 90% and bacteremia in 25% of cases without catheter removal . Unresolved bacteremia was the most common cause of catheter removal and led to the loss of 7% of catheters . Thrombotic complications occurred in 46% of catheters . Urokinase instillation successfully treated catheter occlusion in 81% of cases . When urokinase instillation failed, streptokinase infusion restored catheter patency 97% of the time . The literature on the polytetrafluoroethylene (PTFE) graft was reviewed, and the SDLCDC was found to be similar to the graft in function, duration of use, and frequency of infectious and thrombotic complications . We conclude that the catheter represents an alternative to the graft for long-term vascular access in hemodialysis patients . Because of the frequent complications with both accesses, neither should be considered optimal . Further research is required to improve vascular access for patients in whom placement of an arteriovenous fistula is not possible.

JPEN J Parenter Enteral Nutr, 1990 Sep-Oct, 14(5), 463 - 6
Effect of tracer and intravenous fat emulsion on the measurement of reticuloendothelial system function; Hirschberg Y et al.; Since the addition of lipid to intravenous feeding formulas, animal and human studies have shown impairment of the reticuloendothelial system (RES) due to slow rates of clearance and gradual accumulation of long chain triglycerides (LCT) in the liver . Medium chain triglycerides (MCT) accumulate only minimally in the liver and do not impair the RES . However, results from animal studies using technetium sulfur colloid (TSC) to assess RES function have been inconclusive . The present study reevaluates RES function after lipid infusion in guinea pigs as measured by organ distribution of TSC . Guinea pigs were fed 300 kcal/kg/day of total parenteral nutrition (TPN) for 2.5 days, with 50% of nonprotein calories as fat in the form of LCT or MCT, then injected intravenously with 2.5 or 25 microCi of TSC, and uptake by liver, spleen, and lungs was determined . Liver, lungs, and spleen all increased in size after TPN with LCT or MCT . Liver TSC uptake was significantly affected by the dose of TSC (p less than 0.05), with the high dose probably inducing an increased capacity of the liver to clear TSC from the blood . Liver uptake was not influenced by diet, but feeding MCT did significantly stimulate lung uptake of TSC (p less than 0.0001) . This suggests that the hepatic TSC uptake system is not saturable, and may not be an appropriate measure of Kupffer cell function since the colloid is not phagocytosed . However, TSC blood clearance remains an excellent prognostic indicator for bacteremia and mortality in humans, and is useful for measuring global RES function.

Am J Med, 1990 Aug, 89(2), 134 - 6
Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients; Bianco JA et al.; PURPOSE: To determine the prevalence of clinically relevant bacteremia after upper endoscopy in patients undergoing bone marrow transplantation . PATIENTS AND METHODS: We retrospectively reviewed the records of 151 patients who received an HLA-identical allogeneic bone marrow transplant (BMT) at the Seattle Veterans Affairs Medical Center between September 1983 and December 1988 . Forty-seven patients who required esophago-gastroduodenoscopy (EGD) during their first 100 days after transplant were selected for evaluation . Clinically relevant bacteremia was defined as the development of hypotension, temperature greater than 38.5 degrees C, and a positive blood culture occurring within 24 hours after endoscopy . The presence of acute graft-versus-host disease (GVHD) at the time of endoscopy and the use of prednisone prior to endoscopy were considered possible risk factors for the development of bacteremia . The proportion of subjects who became bacteremic were compared using Fisher's exact test . RESULTS: Within 24 hours following endoscopy, nine patients (19%) developed clinically evident bacteremia (hypotension, temperature greater than 38.5 degrees C, and a positive blood culture) . Eight of 14 patients receiving prednisone at the time of endoscopy developed bacteremia, compared to one of 33 not receiving prednisone (p less than 0.01) . Nineteen patients had acute GVHD of at least grade 2 at the time of EGD, six of whom developed bacteremia . Although acute GVHD alone did not increase the risk of post-EGD bacteremia in patients not receiving prednisone (one of 21 versus zero of 12, p greater than 0.9), the risk of bacteremia was particularly high in patients with acute GVHD treated with prednisone at the time of EGD (six of seven) . CONCLUSION: Allogeneic BMT recipients receiving prednisone for immunoprophylaxis after grafting or for treatment of acute GVHD are at high risk for clinically relevant bacteremia following EGD . Such patients are candidates for antibiotic prophylaxis prior to endoscopy.

Infect Immun, 1990 Aug, 58(8), 2564 - 8
Characterization and growth in human macrophages of Mycobacterium avium complex strains isolated from the blood of patients with acquired immunodeficiency syndrome; Meylan PR et al.; Strains of the Mycobacterium avium complex (MAC) yield opaque and transparent colonial variants when cultivated in vitro . The transparent variants are more virulent than the opaque for animals, but little is known about the respective roles of these colonial variants in humans . To assess which variant infects humans, various blood fractions from eight patients with MAC bacteremia were plated directly onto 7H10 agar . In cell fractionation studies, all the M . avium complex CFU were associated with leukocytes and none were found free in plasma . All colonies on the primary culture plate exhibited the transparent phenotype . However, during subculture in 7H9 broth or on Lowenstein-Jensen agar, opaque variants appeared in seven of eight strains . Isogenic pairs of transparent and opaque variants were prepared and used to infect in vitro human monocyte-derived macrophages from healthy seronegative individuals . Transparent variants invariably grew inside macrophages, but only one of seven opaque variants did so . These observations indicate that the bacteremia of M . avium complex in acquired immunodeficiency syndrome patients consists exclusively of the transparent variants, perhaps because these variants are able to multiply inside macrophages . In contrast, opaque variants appear after in vitro subculture and are controlled by human macrophages, consistent with their reduced virulence in animals.

J Clin Periodontol, 1990 Aug, 17(7 ( Pt 2)), 516 - 24
Implants and infections with special reference to oral bacteria; Haanaes HR; Osseointegration or bony anchorage of oral implants was first described by Branemark and coworkers . This type of connection between the titanium oxide layer and the bone gives stable long-term results for the implants in function . Fibrous tissue interphase between implant and bone will allow mobility which will gradually increase and cause implant failure . The microbiota around stable versus failing implants seem to parallel the patterns around healthy versus diseased natural teeth . Infections most often develop around failing implants . This may create mostly localized, but sometimes even widespread serious infection problems . Metastatic infectious problems related to endo-prosthesis replacing joints and cardiovascular structures are briefly discussed in connection with bacteremia caused by oral infections in general and surgical procedures.

Toxicol Lett, 1990 Aug, 52(3), 227 - 51
Aminoglycoside-induced ototoxicity; Govaerts PJ et al.; One of the major side effects of aminoglycoside antibiotics (AG) is ototoxicity . The authors review the literature revealing many controversies on every aspect of this side-effect . Although epidemiological studies have to face the problem of reliable evaluation techniques, the incidence of cochleo- and vestibulotoxic side-effects has been estimated at 7.5% for each . Netilmicin appears to be less ototoxic . No definite risk factors can be proposed, although age, length of therapy, bacteremia, fever, liver and renal dysfunction are probably very important parameters . Most pathological changes at the cochlear level follow a clear spatial sequence, showing unspecific, degenerative lesions, involving every structure of the cochlea . This makes it impossible to draw etiopathological conclusions . Recent pharmacokinetic studies have rejected the 'accumulation theory' of AGs in perilymph, while also in endolymph no accumulation can be found . Only a few data are available on inner ear tissue levels . Among the different pharmacodynamic hypotheses on the action of AGs, binding of the drug to acidic glycosaminoglycans in the stria vascularis, and interference by the drug with phosphoinositide metabolism in the hair cells seem to be of major importance.

Am J Dis Child, 1990 Aug, 144(8), 879 - 82
Prolonged bacteremia with catheter-related central venous thrombosis; Rupar DG et al.; Infection of a central venous thrombus is a serious but rarely recognized complication of the use of central venous catheters in children . We report the cases of seven children with persistent bacteremia or fungemia in which central venous thrombosis was demonstrated by ultrasonography after removal of the catheter . All patients had signs and symptoms of infection, but only one had clinical evidence of central venous stasis . Bacteremia persisted from 6 to 35 days . Infection did not resolve in any patient prior to catheter removal, and five patients had positive blood cultures for 5 or more days after removal of the catheter . Six patients, including all who survived, were treated parenterally with antibiotics for more than 28 days . Two patients died; neither death was directly attributable to infection . Central venous thrombosis should be suspected in patients with persistent catheter-related bacteremia . Optimal treatment of this problem is not yet known.

Resuscitation, 1990 Aug, 20(1), 1 - 16
Central venous catheter related sepsis: a clinical review; Putterman C; Central venous catheterization is one of the most common invasive vascular procedures performed in hospitals today . Though catheter related sepsis occurs only in a small percentage of catheterized patients, this complication has a tremendous impact due to the ubiquitous use of central venous catheters and consequent morbidity and even mortality . Recent studies have considerably advanced our knowledge regarding the pathogenesis, diagnosis, and prevention of catheter sepsis . In this paper, current concepts regarding catheter-related sepsis are reviewed, regarding the incidence, pathophysiology, diagnosis, prevention, and therapy of this complication . Particular emphasis is placed upon recent research and clinical advances in this field, which have clarified important question and suggested promising approaches to the prevention and treatment of catheter bacteremia . The excessive morbidity and mortality due to catheter-related sepsis can be markedly decreased, by attention to simple infection control methods, and by future implementation of new experimental techniques.

Arch Intern Med, 1990 Jul, 150(7), 1401 - 5
Pneumococcal bacteremia in Charleston County, South Carolina . A decade later; Breiman RF et al.; Since nationwide surveillance for pneumococcal bacteremia in the United States is not done, community-based studies are useful alternative methods to monitor trends in this disease . Data on the incidence of pneumococcal bacteremia in Charleston County, South Carolina, from 1974 to 1976, have been used to support cost-effective pneumococcal vaccine programs for the elderly . We reevaluated the incidence of pneumococcal bacteremia in Charleston County in 1986 and 1987 to assess whether earlier estimates remained valid given changes in medical practice . During 1986 and 1987, overall annual incidence of pneumococcal bacteremia in Charleston County was 18.7 per 100,000 (95% confidence limits, 13.7 to 23.6 per 100,000), which represents a 2.3-fold increase over the earlier rate . The increase coincided with a 2.2-fold increase in the annual number of blood cultures processed at four Charleston County hospital laboratories from 1975 to 1987 despite only a 1.1-fold increase in the number of patients discharged from these hospitals . Annualized rates increased 2.3-fold for adults more than or equal to 65 years old to 53 per 100,000 and 4.6-fold for children less than 2 years old to 162 per 100,000 . The case-fatality rate of bacteremic patients was 18%, compared with 21% in the earlier study . The case-fatality rate for adults more than or equal to 65 years of age was 44% . Ninety-one percent of adults 19 to 64 years old with bacteremia had underlying medical conditions for which pneumococcal vaccine is recommended; all persons 55 to 64 years old had at least one underlying condition . The marked increases in pneumococcal bacteremia rates detected are likely due to more routine culturing of blood from symptomatic patients with pneumococcal disease . These findings emphasize the need for effective programs promoting use of pneumococcal vaccine in high-risk groups, particularly those more than or equal to 65 years old, and the development of a more immunogenic vaccine for children less than 2 years old.

Am J Med, 1990 Jul, 89(1), 53 - 7
Hospitalization decision in febrile intravenous drug users; Samet JH et al.; PURPOSE: To determine the frequency and to identify predictive factors of occult major illness in febrile intravenous drug users (IVDUs) presenting to an emergency room . PATIENTS AND METHODS: A prospective follow-up study was performed involving a consecutive series of 296 presentations of febrile IVDUs to a public hospital emergency room . Follow-up information was obtained for 283 presentations (95.6%) . Physician's initial assessment was obtained for 204 presentations (70%) . Illness was classified as major or minor using explicit criteria . Frequency of occult major illness was determined among patients without obvious major illness on presentation . Risk factors for occult major illness were determined . RESULTS: Occult major illness occurred in 11 patients (4%) . This represented 11% of the 103 presentations without obvious major illness on presentation . Pneumonia and cellulitis occurred in 128 of 180 patients (71%) with obvious major illness on presentation . Bacteremia was present in seven of 11 patients with occult major illness . Physician predictions were not sufficiently sensitive to provide the basis of the hospitalization decision in febrile IVDUs . The best combination of features suggesting major illness were last use of intravenous drugs less than 5 days and fever greater than 38.8 degrees C (102.0 degrees F) (sensitivity 64%, specificity 77%) . CONCLUSION: Clinical tests and physician assessments are unable to distinguish occult major illness from minor illness among febrile IVDUs at presentation . Occult major illness is best identified by blood culture . If patient follow-up is unreliable, then hospitalization of febrile IVDUs, while awaiting blood culture results, remains a wise policy.

J Infect Dis, 1990 Jul, 162(1), 208 - 10
Absence of bacteremia with Mycobacterium avium-intracellulare in Ugandan patients with AIDS; Okello DO et al.; Disseminated infection with Mycobacterium avium-intracellulare is the most common systemic bacterial infection in American patients with the acquired immunodeficiency syndrome . Blood cultures for mycobacteria were obtained from 50 severely ill Ugandan patients fulfilling the World Health Organization criteria for AIDS and considered late in the course of their illness; 98% had antibody to HIV by ELISA . All blood cultures were negative . These data suggest that disseminated infection with M . avium-intracellulare is infrequent in Ugandan patients with AIDS, if it occurs at all.

Mikrobiyol Bul, 1990 Jul, 24(3), 187 - 92
{Early detection of bacteremia in infancy}; Oguz A et al.; The detection of bacteremia in children less than 24 months of age with fever, is very important, since these patients are at serious risk pyogenic complication . The administration of antibiotics in accordance with the results of cultures is too time consuming . So, several laboratory detection bacteremia must be carried out . In this study, blood cultures, the elevation of white blood cell count, toxic granulation and vacuolization in neutrophils were investigated in 56 children with suspicion of bacteremia . 32 of them were males and 24 females . The positive results were obtained in 41.1% in blood cultures . Positive predictive accuracy were 66.6% and 52.3% for vacuolization and toxic granulation respectively . The presence of these were considered as adjunctive procedures in the early diagnosis of bacteremia.

Clin Microbiol Rev, 1990 Jul, 3(3), 269 - 79
Quantitative aspects of septicemia; Yagupsky P et al.; For years, quantitative blood cultures found only limited use as aids in the diagnosis and management of septic patients because the available methods were cumbersome, labor intensive, and practical only for relatively small volumes of blood . The development and subsequent commercial availability of lysis-centrifugation direct plating methods for blood cultures have addressed many of the shortcomings of the older methods . The lysis-centrifugation method has demonstrated good performance relative to broth-based blood culture methods . As a result, quantitative blood cultures have found widespread use in clinical microbiology laboratories . Most episodes of clinical significant bacteremia in adults are characterized by low numbers of bacteria per milliliter of blood . In children, the magnitude of bacteremia is generally much higher, with the highest numbers of bacteria found in the blood of septic neonates . The magnitude of bacteremia correlates with the severity of disease in children and with mortality rates in adults, but other factors play more important roles in determining the patient's outcome . Serial quantitative blood cultures have been used to monitor the in vivo efficacy of antibiotic therapy in patients with slowly resolving sepsis, such as disseminated Mycobacterium avium-M . intracellulare complex infections . Quantitative blood culture methods were used in early studies of bacterial endocarditis, and the results significantly contributed to our understanding of the pathophysiology of this disease . Comparison of paired quantitative blood cultures obtained from a peripheral vein and the central venous catheter has been used to help identify patients with catheter-related sepsis and is the only method that does not require removal of the catheter to establish the diagnosis . Quantitation of bacteria in the blood can also help distinguish contaminated from truly positive blood cultures; however, no quantitative criteria can invariably differentiate contamination from bacteremia.

Am J Med, 1990 Jul, 89(1), 58 - 66
Once-daily dosing regimen for aminoglycoside plus beta-lactam combination therapy of serious bacterial infections: comparative trial with netilmicin plus ceftriaxone; ter Braak EW et al.; PURPOSE: Once-daily dosing of aminoglycosides has been suggested to improve their efficacy and reduce their toxicity . To test the clinical validity of this suggestion, we conducted a prospective, randomized trial comparing a conventional multiple-daily-dosing regimen of netilmicin with once-daily administration of the same total daily dose of this aminoglycoside . PATIENTS AND METHODS: We enrolled 141 predominantly elderly patients with severe bacterial infections . All patients received once-daily doses of 2 g ceftriaxone, in addition to netilmicin . RESULTS: Patients randomized to either of the two dosing strategies were comparable regarding age, APACHE II score, concomitant diseases, infection site, and rate of culture-proven bacteremia . Netilmicin treatment did not differ significantly in mean daily dose per kg body weight and days of therapy between the two treatment arms . Compared to patients receiving conventional doses, patients treated with a once-daily dose had higher serum peak netilmicin levels and lower trough levels . Outcome of infection and mortality were not influenced by dosing strategy . Although the overall incidence of nephrotoxicity was similar in both groups (16%), the occurrence of nephrotoxicity in patients treated with once-daily doses of netilmicin was significantly shifted to those given prolonged treatment, i.e., beyond 9 days . Auditory toxicity was documented in one patient treated with conventional doses and two patients treated with once-daily doses . CONCLUSION: Once-daily dosing of an aminoglycoside plus a long-acting cephalosporin in these patients constituted cost-effective and safe treatment for severe bacterial infections . Netilmicin-induced toxicity may be reduced by using once-daily dosing regimens and limiting the duration of treatment.

Obstet Gynecol, 1990 Jul, 76(1), 28 - 32
Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy; Angel JL et al.; Ninety pregnant women admitted to the high-risk pregnancy unit with a diagnosis of acute pyelonephritis were randomized to receive either oral (cephalexin 500 mg every 6 hours) or intravenous (IV) (cephalothin 1 g every 6 hours) antibiotic therapy . All patients were initially hydrated with 1 L of normal saline IV over 4 hours . Neither parenteral analgesics nor antiemetics were used . Bacteremia was noted in 13 (14.4%) of the 90 patients and mandated IV therapy . There was no difference between the oral and IV groups concerning predefined criteria for successful therapy (91.4 versus 92.9% successful therapy, respectively) . No characteristic available at presentation predicted bacteremia or ultimate failure of therapy . Two patients (2.2%) experienced significant complications . These data suggest that in nonbacteremic patients, oral antibiotics are both safe and effective for the treatment of acute pyelonephritis in pregnancy.

Arch Stomatol (Napoli), 1990 Jul-Sep, 31(3), 507 - 9
{Fragile X syndrome}; Femiano F et al.; The fragile X syndrome include clinical features macroorchidism, ear large, prognathism, elongated facies, speech dysfunction, mental retardation and mitral valve prolapse . The interest for this syndrome is linked to the antibiotic prophylaxis for bacterial secondary endocarditis and bacteremia.

J Leukoc Biol, 1990 Jul, 48(1), 67 - 73
Recombinant granulocyte-macrophage colony-stimulating factor activates human macrophages to inhibit growth or kill Mycobacterium avium complex; Bermudez LE et al.; Organisms belonging to the Mycobacterium avium complex (MAC) are associated with life-threatening bacteremia in patients with the acquired immunodeficiency syndrome (AIDS) . As these organisms survive within macrophages, we examined the ability of recombinant human granulocyte-monocyte colony-stimulating factor (GM-CSF) to activate human monocyte-derived macrophages to inhibit the intracellular growth or kill the most mouse-virulent MAC strain in our collection that belongs to serotype 1 . While unstimulated cells did not inhibit intracellular growth of MAC, macrophages activated by GM-CSF (10-10(4) U/ml) inhibited or killed up to 58 +/- 5% of the initial inoculum . This activation was dose-dependent, with maximal change occurring with a dose of 100 U/ml after 72 hr exposure . Inhibition or killing was demonstrated if GM-CSF was given both before or after establishment of infection . The combination of GM-CSF (10(2) U/ml) plus TNF (10(2) U/ml) augmented macrophage killing (range, 31 +/- 4%) compared with GM-CSF (10(2) U/ml) alone, but the combination of recombinant human interferon-gamma (IFN gamma) plus GM-CSF resulted in a significant decrease in intracellular inhibition of growth or killing (13.3 +/- 2%) compared with 57.7 +/- 5% obtained with GM-CSF alone . These results indicate that: 1) GM-CSF can activate macrophages to inhibit intracellular growth or kill MAC; 2) killing may be augmented by TNF; and 3) IFN gamma may impair GM-CSF-dependent macrophage activation.

Acta Chir Scand, 1990 Jun-Jul, 156(6-7), 487 - 8
Fatal pneumococcal bacteremia with disseminated intravascular coagulation and Waterhouse-Friderichsen syndrome in a vaccinated splenectomized adult . Case report; Lindblad BE et al.; Fatal pneumococcal bacteremia, disseminated intravascular coagulation and Waterhouse Friderichsen syndrome in a vaccinated, splenectomized adult were caused by serotype 22F (Danish classification), which was not included in the vaccine . Revaccination with a 23-valent pneumococcal vaccine and antibiotic prophylaxis are advocated for patients who have undergone splenectomy.

Am J Infect Control, 1990 Jun, 18(3), 201 - 7
Colonization and bacteremia related to duration of triple-lumen intravascular catheter placement; Ullman RF et al.; The increased use of triple-lumen catheters has brought with it an increase in sepsis . We undertook a study to determine whether this increase was related to the length of time a catheter was in place . Culture of the fluid in each of the three lumens of all triple-lumen catheters in the medical intensive care units was done daily for a 6-month period . In 14 of 31 catheters, 28 of 93 lumens showed bacterial or fungal growth . A temporal relationship between the time a catheter was placed and the onset of catheter colonization and patient sepsis was established (p less than 0.01) . Catheter colonization preceded sepsis in three of four patients who became bacteremic with the same organisms that were cultured from the lumens and the catheter tips . As a result of this study, centrally placed intravascular lines are now changed every 7 days in our institution with a noticeable decrease in line-related sepsis.

Arch Intern Med, 1990 Jun, 150(6), 1270 - 2
Occult bacterial infection in adults with unexplained fever . Validation of a diagnostic index; Leibovici L et al.; We tested the performance of a previously developed index to diagnose occult bacterial infection and bacteremia in febrile patients . A total of 113 patients consecutively hospitalized because of an acute febrile disease, without a recognizable source of fever, were divided into four groups, with increasing probability of bacterial infection and bacteremia . None of the patients in the first group had bacterial infection or bacteremia . The incidence of bacterial infection and bacteremia was 27% and 11% in the second group, 32% and 17% in the third group, and 53% and 35% in the fourth group . No patient in the first group died, as opposed to 29% of patients in the fourth group . The use of the index at admission would have probably changed the treatment of 11% of patients . Thus, the index could be used to identify patients to be discharged from the emergency department (first group) or hospitalized and treated empirically (fourth group).

J Med Assoc Thai, 1990 Jun, 73(6), 345 - 52
Community-acquired pneumonia in adults at Srinagarind Hospital; Boonsawat W et al.; A prospective study of community-acquired pneumonia in adults at Srinagarind Hospital, Khon kaen University was conducted from September 1987 to August 1988 . Laboratory specimens were tested for bacterial and mycoplasmal culture, CIE for pneumococcal antigen and serological data for mycoplasma and P . pseudomallei . The results supported by clinical data were evaluated . We could identify the pathogens from 62 of 113 cases (55%) . P . pseudomallei was the most frequent etiologic agent (32%) and S . pneumoniae was the second (27%) . Overall mortality was 21 per cent and it was high in cases with bacteremia and pneumonia due to P . pseudomallei . Sixty-six per cent of the patients had associated diseases . Diabetes mellitus, chronic renal failure and renal calculi were commonly found in patients with pneumonia due to P . pseudomallei . The results of this study showed the relatively high prevalence of P . pseudomallei pneumonia in our region which was different from other reports.

Arch Intern Med, 1990 Jun, 150(6), 1332 - 4
Moraxella (Branhamella) catarrhalis bacteremia . A case report and literature review; Wallace MR et al.; Moraxella catarrhalis is increasingly recognized as a cause of pulmonary and upper airway disease, but bacteremia remains unusual . We treated a 71-year-old man who died of rapidly progressive bacteremic M catarrhalis bronchopneumonia . This case, and a review of the 27 previously reported M catarrhalis bacteremias in the literature, demonstrated that M catarrhalis can be a virulent organism capable of causing serious infection and death in both immunocompetent and compromised hosts.

J Trauma, 1990 Jun, 30(6), 706 - 12
An evaluation of triple-lumen catheter infections using a guidewire exchange technique; Norwood S et al.; One hundred fifty-six triple-lumen central venous catheters placed into 65 different sites in 52 surgical or trauma patients were prospectively evaluated to determine the frequency of catheter-related infection and the efficacy of multiple guidewire exchanges . Thirty-four anatomic sites in 33 patients without clinical signs of sepsis were compared to 31 anatomic sites in 19 patients with a clinical diagnosis of sepsis based on clinical, microbiologic, and radiologic evaluation . Anatomic sites were used indefinitely unless a positive semiquantitative catheter culture (greater than or equal to 15 cfu) or catheter-associated bacteremia developed . Seven catheter-related infections developed in five septic patients (26.3%) while no infections developed in the nonseptic group (p = 0.004) . Three of 31 anatomic sites (9.6%) were associated with bacteremia . The number of hospital days to initial catheter insertion and the length of catheter site use were considerably higher in the septic patients compared to the nonseptic group . We conclude that triple-lumen catheter-related infections are uncommon in patients with no evidence of infection and can be safely guidewire-exchanged to prolong site use . Catheter-related infections in septic patients are much more frequent and unpredictable . Although guidewire exchange has a role in septic patients, multiple exchanges cannot routinely be recommended.

Vrach Delo, 1990 May, (5), 108 - 11
{The anginal form of yersiniosis}; Markov IS; The anginal form of yersiniosis is described in 16 patients (1.3% of all patients with this kind of infection) . Clinico-laboratory investigations revealed signs of a generalized process with bacteremia and toxemia . The syndrome complex of infectious mononucleosis is often observed in this form of yersiniosis . Two patients showed a diphtheria-like form of severe angina . In 31% of patients recurrence developed but usually without angina . The outcomes are favourable.

Am J Med, 1990 May, 88(5N), 28N - 32N
Diagnostic value of bacterial and fungal blood cultures in patients with the acquired immunodeficiency syndrome; Katz SJ et al.; PURPOSE: To evaluate the usefulness of bacterial and fungal blood cultures in febrile hospitalized patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) . PATIENTS AND METHODS: We reviewed all cases of bacteremia and fungemia detected in 446 patients admitted to a university hospital with AIDS or ARC over a 54-month period, and records of all patients with AIDS or ARC, with or without bacteremia, who were admitted during a 12-month subset of the study period . RESULTS: Only four of the 28 cases of fungemia detected during the study period resulted in unique diagnoses of serious fungal infections, and all four patients died prior to discharge . Among the 46 cases of bacteremia diagnosed during the same period, all 36 (78%) with suggestive clinical findings were detected by culturing three times; nine of 10 without such findings were detected by culturing once and all by culturing twice . Medical record review of 132 patients admitted with AIDS or ARC during a 12-month subset of the study period revealed that culturing was common but the yield was low: positive culture rates were 1.9% for fungal cultures and 6.5% for bacterial cultures when clinical findings suggested bacteremia (versus 1.5% without such findings, p less than 0.025) . CONCLUSION: Fungal blood cultures had very little clinical value in the population studied, yielding unique diagnoses only in patients near death . In those with fever, but without clinical findings suggesting bacteremia, obtaining bacterial cultures on two occasions was sufficient to detect all cases.

Dig Dis Sci, 1990 May, 35(5), 661 - 4
Ruptured mycotic pseudoaneurysm of the gastroduodenal artery presenting with hemoperitoneum and subcapsular liver hematoma; Rogers DW et al.; We report a case of a patient with mycotic pseudoaneurysm of the gastroduodenal artery who presented with hemoperitoneum and subcapsular hematoma of the liver . The diagnosis was established with contrasted abdominal CT scanning . Visceral angiography was not needed . Prompt recognition and surgical intervention led to a favorable outcome . Pseudoaneurysm of visceral vessels is an uncommon disease process, and to our knowledge, this is the first reported case that has presented with free blood in the peritoneal cavity and beneath the liver capsule . This case may also represent a rare complication of therapeutic ERCP procedures . Mycotic aneurysm or pseudoaneurysm of visceral vessels may develop from bacteremia and its dissection or rupture should be suspected in patients presenting with sepsis and abdominal pain.

ZWR, 1990 Apr, 99(4), 266 - 70
{Endocarditis risk in use of dental irrigators}; Rahn R et al.; The incidence of bacteremia after application of a dental irrigator was investigated in 100 healthy volunteers . Venous blood was inoculated in routine blood culture bottles one, three and five minutes after dental irrigation . In 39 volunteers a transient bacteremia was detected, mainly Strep . Viridans was cultured . Incidence correlated with the grade of oral hygiene und periodontal disease.

J Clin Microbiol, 1990 Apr, 28(4), 742 - 6
Virulence-related genes in ColV plasmids of Escherichia coli isolated from human blood and intestines; Fernandez-Beros ME et al.; DNA probes for the colicin V, traT, iss, and iu genes were used in this study of four representative ColV plasmids together with 200 Escherichia coli strains isolated from the stools of patients with diarrhea and 146 E . coli strains isolated from the blood of patients with bacteremia . The study indicated that the ColV plasmids are heterogeneous . Southern and colony hybridization analyses showed that in most of the colicin V-producing intestinal E . coli strains, the colicin V genes are located in the chromosome (14 of 16); in most of the colicin V-producing E . coli strains isolated from the blood, they are located in plasmids (18 of 22) . In both intestinal and blood E . coli isolates, the traT, iss, and aerobactin receptor genes were present at similar frequencies, but the frequency of the aerobactin synthesis genes was significantly different . The aerobactin receptor gene was present in 25% of the intestinal E . coli strains that lack the aerobactin synthesis gene . In the blood isolates, the aerobactin synthesis and receptor genes were present at almost equal frequencies . Among the colicin V-producing isolates, the iss, traT, and iu genes were present in 95.5, 86.4, and 90.9% of the blood isolates and in only 68.8, 43.8, and 81.3% of the intestinal isolates, respectively . The ColV plasmids from blood isolates that were tested for the presence of traT, iss, and iu genes were homogeneous and had DNA sequences that hybridized with each of the probes . On the other hand, the two intestinal strains containing ColV genes in a plasmid were heterogeneous in regard to the carriage of these genes . The presence of ColV is not restricted to specific O types.

J Infect Dis, 1990 Apr, 161(4), 801 - 5
Quadruple-drug therapy for Mycobacterium avium-intracellulare bacteremia in AIDS patients; Hoy J et al.; The mycobacterial response was evaluated for patients with Mycobacterium avium-intracellulare complex (MAC) bacteremia treated with a quadruple regimen of rifabutin, clofazimine, isoniazid, and ethambutol . Mycobacteremia was cleared in 22 of 25 patients who received this regimen, and 18 patients experienced complete resolution of symptoms associated with MAC infection . All of the patients were immunodeficient, with a mean CD4 cell count at the time of diagnosis of MAC infection of 54.7 +/- 54.6 cells/microliters . All MAC isolates were resistant to clofazimine, isoniazid, and ethambutol . Sixteen of 24 isolates were resistant to rifabutin . Improved results of treatment may be related to the use of a higher dose of rifabutin (300-600 mg/day) compared with other studies (150-300 mg/day), earlier diagnosis and institution of treatment, and synergy between rifabutin and ethambutol . The quadruple regimen used in this study appears effective in clearing mycobacteremia and in ameliorating symptoms of infection.

Arq Gastroenterol, 1990 Apr-Jun, 27(2), 80 - 2
{Crepitant abdominal cellulitis: a rare clinical presentation of sigmoid tumor}; Chaib E et al.; Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to presence of malignancy . The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors . The authors present one case of spontaneous crepitant cellulitis in the lower abdominal wall, associated with sigmoid tumor . The patient had abdominal pain in the left iliaca fossa, fever and skin necrosis of the lower abdominal wall in the last 4 hours . At surgery they performed debridement and excision of necrotic tissue (lower abdominal wall) and partial sigmoidectomy with sigmoid colostomy . The patient died 9 months after initial surgery . A study of tumor mass revealed an adenocarcinoma . The presence of crepitant cellulitis in a lower abdominal wall should result in a search for bowel perforation.

Schweiz Med Wochenschr, 1990 Mar 31, 120(13), 440 - 5
{Sepsis caused by Fusobacterium necrophorum: the re-discovered postangina sepsis Lemierre syndrome and other manifestations}; Gubler JG et al.; Among 5 patients with bacteremia due to Fusobacterium necrophorum, 3 young adults had post-anginal sepsis (Lemierre syndrome), including one with the classical secondary metastatic complications of pulmonary abscesses, pleural empyema, arthritis and hepatobiliary disturbances . The primary focus was a cholangiogenic abscess in an 81-year-old woman, and fetid otitis following a radical operation for cholesteomatous chronic otitis media in a 29-year-old male . Septicemia due to Fusobacterium necrophorum, and in particular Lemierre syndrome, are presented in the light of the literature.

Am J Clin Pathol, 1990 Mar, 93(3), 391 - 4
The effect of bacteremia on automated platelet measurements in neonates; Patrick CH et al.; Platelet volume measurements have been used to differentiate consumptive and hypoplastic thrombocytopenia . Since thrombocytopenia is a frequent complication of neonatal sepsis, the authors explored the utility of correlating mean platelet volume (MVP) and platelet distribution width (PDW) with bacteremia . In a sample of 156 infants, there was a significantly increased presence of bacteremia in those infants with MPV greater than 10.8 fL and/or PDW greater than 19.1% . High MPV and PDW showed high specificity for detecting bacteremia (95% and 79%, respectively), and had good negative predictive value . Neonates with blood cultures positive at birth (early infection) tended to have normal platelet volumes, while those infected after three days of age (late infection) had dramatic increases in MPV and PDW . Changes in MPV and PDW should be noted when the diagnosis of late sepsis is considered.

Rinsho Byori, 1990 Mar, 38(3), 260 - 6
{Inflammatory reaction and laboratory tests: hematologic examination}; Kumasaka K et al.; The leukocyte count, the differential leukocyte count and the erythrocyte sedimentation rate (ESR) are the more commonly used tests for diagnosing or managing an inflammatory process . Measurements of acute-phase proteins has an advantage over that of the leukocyte count and ESR . Especially microscopic examination of peripheral blood smear can be time consuming, but the simple and inexpensive technique is still clinically useful when a high grade bacteremia is likely to be present . Although the results are examiner dependent, it should be reliable in the proper clinical setting . In the guidelines for the selection of laboratory tests for monitoring the acute phase response, published in 1988, the International Committee for Standardization in hematology (ICSH) considered the biohazzard of ESR . Therefore the ESR should not routinely be performed on blood samples from patients who show a positive test for hepatitis virus or human immunodeficiency virus . The subcommittee for laboratory tests in daily care situations in Japan Society of Clinical Pathology published the "Essential Laboratory Tests" in 1989 . We conclude that the differential leukocyte counts and the ESR should be used to follow the activity and response to treatment of certain inflammatory disorders when other objective indicators are not available.

Acta Chir Scand, 1990 Mar, 156(3), 215 - 21
Feline E . coli bacteremia--effects of misoprostol/scavengers or methylprednisolone on hemodynamic reactions and gastrointestinal mucosal injury; Arvidsson S et al.; Live E . coli were infused i.v . in cats to induce gastrointestinal mucosal injury and the gastric mucosa was exposed to bile and a luminal pH of 1 . A gastric lesion index was calculated and intestinal injury was graded . The effects of i.v . methylprednisolone before and after induction of bacteremia were compared with those of intragastric misoprostol combined with i.v . superoxide dismutase (SOD) and catalase and with a control group . Methylprednisolone, but not misoprostol/SOD/catalase, significantly reduced the gastric lesion index (p less than 0.05) . The duodenum/small intestine was significantly injured in 4/6, 2/6 and 4/6 cats in the misoprostol/SOD/catalase, methylprednisolone and control groups, respectively (NS) . End gastric luminal pH was 3.9, 2.7 and 4.5 in the respective groups (p less than 0.05), with systemic arterial pH 7.15, 7.15 and 7.32 (NS) . Mean arterial pressure and cardiac output were improved with methylprednisolone . Misoprostol/SOD/catalase reduced late hypotension . Pulmonary arterial pressure rose to c . 200% of basal in all groups . Methylprednisolone, but not misoprostol/SOD/catalase, thus protected the gastric mucosa from sepsis-induced gastric injury concomitant with reduced disappearance of protons from the gastric lumen, but did not significantly affect small-bowel damage . Hemodynamic responses were significantly improved in methylprednisolone-pretreated cats.

Fortschr Med, 1990 Feb 28, 108(6), 100, 101 - 2
{Bacteremia in therapeutic endoscopy}; Stoppel G et al.; In a prospective study of 70 patients undergoing therapeutic endoscopy, the incidence of bacteremia was established . It was observed in 20 after bougienage, 30% after the placement of an endoprosthesis, 15% after endoscopic sphincterotomy, and 25% after percutaneous biliary drainage . Although clinical symptoms were observed in only a few of these patients, perioperative antibiotic therapy is recommended in elderly patients with malignant diseases, diabetes mellitus, renal insufficiency or liver disorders.

An Esp Pediatr, 1990 Feb, 32(2), 136 - 8
{Occult bacteremia at a pediatric emergency clinic}; Gomez Papi A; In order to known the incidence of unsuspected bacteremia in our area and to determine the usefulness of the laboratory tests to identify children with such pathology, a prospective study was designed including 61 infants between 3 and 24 months of age admitted to our emergency room with fever of 39 degrees centigrade or more, without apparent focality or respiratory symptoms . All underwent blood culture, complete blood count and C-reactive protein plasma levels determination . No positive blood cultures were obtained . The relation bands/total neutrophils greater than 0.15 with leucocytosis or neutrophilia was not found in any child, and leucopenia was found in only one . We conclude that occult bacteremia is not present in our milieu amongst children who fit into the risk factor criteria defined by TEELE et al . and that it might be convenient to include a fever of less than 24 hours as a risk factor in order to exclude many children with fever and a clear focality.

Rev Clin Esp, 1990 Feb, 186(2), 68 - 73
{Antilymphocytic sera versus azathioprine, combined with cyclosporin and steroids, in liver transplant . Comparison of the results at the intensive care unit and 2 years' follow-up}; Cisneros Alonso C et al.; The use of anti-lymphocyte globulins (ATG, ALG, OKT3) for the control or organ rejection in humans, has been of major importance both in preventing and treating organ rejection resistant to other treatments . We present here the results of our immunosuppression protocol using two different therapeutic associations . To the first group consisting of 29 patients, low doses of cyclosporine, steroids and anti-lymphocyte globulins were given, and to another group of 11 patients azathioprine was given together with cyclosporine and steroids at the same doses as in the first group . We want to point out that the incidence of acute rejections was similar in both groups (17.2% vs 18.1%) immediately after surgery and a greater incidence of rejections at a later time during the follow up period in the group treated with azathioprine (34.4% vs 54.6%) . The incidence of chronic rejections was similar in both groups (10.3% vs 8.9%) . During the follow up period, the incidence of infections was higher in the group treated with azathioprine (13.7% vs 36.4%) as well as bacteremia episodes (17.2% vs 45.4%) (p less than 0.1) . We also want to highlight that patients with graft complications (primary graft rejection) suffered infections (p less than 0,001) and had a higher mortality rate (p less than 0,05) in association to the infection.

Pneumologie, 1990 Feb, 44 Suppl 1, 208 - 9
{Transitory bacteremia in bronchologic-biopsy procedures}; Durschmied H et al.; In 105 patients, the incidence of transitory bacteraemia seen following bronchological-bioptic interventions was investigated . In three patients (2.9%), the identical pathogens were detected both in the bronchial secretion and in venous blood culture following bronchoscopy.

Semin Oncol, 1990 Feb, 17(1 Suppl 2), 36 - 9
Phase II study of daily oral etoposide in refractory germ cell tumors; Miller JC et al.; Etoposide was found to be schedule-dependent in both preclinical and clinical trials . A study was initiated in March 1988 at Indiana University (Indianapolis, IN), using daily oral etoposide in patients with refractory germ cell tumors . The dose was 50 mg/m2/d, administered daily until progression or toxicity not ameliorated by dose adjustment occurred . Twenty-two patients have been entered to date . Primary sites were testis (11 patients), retroperitoneum (five patients), and mediastinum (six patients) . All 22 patients had had previous treatment with cisplatin/etoposide combination regimens, including six patients who were also previously treated with high-dose etoposide and carboplatin with autologous bone marrow transplantation . The median number of treatment regimens was 2.9 (range, 1 to 4) . Five patients had progressive disease during treatment with etoposide . Median length of treatment was 11.5 weeks (range, 2 to 30), with six patients continuing on treatment . Median white blood cell nadir was 1.5 x 10(9)/L, median hemoglobin nadir 9.1 g/dL, and the median platelet nadir 184,000/microL . Granulocytopenia required temporary cessation of treatment in eight patients and dose reductions in four . Five patients developed granulocytopenic fevers, including pneumonia (two patients) and bacteremia (one patient) . Additionally, two patients (who tested negative for human immunodeficiency virus) died from Pneumocystis pneumonia with granulocyte counts higher than 500/microL . Of 21 evaluable patients (there was one protocol violation), three responded with a greater than 90% decrease in markers and a greater than 50% decrease in measurable radiographic disease . One of these had previously progressed on cisplatin/etoposide combination therapy . Three other patients responded with a greater than 90% decrease in markers but with stable radiographic disease; two of them had previously resected teratoma . The remaining ten patients were nonresponders . In conclusion, daily oral etoposide has definite activity in refractory germ cell tumors . Further evaluation of this regimen is warranted.

Oral Surg Oral Med Oral Pathol, 1990 Feb, 69(2), 177 - 81
Pathogenesis, management, and prevention of infective endocarditis in the elderly dental patient; Friedlander AH et al.; Aortic stenosis and mitral valve insufficiency are common precipitating causes of infectious endocarditis in older persons . These degenerative cardiac valvular lesions may result from an exaggerated calcification process seen in association with aging . Mitral valve prolapse, especially when noted in an older man, may predispose the person to infectious endocarditis . Infectious endocarditis is harder to diagnosis and treat in older persons, and about half of patients die of the disease or its complications . Prophylactic antibiotics must be prescribed for patients with degenerative cardiac or atherosclerotic valvular defects having dental procedures likely to produce a bacteremia.

J Clin Microbiol, 1990 Jan, 28(1), 140 - 2
Bacteremias caused by Selenomonas artemidis and Selenomonas infelix; Bisiaux-Salauze B et al.; We report two different cases of bacteremia caused by two recently described Selenomonas species, Selenomonas artemidis and Selenomonas infelix . Both species are normally found in human buccal flora . S . artemidis bacteremia appeared in a patient (number 1) who presented with an air-fluid pulmonary cavity and clinical conditions consistent with an anaerobic lung abscess . While the patient improved with antibiotic therapy, cultures of respiratory secretions yielded Mycobacterium tuberculosis . This case demonstrated a strong possibility of a coexisting lung abscess due to S . artemidis . S . infelix bacteremia appeared in a cancer patient (number 2) with heart disease during preterminal acute respiratory distress . It was more difficult in this case to assess the clinical impact of the Selenomonas organisms on the patient.

Am J Surg, 1990 Jan, 159(1), 85 - 9; discussion 89-90
Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia; Redan JA et al.; Translocation of carbon-14-labeled Escherichia coli from the gut was studied at the specified times in the following groups of rats: Group 1, 5 hours after ligation of the superior mesenteric artery; Group 2, 5 hours after laparotomy and exposure of the superior mesenteric artery with gentle removal and replacement of the intestines; and Group 3, 5 hours after handling but no surgical manipulation . Both living and dead bacteria were administered by means of gavage, and the effect of viability, intestinal ischemia without reperfusion, and bowel manipulation on the translocation of enteric bacteria was assessed . We demonstrated that (1) even gentle bowel manipulation causes bacteremia as great as that associated with ligation of the superior mesenteric artery; (2) dead E . coli are absorbed into the blood in the presence of bowel manipulation or ischemia but less effectively than are live E . coli; (3) live bacteria are found in highest concentration in the lung and in descending order in the liver, kidney, heart, and spleen; (4) dead bacteria absorbed from the gut are found in highest concentration in the kidney and the liver . Lesser amounts are found in the lung, spleen, and heart.

Med Pediatr Oncol, 1990, 18(1), 1 - 5
Bone marrow transplantation in childhood leukemia using reverse isolation techniques; Ogden AK et al.; Between 1979 and 1986, 29 pediatric patients underwent bone marrow transplantation at Texas Children's Hospital using routine reverse isolation . Laminar air flow rooms, prophylactic antibiotics, and gut sterilization were not utilized . The diagnoses included acute lymphocytic leukemia (ALL) (16 patients), acute nonlymphocytic leukemia (ANLL) (10 patients), and chronic myelogenous leukemia (CML) (three patients) . All patients had fever during hospitalization . There were 11 episodes of bacteremia in seven patients giving a bacteremia rate of 37.9% . Moderate-to-severe (grade II-IV) acute graft-versus-host disease (GVHD) was seen in eight patients (27.6%) . The incidence of infection and GVHD during the first 100 days post-transplantation is comparable to published reports from centers utilizing rigid isolation and sterilization of the gut . It is suggested that bone marrow transplantation may be done using standard reverse isolation techniques without increasing the morbidity or mortality of the procedure.

NCI Monogr, 1990, (9), 49 - 50
Prechemotherapy dental treatment to prevent bacteremia; Greenberg MS; Infection is the most common cause of morbidity and death in patients receiving chemotherapy for treatment of acute leukemia . Studies performed during the past decade suggest that over 30% of these infections originate from oral sources, particularly periodontal pockets and pericoronal flaps . Studies of large numbers of patients receiving a variety of myelosuppressive chemotherapy protocols are necessary to determine the risk-benefit ratio of dental treatment prior to chemotherapy.

Surg Endosc, 1990, 4(1), 18 - 9
Bacteremia after injection of esophageal varices; Lorgat F et al.; Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients . The clinical importance of this phenomenon is uncertain . This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia . Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned . In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia . After 4 h, all blood cultures were sterile . No infective complications were identified . Bacteremia appears to be an infrequent and transient event after elective sclerotherapy . Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis.

Transplantation, 1990 Jan, 49(1), 122 - 5
Increased risk of pneumococcal infections in cardiac transplant recipients; Amber IJ et al.; We observed 5 episodes of pneumococcal infection among 129 cardiac transplant patients between March 1985 and December 1987, giving an estimated incidence of 36 cases per 1000 patient-years . Infections occurred a mean of 58 days after transplantation and included bacteremia with empyema, bacteremia alone, and pneumonia . All patients recovered from their infections . There was no correlation between infection and age, sex, immunosuppression, or rejection episodes . We also measured antibody levels to 12 pneumococcal antigens in 6 unvaccinated, uninfected patients before and after cardiac transplantation, to see if baseline antibody levels decreased . Protective levels of antibody were defined as greater than or equal to 300 ng of anticapsular antibody nitrogen per milliliter serum . Before transplantation patients had protective antibody levels to a mean of 8.7 +/- 1.2 pneumococcal serotypes; after transplantation, the number of presumably protective antibody levels decreased to 6.5 +/- 1.4 (P = 0.021) . One of these patients subsequently developed pneumococcal pneumonia . Cardiac transplant patients are at increased risk of pneumococcal infections . Vaccinating transplant candidates prior to transplantation may provide protection after transplantation.

Am J Med, 1990 Jan, 88(1), 21 - 6
Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease; Nadelman RB et al.; PURPOSE: Borrelia burgdorferi, the etiologic agent of Lyme disease, has rarely been successfully cultured from blood . We report on seven patients from Westchester County, New York, with B . burgdorferi bacteremia diagnosed between April 1987 and August 1987 . PATIENTS AND METHODS: One hundred thirty-two attempts to isolate spirochetes were made on blood specimens obtained from 104 patients . Twenty-two of these specimens were obtained from nine patients who had recently been bitten by Ixodes ticks but who were asymptomatic . Heparinized blood or serum specimens (0.2 to 0.4 mL) were inoculated onto 6 mL of modified Barbour-Stoenner-Kelly medium . Lyme serology was performed by enzyme-linked immunosorbent polyvalent, IgM, and IgG assays, fluorescent immunoassay, and microhemagglutination . RESULTS: Four of the seven patients had erythema migrans, two had facial nerve palsy, and one had a flu-like syndrome without rash . These patients represented 21% (four of 19) of all patients with the characteristic skin lesion who had blood cultures for B . burgdorferi, and 40% (two of five) of all those with facial nerve palsy . Serologic testing was frequently nonreactive; two patients had no detectable antibody on multiple sera by five different assays . All patients improved with antibiotic treatment, and had negative subsequent blood cultures, but five of seven had persistent complaints after completion of therapy . CONCLUSION: Culturing blood for B . burgdorferi may be useful in confirming the diagnosis of Lyme disease in selected patients . Use of spirochete blood cultures may facilitate a better understanding of the pathogenesis and natural history of Lyme disease.

J Oral Maxillofac Surg, 1990 Jan, 48(1), 45 - 8
Bacteremia following laser and conventional surgery in hamsters; Kaminer R et al.; The CO2 laser prevents bleeding by sealing blood and lymph vessels as it vaporizes tissue . Bacteremia following oral surgery might not occur under these conditions . To test this hypothesis, a 0.2-mm-deep incision 1 cm long was made in the right buccal cheek pouch of hamsters using either laser, electrosurgery, or a scalpel . Twenty minutes later, 1 mL of blood was taken from each animal by cardiac puncture, inoculated on a blood agar medium, and incubated anaerobically for 4 days; then the colonies were counted . Using an operational definition of bacteremia as five colonies or more per plate, there were no positive results out of 18 trials (0/18) for laser surgery, 7/8 for electrosurgery, and 8/12 for scalpel surgery . Based on the Student t test using the binomial distribution, the laser produced statistically less bacteremia than the other two methods (P less than .01) . Because the five-colony cutoff was arbitrary, the nonparametric Wilcoxon Rank test was also used . Colony formation from blood from the laser group was significantly less than from the electrosurgery group (P less than .01) and the scalpel group (P less than .05) . The laser surgery group was not statistically different from the control (nonsurgerized) group . These results suggest that there is a considerable bacteremia following scalpel and electrosurgery, but that laser surgery produces no bacteremia.

Intensive Care Med, 1990, 16(8), 500 - 5
Pulmonary capillary pressure and gas exchange after E . coli bacteremia in pigs; Fretschner R et al.; In 9 Goettingen minipigs we studied the effect of E . coli bacteremia on effective pulmonary capillary pressure and the longitudinal distribution of pulmonary vascular resistance . Precapillary pressure gradient (dPa) was calculated as the difference between mean pulmonary artery pressure (MPP) and effective pulmonary capillary pressure (Pc) (dPa = MPP-Pc), postcapillary pressure gradient (dPv) as the difference between Pc and left atrial pressure (dPv = Pc-LAP) . The disturbance of pulmonary gas exchange was quantified by the AaDO2 quotient 1-PaO2/PAO2 . Live E . coli infusion resulted in hypodynamic circulatory failure . Cardiac index fell from 3.7 +/- 0.81 . min-1.m-2 to 2.2 +/- 0.71 .min-1.m-2 after bacteremia lasting for 3.5 h . Simultaneously venous pulmonary vascular resistance rose from 25% of total pulmonary vascular resistance before to 32% after 3.5 h bacteremia, thus raising Pc from 11 mmHg to 16 mmHg . The degree of respiratory insufficiency was correlated with changes of MPP, dPa and dPv: 1-PaO2/PAO2 = 0.2 + 0.035.dPv (r = 0.829) . Our results show, that the longitudinal distribution of pulmonary vascular resistance changes during septicemia, thus raising Pc . This may be an important factor in the genesis of septic pulmonary failure.

J Clin Epidemiol, 1990, 43(12), 1319 - 25
Parents' vs physicians' utilities (values) for clinical outcomes in potentially bacteremic children; Kramer MS et al.; Our previous analyses of decision strategies in children 3-24 months with acute-onset fever greater than or equal to 39 degrees C and no evident bacterial focus of infection indicated that the risks of routine blood cultures (the unnecessary hospitalization and treatment of children who clear their bacteremia spontaneously) outweigh its benefits (the prevention of a few cases with major infectious sequelae) . Because those analyses were based on parents' values for beneficial and adverse clinical outcomes, we wished to examine whether those values differed in physicians and, if so, whether the differences were sufficient to change the results of the decision analysis . Using a pre-tested linear analog utility (value) scale, we evaluated eight potential clinical outcomes in potentially bacteremic children by surveying 121 parents of healthy 3-24-month-old children attending a private pediatric group practice and 57 attending physicians of a tertiary-care children's hospital emergency room . Utilities were based on a 0-1 normalization, where 0 is the utility of the worst outcome (meningitis or other major bacterial infection, plus venipuncture), and 1 the utility of the best outcome (complete recovery without venipuncture or hospitalization), and were analyzed using a recently developed statistical model of utility . The majority of parents and physicians combined the imputed components of the outcomes (disease, pain of venipuncture, and stress of hospitalization) in a nonlinear fashion . Parents assigned substantially lower utility (i.e . greater disutility) to venipuncture, minor infection, and hospitalization than did physicians, and these utilities were even lower in parents with other children at home.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Physiol Imaging, 1990, 5(2), 75 - 9
Investigation by scintigraphic methods of platelet kinetics under normal and septic shock conditions in the experimental baboon model; Dormehl IC et al.; This study concerned the correlation of platelet kinetics with the pathogenic course of septic shock and adult respiratory distress syndrome (ARDS) in the anesthetised baboon model . 111In-tropolonate platelets were traced in vivo in normal baboons (n = 7) and in Escherichia coli-infected baboons, which were reinjected with the labeled autologous platelets either 2 hr after the onset of the E . coli infusion (procedure A: n = 4) or simultaneously with the infusion (procedure B; n = 3) . One minute images were taken hourly for 5 hr, using a gamma camera and data processor . Time-activity curves were obtained for platelet clearance from the blood and the lungs and for platelet accumulation in the liver and spleen . A significant retention of platelets in the lungs of baboons with E . coli-induced septic shock was noted, as well as an accelerated clearance from the circulation . Platelets were distributed mainly to the spleen after induction of bacteremia, later substantially moved to the liver, and even later moved back to the spleen.

Zentralbl Chir, 1990, 115(17), 1101 - 11
{Results of sonographically-guided percutaneous procedures as therapy of liquid-filled space-occupying lesions in acute abdomen}; Bunk A et al.; In the period from 1985 emergency sonographic study has been performed in 56 patients . In 44 cases we found intraabdominal abscesses, in 5 liver cysts with internal bleeding, in 5 postoperative lymphatic cysts, and in 2 cases loculated pleural empyemas . In 35 patients ultrasound guided therapeutic procedures were performed; there were 13 punctures (some repeated) and 22 drainages . In 29 patients no further surgical treatment was necessary . The over all success rate was 82.9% . One patient developed bacteremia after percutaneous drainage and an other developed subcutaneous abscess (complication rate: 5.7%) . When abscesses are sufficiently drained no antibiotic therapy is needed.

J Med, 1990, 21(1-2), 27 - 49
In vitro cardiac function in early sepsis; McDonough KH et al.; The involvement of the myocardium in the injury resulting from bacteremia has been somewhat controversial . Recently, some investigators have suggested that the transition from an early stage of sepsis, in which the cardiovascular system is stable and mortality is relatively low, to the late or preterminal stage of sepsis is a result of cardiac dysfunction . Here, however, data are presented to show that contractile defects and loss of myocardial reserve occur even early during a septic episode, i.e., at a time when cardiac output is elevated or normal . Efforts to determine the mechanism of the cardiac dysfunction are described . These entail studies of whole heart performance under conditions of varying the calcium availability for contraction and assessment of subcellular organelle function . The data indicate that calcium dyshomeostasis may at least partially contribute to the cardiac dysfunction of sepsis . The in vivo adequacy of cardiac function probably results from the capacity of the myocardium in early sepsis to respond to catecholamine support of chronotropy and inotropy.

J Med, 1990, 21(1-2), 104 - 20
A "treated" model for severe hemorrhagic shock: a comparison of conventional and germ-free animals; Flanagan JJ Jr et al.; In an unanesthetized "treated" model of severe hemorrhagic shock, a bacteremia originating from the animal's enteric flora was demonstrated by finding radiolabeled Escherichia coli in the blood as early as 2 hr after the onset of shock . In 50 patients admitted to our trauma unit, the observation was similar, with 56% positive blood cultures, when their mean arterial blood pressure was 80 mmHg or less . The relationship of bacterial translocation and the high post-shock mortality in our conventional (CV) animal model is being evaluated in germfree (GF) Sprague-Dawley rats . Preliminary observations in 15 GF animals showed 80% survival at 24 hr post-shock, 54% at 48 hr, and 42% at 72 hr compared with those of CV animals in previous experiments with survival at similar times of 73%, 20% and 7%, respectively.

Arkh Patol, 1990, 52(5), 3 - 7
{The basic features of the pathogenesis of pseudotuberculosis (yersiniosis)}; Avtsyn AP et al.; A new pathogenetic pattern of pseudotuberculosis has been derived on the basis of original clinical, anatomical and experimental findings as well as literature data . Careful consideration is given to: a basic mode of infection (alimentary), emergence of the primary affection with a rapid blood invasion by the agent (primary bacteremia), development of specific sensitization, multiorgan secondary focal impairment with lymphogenic dissemination of the infective agent (specific pseudotuberculous polyadenitis), formation of secondary immunodeficiency, consequent repeat bacteremias, recurrences, symptoms of infectious process aggravations, immunological rearrangement with dominating delayed hypersensitivity . As a rule, the disease terminated by elimination of the secondary foci and recovery.

G Batteriol Virol Immunol, 1990 Jan-Dec, 83(1-12), 53 - 60
{Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital . I . Epidemiologic aspects}; Guasco C et al.; Data on all blood cultures from patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) from June 1986 to September 1989 were collected and processed in a retrospective study of the quantity of cultures prepared in the hospital as a whole and per department, the percentage of culture positivity and the incidence of bacteremias . The results were: 1) mean incidence of cultures: 12.37 per 1000 patients, increasing through the period; almost 2/3 of the cultures were requested by the three medical division; 2) positivity 21.2%; 3) incidence of bacteremias: 3 per 1000 patients . These findings are critically compared with others obtained both in Italy and abroad (United States, United Kingdom, South Africa), and it is suggested that the increased request for cultures observed should lead to an increase in the number of bacteremias diagnosed.

Nippon Ronen Igakkai Zasshi, 1990 Jan, 27(1), 45 - 51
{A clinicopathological study of candidemia in the elderly}; Kawahata N et al.; Candidemias were reviewed in 22 elderly patients hospitalized in Yokufukai Geriatric Hospital . Their ages ranged from 62 to 101 years, with a mean age of 81 years . Sixteen patients had either old cerebrovascular disease or senile dementia . In seven patients, synchronous or metachronous bacteremia in the blood culture was associated with the candidemia . Eighty-six percent of total candidemias were related to intravenous hyperalimentation (IVH) . The mean duration from the start of IVH to candidemia was 46 days . Eleven patients (50%) developed candidemia within one month after the beginning of IVH . Fourteen patients had the IVH catheters changed one or more times before the time of positive candida in the blood culture . The mean duration from the start of IVH to candidemia was 59 days . Eight patients, on the other hand, had the catheters unchanged and the mean duration was 23 days . Ninety-six percent were receiving broad-spectrum antibiotic therapy at the time of the positive candida in blood culture . Eight patients developed DIC . The overall mortality was 91% (twenty patients) and thirteen (65%) of them died within one month after the onset of candidemia . There was no difference in mortality when all candidemic patients received no anti-mycotic therapy were compared with the patients given any amount of miconazole or 5-FC . The causes of death for candidemic patients included fungemic shock (6 patients), hemorrhagic shock (4 patients), and shock associated with DIC (3 patients) . From the results of this study, candidemia in the elderly was produced by various underlying diseases such as central nervous system diseases or pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

J Burn Care Rehabil, 1990 Jan-Feb, 11(1), 71 - 3
Branhamella catarrhalis pneumonia with bacteremia in a pediatric patient with smoke inhalation; Dietrich MC et al.; Branhamella catarrhalis, a common inhabitant of the upper respiratory tract, has been identified recently as a cause of lower airway infection . In this report we present a case of B . catarrhalis pneumonia and bacteremia in a child with smoke inhalation as the first description of invasive disease involving this organism in a traumatized airway . In addition, other pediatric cases of B . catarrhalis bacteremia are reviewed, suggesting immunocompromise as a risk factor.

Chir Pediatr, 1990, 31(3), 157 - 9
{Transient fever associated with a reduction of intestinal invagination}; Luks FI et al.; Intussusception is a common cause of small bowel obstruction in infancy and early childhood . As in other forms of intestinal obstruction, there is stagnation of enteral content and edema of the bowel wall, theoretically facilitating translocation of bacteria . Since 1987, 85 cases of intussusception have been at this institution, of which 24 underwent laparotomy . Twenty (83%) developed a fever of more than 38.0 degrees at a mean of 11 hours postoperatively, lasting for less than 24 hours . Of the 61 cases that were treated by barium enema (a success rate of 72%), a similar fever peak was recorded in 26 (43%) . All but who patients were afebrile on admission, and all were afebrile upon discharge . Hospital stay was 1.8 days for non-operated patients two remained afebrile and 2.9 days for those who developed a transient fever (p less than 0.05) . We postulate that this temporary rise in temperature following manipulation of intussuscepted bowel is caused by a transient bacteremia or endotoxinemia due to bacterial translocation through the intestinal wall, similar to the process that has been described in other forms of intestinal obstruction . Awareness of this phenomenon could avoid needless fever workups, thereby reducing costs and hospital stay . The concept of bacterial translocation casts a doubt on the infectious theory of idiopathic intussusception, since the presence of infected mesenteric lymph nodes could follow, rather than proceed the intussusception.

Infect Immun, 1990 Jan, 58(1), 275 - 8
Impaired colonization by and full invasiveness of Escherichia coli K1 bearing a site-directed mutation in the type 1 pilin gene; Bloch CA et al.; A type 1 pilus-deficient mutant of a systemically invasive Escherichia coli K1 strain was constructed by directed mutagenesis of pilA, the gene that codes for the major structural subunit of type 1 pili . By comparing this mutant with an isogenic pilA+ strain, we were able to assess the role of type 1 piliation in alimentary tract colonization and bloodstream invasion in neonatal rats . Intestinal colonization was not significantly affected by the pilA mutation; in contrast, loss of type 1 piliation correlated with a dramatic decrease in oropharyngeal colonization . Nevertheless, development of bacteremia after oral administration of E . coli K1 was not diminished by the mutation in pilA . Thus, loss of type 1 piliation correlated with a site-dependent effect on colonization within the alimentary tract while not interfering with bloodstream invasion.

Clin Immunol Immunopathol, 1990 Jan, 54(1), 117 - 25
Flow cytometric analysis of neutrophil subsets in thermally injured patients developing infection; Babcock GF et al.; The expression of CD11b (CR3, complement receptor type three), CD16 (FcR, Fc IgG receptor), and CD35 (CR1, complement receptor type one) on neutrophils obtained from thermally injured patients was examined using immunofluorescence and flow cytometry . Because defects in neutrophil function have been related to an increased risk of infection and death following thermal injury, we compared changes in neutrophil subpopulations following thermal injury with the onset of infection . Neutrophils from 34 patients with large thermal injuries were monitored weekly for CD11, CD16, and CD35 . Changes in the cell surface antigens over time were compared with the incidence of bacteremia and pneumonia . Although the percentages of CD16+ CD11+ neutrophils were suppressed in almost all patients, the changes which occur in each individual patient rather than the actual values appear to be of major importance . Patients developing bacteremia or pneumonia displayed a significant reduction in both the percentage and absolute number of CD16+ CD11+ neutrophils compared to their preinfection values . The values did not increase until the infections were completely cleared . Patients remaining free of bacteremia or pneumonia usually had lower than normal percentages of CD16+ and CD11+ neutrophils with no predictable pattern being noted . The percentage of CD35+ neutrophils dropped within 1 week following thermal injury in all patients but did not correlate with the onset of infections.

Semin Respir Infect, 1989 Dec, 4(4), 293 - 8
Pneumococcal vaccine; LaForce FM; Pneumococcal infections are common and serious infections, and their control is an important public health priority . A multivalent pneumococcal vaccine was introduced several years ago, but there is still controversy about its effectiveness in United States populations . One randomized controlled study in high-risk veterans did not demonstrate efficacy . The study has been criticized because the case definitions used for pneumococcal infection had uncertain specificity . Two large case control studies done in Pennsylvania and Connecticut hospitals have compared vaccination rates in patients with pneumococcal bacteremia with controls matched for disease severity and age . Bacteremic immunosuppressed patients who were unlikely to have responded to pneumococcal vaccine were excluded . These studies showed vaccine efficacy rates in the 60% to 70% range as did a prospective randomized controlled French trial that used episodes of pneumonia as an end point . Pneumococcal vaccine is effective when given to patients likely to respond immunologically and who are at increased risk from pneumococcal infection.

Circ Shock, 1989 Dec, 29(4), 335 - 44
Differential response of the microvasculature in the liver during bacteremia; Unger LS et al.; To determine the initial hepatic microvascular responses to bacteremia, male Sprague-Dawley rats (n = 19) were decerebrated and the left liver lobe from each animal exteriorized and suffused with environmentally controlled Krebs solution . Direct in vivo videomicroscopy was used to measure diameter changes in at least four portal venules (PV) and four proximal periportal sinusoids (PS) at the inlet of hepatic lobules in each of seven livers or four terminal centrilobular sinusoids (CS) and four collecting central venules (CV) at the outlet in each of 12 livers during a baseline period and for 2 hr after intravenous (i.v.) infusion of 1 X 10(9) live Escherichia coli or saline (control) . Cardiac output, systemic arterial blood pressure, and body temperature were monitored continuously during the experiments . These data indicate that E . coli bacteremia causes a redistribution of hepatic microvascular blood flow within the liver lobule at both the inlet and outlet regions with increased perfusion of certain microvascular segments and decreased perfusion of others . In the areas observed, a 2:1 dilated/constricted microvessel ratio suggests an initial increased overall liver blood flow within the first 2 hr of experimentally induced bacteremia.

Hawaii Med J, 1989 Dec, 48(12), 513 - 4, 517-8
Pneumococcal bacteremia in Hawaii: initial findings of a pneumococcal disease prevention project; Campbell JF et al.; The Hawaii Department of Health (DOH) recently established a pneumococcal disease initiative to determine the scope of serious pneumococcal disease in residents of Hawaii and to investigate methods of increasing vaccine utilization in the State . The initial phase of the project involved a review of pneumococcal bacteremia at all 38 microbiology laboratories in Hawaii during 1986 and 1987 . Two hundred twenty-two residents with bacteremia were identified . Eighty-six percent of adults had pneumonia as the primary source of bacteremia . In children greater than 5 years old, pneumonia was present in 24%, otitis media in 35%, and meningitis in 11% . Bacteremia with no apparent focus of infection was found in 30% of children . The overall annual incidence of pneumococcal bacteremia was 9/10(5) population . Rates were highest in children greater than 2 years old (103/10(5} and persons greater than or equal to 65 years old (22/10(5} . These are similar to rates reported from other populations in the United States during the 1970s and early 1980s, but are less than those detected in 2 more recent population-based studies . The overall case-fatality rate in our study was relatively low (16%); however, 35% of persons greater than or equal to 65 years old died . A record of previous pneumococcal vaccination was found in the medical records of only 2 (1%) patients . Our study confirms that pneumococcal bacteremia causes significant morbidity and mortality among elderly residents of Hawaii and suggests that vaccine coverage is very low among this high-risk population . Phase 2 of the initiative included surveys of Hawaii physicians and the public to ascertain attitudes toward pneumococcal immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr, 1989 Dec, 115(6), 888 - 91
Temperature response to acetaminophen and risk of occult bacteremia: a case-control study; Mazur LJ et al.; A case-control study of 34 children with occult bacteremia was conducted to test the hypothesis that nonresponse to acetaminophen (decrease less than or equal to 0.8 degrees C) is a risk factor for occult bacteremia . Febrile children visiting the emergency center from May 1986 to October 1987 were monitored for occult bacteremia . Inclusion criteria were age 2 months to 6 years, temperature greater than or equal to 38.9 degrees C, and having a blood culture . Exclusion criteria were serious acute or chronic illness, sponging for fever reduction, current therapy with antibiotics or steroids, and admission to the hospital . Records of 3892 febrile children were reviewed . Of these, 2101 (54%) had a blood culture and 1028 (26%) were eligible . All patients (positive blood culture) were matched with two control subjects (negative blood culture) . Patients and control subjects had similar age, gender, ethnicity, height of initial temperature, time to second temperature, and dose of acetaminophen . The estimated risk of occult bacteremia for nonresponders was 9.2 (95% confidence interval 2.7, 32.0) . We conclude that children who do not respond to acetaminophen by at least a 0.8 degrees C decrease in temperature have an increased risk of occult bacteremia . However, achieving a response to acetaminophen does not eliminate the possibility that the child has occult bacteremia.

Am Rev Respir Dis, 1989 Dec, 140(6), 1611 - 3
Frequency of Mycobacterium tuberculosis bacteremia in patients with tuberculosis in an area endemic for AIDS; Shafer RW et al.; Mycobacterium tuberculosis bacteremia has recently been reported in patients infected with the human immunodeficiency virus (HIV) . At our institution, tuberculosis occurs commonly among patients with and without HIV infection . We sought to determine the frequency of M . tuberculosis bacteremia among patients with newly diagnosed tuberculosis . During a 4-month period, mycobacterial blood cultures were obtained on all identifiable patients with newly diagnosed tuberculosis . Fifteen percent (9/59) of consecutive patients with tuberculosis had positive blood cultures for M . tuberculosis . Twenty-six percent (7/27) of patients known to be infected with HIV had positive mycobacterial blood cultures; two intravenous drug users who refused HIV-serologic testing also had positive mycobacterial blood cultures . M . tuberculosis bacteremia occurred at a higher rate among HIV-infected patients with an AIDS-defining opportunistic infection in addition to tuberculosis (3/3) than among HIV-infected patients without such an opportunistic infection (4/24; p less than 0.02) . M . tuberculosis bacteremia occurred in 83% (5/6) of patients with disseminated tuberculosis and in 8% (4/53) of patients without disseminated tuberculosis (p less than 0.001) . In all cases, tuberculosis was diagnosed in patients with M . tuberculosis bacteremia or else they died prior to the blood cultures demonstrating mycobacterial growth (mean time to detection of mycobacterial growth: 43 days) . However, the frequent occurrence of M . tuberculosis bacteremia in HIV-infected patients with disseminated tuberculosis suggests that mycobacterial blood cultures may help confirm the diagnosis of tuberculosis in this group of patients.

J Surg Res, 1989 Nov, 47(5), 397 - 402
Bacteremia-induced suppression of alveolar surfactant production; Oldham KT et al.; Sepsis is characterized by Adult Respiratory Distress Syndrome (ARDS)-like pulmonary dysfunction largely attributed to alveolar capillary endothelial cell injury which causes increased microvascular permeability and interstitial edema formation . In addition, quantitative and qualitative abnormalities of the pulmonary surfactant system may be important features of some clinical and experimental lung injuries . This study was designed to investigate the relationship of bacteremia and endotoxemia to pulmonary surfactant production in vivo . A technique for estimation of pulmonary surfactant phospholipid synthesis measuring incorporation of a stable isotope precursor {( 2-13C}acetate) into dipalmitoylphosphatidylcholine (DPPC) in alveolar lavage fluid was developed . Male 350 g Sprague-Dawley rats had placement of central venous catheters . After overnight recovery, sublethal bacteremia (Escherichia coli, 1 x 10(8) organisms, iv) and sublethal endotoxemia (Difco; 10 mg/kg, iv) were induced . Both were associated with lung microvascular permeability increases consistent with capillary endothelial injury . Eight-hour infusions of {2-13C}acetate were given . After sacrifice, bronchoalveolar washings and lung tissue were obtained and {2-13C} incorporation into lavage and lung DPPC was measured by gas chromatography mass spectroscopy . Endotoxin-treated animals had a 21.5% reduction in label incorporation into DPPC {1.215 +/- 0.145 APE (%) sham versus 0.954 +/- 0.144 APE (%) experimental, P greater than 0.05} and bacteremic animals had a 56.9% diminution of {2-13C}acetate incorporation {1.215 +/- 0.145 APE (%) sham versus 0.524 +/- 0.56 APE (%) experimental, P less than 0.05} . Bacteremia-induced dysfunction of alveolar type II epithelial cells manifested as diminished alveolar surfactant phospholipid production may be a contributing factor to sepsis-induced respiratory failure.

J Immunol, 1989 Nov 1, 143(9), 2996 - 3000
Treatment of experimental disseminated Mycobacterium avium complex infection in mice with recombinant IL-2 and tumor necrosis factor; Bermudez LE et al.; Mycobacterium avium complex (MAC) is the most common bloodstream pathogen isolated from patients with AIDS . We have previously shown that TNF alone or in combination with IL-2 can activate human and murine macrophages in vitro to kill MAC strains isolated from disseminated infections . To determine whether treatment with TNF and IL-2 could effect the course of disseminated MAC infections in a murine model of disseminated MAC infection, we infected C57BL mice with 3 x 10(8) bacteria i.v . and 1 wk later administered: 1) IL-2, 100 micrograms/kg; 2) TNF, 25 micrograms/kg; 3) IL-2, 50 micrograms/kg, and TNF, 12.5 micrograms/kg; and 4) saline . IL-2 was injected i.p . daily with TNF being administered in cycles of 3 out of 4 consecutive days . Fourteen days after starting therapy, blood was cultured and mice were sacrificed for quantitative cultures of liver and spleen homogenates . IL-2, TNF, and IL-2/TNF treated groups showed an 87 +/- 5%, 57 +/- 9%, 88 +/- 6% decrease in bacteremia (p = 0.05 for TNF-treated animals and less than 0.04 for the other two groups, compared with control) . The combination IL-2/TNF was the only treatment that showed a trend toward an absolute decrease in the number of bacteria in the blood . Reduction in colony counts of liver and spleen were 77 +/- 4% and 87 +/- 6%, respectively, for treatment with IL-2, 58 +/- 7% and 87 +/- 5% for TNF, and 60 +/- 10% and 82 +/- 6% for IL-2/TNF, respectively . These results suggest that both cytokines may play a role in the control of Mycobacterium avium infection and that the combination of a half-dose of IL-2 and TNF, despite not showing any greater efficacy, can be less toxic than TNF or IL-2 alone and might be useful for the therapy of disseminated infection.

Mil Med, 1989 Nov, 154(11), 564 - 7
A survey of infants with neonatal sepsis in U.S . Army hospitals; Horton JA et al.; Data on 109,312 singleton births at U.S . Army hospitals over 3 years were examined to determine differences in perinatal risk factors between infants with a diagnosis of sepsis confirmed by blood culture and those whose cultures remained negative . The incidence of confirmed sepsis (1.1/1000 live births) and the importance of perinatal complications and prematurity were consistent with other reported findings . No reliable indicators of bacteremia that could be used in conjunction with other clinical data were found . These findings support continued empiric therapy in infants at risk until infection can be verified by culture.

Cancer Nurs, 1989 Oct, 12(5), 265 - 70
Incidence of fever following invasive oral interventions in the myelosuppressed cancer patient; Weikel DS et al.; Oral complications in cancer patients with chemotherapy-induced myelosuppression contribute to morbidity and mortality . However, guidelines for oral care to prevent such complications, including disorders involving the periodontium, are not clear . This study specifically analyzed the impact of a noninvasive oral examination versus invasive oral interventions (periodontal probing, dental scaling) prior to chemotherapy on subsequent development of fever and/or bacteremia in these patients . Medical and dental records were reviewed for 100 patients who had been assigned to receive either the invasive or noninvasive procedures prior to chemotherapy . Temperature values immediately before and up to 48 h after the oral intervention were recorded, and the occurrence of fever and/or bacteremia was documented for each group . There was no statistically significant difference in the incidence of fever and/or bacteremia between the two groups of patients . Although periodontal probing and dental scaling are procedures that invade mucosal barriers, such interventions did not appear significantly to affect the incidence of fever or bacteremia among persons in this study.

Arch Intern Med, 1989 Oct, 149(10), 2246 - 8
Abnormalities in bilirubin and liver enzyme levels in adult patients with bacteremia . A prospective study; Sikuler E et al.; Eighty-four patients with bacteremia were surveyed prospectively for biochemical markers of liver damage . Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels were elevated in 44 (53%), 39 (47%), 45 (54%), and 5 (6%) of the patients on the first determination (2.0 +/- 0.1 days after onset of fever) and in 11 (13%), 17 (20%), 26 (31%), and 1 (1%) on the second determination (5.4 +/- 0.2 days after onset of fever), respectively . The elevation rarely exceeded three times the upper limit of normal . One patient had severe jaundice . An abnormality of at least one of these values was found in 55 patients (65%) . There were no differences in site of infection, bacteria isolated, and outcome between patients with and without biochemical abnormalities . We conclude that in adult patients with bacteremia, elevation of liver enzymes and bilirubin is common, usually mild, of short duration, and of no prognostic significance.

Arch Intern Med, 1989 Oct, 149(10), 2226 - 8
Prospective study of Candida endophthalmitis in hospitalized patients with candidemia; Brooks RG; To determine the frequency of endogenous Candida endophthalmitis in patients with candidemia, we prospectively evaluated 32 inpatients with fungemia by weekly indirect ophthalmoscopic examinations . Chorioretinitis compatible with Candida infection was found in 9 (28%) patients . Patient age, sex, underlying diseases, or hospital-acquired factors, such as presence of central venous or Foley catheters, bacteremia, use of multiple antibiotics, hyperalimentation, or surgery, did not distinguish between groups . Groups were also similar in number of sites colonized with yeast and species of Candida recovered . Patients with endophthalmitis tended to have more blood cultures positive for Candida (mean, 4.3) than the patients without endophthalmitis (mean, 2.8), but this trend did not reach statistical significance . Based on these results, we recommend periodic ophthalmoscopic examinations in all patients with documented candidemia.

South Med J, 1989 Oct, 82(10), 1317 - 8
Branhamella catarrhalis pneumonia with bacteremia; Choo PW et al.; A woman with diabetes mellitus and coronary artery disease developed pneumonia and bacteremia from Branhamella catarrhalis . This is only the fifth reported case of pneumonia with bacteremia due to this organism, which was previously considered normal upper airway flora.

J Infect Dis, 1989 Sep, 160(3), 476 - 82
An infant rat model of bacteremia with Brazilian purpuric fever isolates of Hemophilus influenzae biogroup aegyptius . Brazilian Purpuric Fever Study Group; Rubin LG et al.; Brazilian purpuric fever (BPF) is a newly recognized fulminant pediatric infection caused by bacteremia with Hemophilus influenzae biogroup aegyptius (Hae) . Following intraperitoneal inoculation, each of five disease isolates caused bacteremia more frequently than control, conjunctival isolates of Hae in complement-depleted 6-d-old rats . Sustained but self-limited bacteremia was observed in normal infant rats after inoculation with a disease strain . These rats developed meningitis and had depressed hemoglobin concentration and platelet counts . Pathologic examination showed meningitis and contiguous otitis . Pretreatment of infant rats with immune adult rat serum raised against disease isolates protected rats from bacteremia . Normal adult rat serum or immune rat serum against control strains failed to protect infant rats . Thus, strains of Hae isolated from patients with BPF are more virulent than control strains . Antibody against antigens unique to disease isolates protects infant rats from bacteremia.

Ann Surg, 1989 Sep, 210(3), 342 - 5; discussion 346-7
Does the bacteremia observed in hemorrhagic shock have clinical significance? A study in germ-free animals; Rush BF Jr et al.; We have recently reported the rapid appearance of bacteria and endotoxin in the blood of rats and of trauma patients in the course of 30 minutes to 2 hours of hemorrhagic shock . The current study was designed to determine the effect of this bacteremia and endotoxemia on survival . Thirty-three conventional (C:group 1) and 36 germ-free (GF:group 2) Sprague Dawley rats were subjected to our previously described model of treated hemorrhagic shock . Survival in the GF group was significantly better than the C group at 24, 48, and 72 hours after shock . Endotoxin levels were elevated in 88% of C group during shock and in 28% of GF group . The gut of the GF animal contains endotoxin (26 ng/gm of stool) as does the sterile food supply (393 ng/gm of rat chow).

Pediatr Emerg Care, 1989 Sep, 5(3), 193 - 7
Septic shock: principles of management in the emergency department; Pryor RW et al.; Bacteremia is a potentially serious event which must be recognized early and treated aggressively to prevent progression to septicemia and septic shock . The pathophysiology of septicemia and shock includes inadequate tissue perfusion and oxygenation . Expansion of intravascular volume and pharmacologic cardiovascular support are designed to minimize resulting end-organ injury . Initial antibiotic therapy must be individualized and should include an agent or agents active against the common pathogens encountered in the specific clinical setting . Once the causative organism is isolated, therapy is targeted more narrowly . Despite the availability of a variety of newer antibiotics, the morbidity and mortality of septicemia and septic shock remain unacceptably high . Development of new pharmacologic agents active against the mediators of shock may offer future promise.

Circ Shock, 1989 Sep, 29(1), 13 - 25
Cardiopulmonary dysfunction in a feline septic shock model: possible role of leukotrienes; Schutzer KM et al.; The aim of the present study was to explore the possible involvement of leukotrienes (LTs) in the development of cardiopulmonary dysfunction in experimental septic shock . Sepsis was induced in anesthetized cats by infusion of liver Escherichia coli bacteria . One series (N = 6) was pretreated with diethylcarbamazine (DEC), a 5-lipooxygenase inhibitor; another series (N = 7) was pretreated with FPL 55712, a LTC4-D4 antagonist; and a third series (N = 8) served as septic controls . After 2 hr of bacteremia, there were no differences in cardiac function in the three series . By subjecting the heart to volume load, two points on a Starling curve were obtained, indicating the limits of the functional cardiac reserve . This loading procedure disclosed a significantly better preserved left ventricular function in the DEC-pretreated group as compared with the other two groups . Pretreatment with DEC and FPL 55712 had no effects on early pulmonary vascular reactions . However, the tracheal pressure response was less pronounced after pretreatment compared with septic controls . Calculated airway resistance was less increased and pulmonary compliance less decreased in the two pretreated groups . Furthermore, arterial hypoxia was prevented by pretreatment . It is concluded that this study suggests that LTs are involved in the development of myocardial insufficiency in experimental bacteremic septic shock . Moreover, the results strongly indicate that LTs may be of importance in compromising pulmonary gas exchange, partly by effects on the smaller airways.

Transfusion, 1989 Sep, 29(7), 646 - 5
Lyme disease--another transfusion risk?
Aoki SK, Holland PV.
Lyme disease (or Lyme borreliosis) is caused by a spirochetal bacteria, Borrelia burgdorferi . Increased recognition of the disease and increased exposure to the vector (ticks) capable of spreading B . burgdorferi from animal hosts have resulted in a rise in the number of cases of Lyme borreliosis reported in the United States . There are three stages of the clinical course of Lyme borreliosis; however, not all those infected will have typical manifestations of each stage, such as the arthritis of the third stage . Routine blood cultures will rarely document bacteremia and serologic testing is not yet reliable . Early treatment can prevent later stages of Lyme borreliosis . There is evidence that transmission of B . burgdorferi by blood transfusion is possible, but, to date, there has been no documentation of transfusion-associated Lyme borreliosis . Thus, no new recommendations for screening donors to identify possible carriers of B . burgdorferi are suggested at this time.

Compendium, 1989 Sep, 10(9), 472, 475 - 7, 480-2
Dental bacteremia and its relationship to bacterial endocarditis: preventive measures; Bender IB et al.; This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone . In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated . This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash . The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately . Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens.

Pediatr Emerg Care, 1989 Sep, 5(3), 163 - 5
Clinical characteristics of children with fever and transient neutropenia who experience serious bacterial infections; Bonadio WA et al.; A review of consecutive previously healthy children with fever and newly discovered neutropenia without underlying malignancy, evaluated during a three-year period, was performed . A total of 68 episodes occurred in 68 patients; blood culture was performed on each . Of 17 patients who appeared compromised (ill, irritable, toxic) on presentation, five (30%) had either bacteremia or bacterial meningitis . All five patients had clinical evidence of a fulminant disease process on examination . By contrast, all 51 patients who appeared to be well on presentation were culture-negative . Fever and new-onset neutropenia in children is a heterogeneous disorder with several outcomes . Any child with fever and newly discovered neutropenia who appears ill should be presumed to be at high risk for systemic bacterial infection and receive hospitalization for parenteral antibiotic therapy . By contrast, the previously healthy child older than two months of age with fever and new-onset neutropenia who appears to be well, and whose clinical evaluation does not indicate a serious underlying disease process, is at low risk for accompanying systemic bacterial infection; hospitalization with empiric antibiotic therapy pending culture results is not warranted for the majority of such children . Close outpatient monitoring with serial evaluation of the peripheral blood absolute neutrophil count to document bone marrow recovery is recommended for such cases.

Eur J Clin Microbiol Infect Dis, 1989 Sep, 8(9), 815 - 24
Detection of bloodstream infections in children; Campos JM; A critical responsibility of the clinical microbiology laboratory serving clinicians who care for infected children is accurate and timely detection of bacteremia . Blood culture protocols which are suitable for processing adult specimens are not necessarily the first choice for processing pediatric specimens . In this review, the following aspects of detection of bacteremia in children are covered: obtaining blood culture specimens from children, including skin disinfection, specimen volume and timing of specimen collection; the array of blood culture methods available, focusing upon conventional, radiometric, infrared spectroscopic and manometric broth cultures, as well as biphasic agar/broth and lysis direct plating techniques: the strengths and weaknesses of the various methods; and recommendations to laboratories for selection of a blood culture method based upon the laboratory's staffing level.

Gynecol Oncol, 1989 Aug, 34(2), 216 - 8
Experience with the Groshong long-term central venous catheter; Delmore JE et al.; A study of the Groshong catheter in a gynecologic oncology population is presented, describing the catheter's ease of insertion, and patient acceptance and compliance in catheter care . From December 1985 through November 1987, 72 Groshong catheters were inserted in 67 patients . The Groshong differs from conventional Hickman-type catheters in design and maintenance . Thirty-two of 72 catheters (44%) were inserted under local anesthesia . The remaining catheters were inserted under general anesthesia at the time of major gynecologic procedures . None of the cases required fluoroscopy . The insertion technique is less traumatic than conventional approaches because of a stainless steel tunneling device . The median duration of use was 191 days . There were no cases of pneumothorax or catheter occlusion . Catheter removal was required in four cases with skin infection unresponsive to local therapy and in two cases with bacteremia . One patient developed thrombosis of the right subclavian vein but was treated without catheter removal . One patient with a skin infection at the exit site accidentally dislodged her catheter . The overall complication rate was 11% (8 of 72 cases).

Dtsch Zahnarztl Z, 1989 Aug, 44(8), 622 - 4
{Incidence of bacteremia following extractions--a double blind study on local disinfection using chlorhexidine}; Rechmann P et al.; In a randomised double-blind study the incidence of bacteremia after two minutes mouth rinsing with chlorhexidine 0.1% followed by tooth extractions was registered . A significant reduction of bacteremia could not be observed in comparison with mouth rinsing with physiological saline solution . Tooth extractions always require the preventive administration of antibiotics to patients known with high risk of endocarditis.

Enferm Infecc Microbiol Clin, 1989 Aug-Sep, 7(7), 358 - 63
{Bacteremia at a community hospital during a 1-yr period . Epidemiologic, clinical and prognostic aspects}; Morano Amado LE et al.; To evaluate the epidemiology, etiology, mortality and prognostic factors of bacteremia in a district hospital, we carried out a retrospective study of all blood cultures (Bc) performed in 1987 in our institution . The criteria for contamination community or hospital acquired disease, and terminal or rapidly fatal disease were those commonly accepted . Two patients were excluded owing to incomplete data . Overall 1,693 Bcs were performed; 257 of these were positive, 189 were considered as true positive (11.1%) and corresponded to 70 episodes of bacteremia (9.1/1000 admitted patients) . Sixty-eight patients were included, 48 from the community and 20 of hospital origin . The male/female ratio was 43/25 . There was shock in 27% of the community acquired and in 55% of the hospital acquired cases (p less than 0.1) . There were no mortality differences between both groups, but there were differences in the spectrum of causative organisms . A comparison with a previous series from our institution was made . Its results shown some peculiarities of the disease in our area.

Jpn J Surg, 1989 Jul, 19(4), 462 - 7
Complement activation and neutrophil dysfunction in burned patients with sepsis--a study of two cases; Utoh J et al.; The changes in complement components and neutrophil functions were investigated in two cases of flame burn patients who died of multiple organ failure following septic shock . In the period of bacteremia, complement activation was observed in the plasma of both patients, using an immunoblotting method demonstrating C3a-related antigens . Coincidently, reduced neutrophil function and a decrease in the superoxide and leukotriene producing capacity, were also observed . An in vitro study showed that the capacity to produce superoxide and leukotriene became reduced in normal neutrophils after exposure to complement activated serum . These observations suggested that complement activation, probably brought about by massive bacterial infection, induced the impairment of neutrophil functions and resulted in a further breakdown of the host defence system, thereby leading to sepsis.

Ann Vasc Surg, 1989 Jul, 3(3), 261 - 3
Liver abscess following superior mesenteric artery revascularization for acute mesenteric ischemia; Shah PM et al.; A case of pyogenic liver abscess following successful mesenteric artery revascularization is described in a patient with acute mesenteric ischemia . Prior to revascularization, arteriography confirmed celiac and superior mesenteric artery occlusion . Occurrence of liver abscess is explained on the basis of ischemia impairing the barrier function of the intestinal mucosa, contributing to portal bacteremia that seeds ischemic or necrotic liver . In patients with acute mesenteric ischemia, sequential sonographic examination of the liver following mesenteric revascularization is advocated for early diagnosis of liver abscess if there is clinical evidence of the sepsis.

J Vasc Surg, 1989 Jul, 10(1), 20 - 7; discussion 27-8
Utility of the indium 111-labeled human immunoglobulin G scan for the detection of focal vascular graft infection; LaMuraglia GM et al.; The ability to diagnose and localize vascular graft infections has been a major challenge . Recent studies in animal models and humans with focal bacterial infection have shown that radiolabeled, polyclonal, human immunoglobulin G accumulates at the site of inflammation and can serve as the basis for an imaging technique . This study investigated this new technique for the diagnosis and localization of vascular graft infections . Twenty-five patients with suspected vascular infections involving grafts (22), atherosclerotic aneurysms (2), and subclavian vein thrombophlebitis (1) were studied . Gamma camera images of the suspected area were obtained between 5 and 48 hours after intravenous administration of 1.5 to 2.0 mCi (56 to 74 mBq) of indium 111-labeled, human, polyclonal immunoglobulin G . Scan results were interpreted without clinical information about the patient and were subsequently correlated with surgical findings, other imaging modalities, and/or clinical follow-up . In 10 of 10 patients found to have positive scan results, localized infections were confirmed at the involved sites . In 14 of 15 patients whose scan results were interpreted as negative, no vascular infections were identified at follow-up . The patient with false-negative results and recurrent bacteremia from an aortoduodenal fistula was found to have a negative scan outcome at a time when his disease was quiescent . These data suggest that nonspecific, human, indium 111-labeled immunoglobulin G scanning can be a useful noninvasive means of localizing vascular infections.

Pediatrics, 1989 Jul, 84(1), 18 - 27
Should blood cultures be obtained in the evaluation of young febrile children without evident focus of bacterial infection? A decision analysis of diagnostic management strategies; Kramer MS et al.; The technique of decision analysis was used to compare the benefits (prevention of major infectious sequelae of bacteremia) and risks (unnecessary hospitalization and intravenous antibiotic treatment of children whose bacteremia would have resolved spontaneously, discomfort of venipuncture) of alternative diagnostic management strategies in the evaluation of children 3 to 24 months of age with fever (rectal temperature greater than or equal to 39 degrees C) of acute (less than or equal to 4 days) onset and without evident focus of bacterial infection . The diagnostic strategies compared at the initial visit were blood culture in all, blood culture in none, and selective blood culture (restricted to children judged to be at high risk) . Probability estimates were based on published epidemiologic studies and case series, and utilities were elicited from mothers of 3- to 24-month-old children and from pediatricians . Based on initial probabilities and utilities, the "no blood culture" strategy had the highest expected utility, followed closely by the "selective blood culture" strategy, with the "blood culture all" strategy a distant third . Sensitivity analyses based on increased risk of major infectious sequelae or of bacteremia had no effect on the ranking of the three initial management options . Eliminating the "disutility" of venipuncture or augmenting the disutility of major infectious sequelae also failed to alter the ranking . Even when an extreme relative disutility for major sequelae was assumed, the "blood culture all" strategy was not favored . Thus, the risk of unnecessary hospitalization and intravenous antibiotic treatment of the relatively large number of children whose bacteremia spontaneously resolves appears to outweigh the benefit of preventing serious infectious sequelae in the few children in whom positive blood culture results permit timely intervention . The explicitness and coherence of the decision analysis approach should help in developing a rational diagnostic approach to the young febrile child.

J Pediatr, 1989 Jul, 115(1), 151 - 5
Rapid removal of excessive iron with daily, high-dose intravenous chelation therapy; Cohen AR et al.; We investigated the value of high-dose intravenous iron chelation therapy with deferoxamine as an alternative to conventional subcutaneous therapy in eight patients receiving regular transfusions who had massive iron stores, including two with clinical heart disease . Six to twelve grams of deferoxamine was infused daily for 12 hours over 12 to 25 months through externalized central venous catheters or implanted reservoirs . Serum ferritin levels decreased by 56% to 99% . Liver iron concentrations, measured by magnetic susceptibility in two patients, were 1234 and 2438 micrograms/gm wet weight (22.1 and 43.6 mumol/gm wet weight) after treatment for 17 and 25 months, respectively . A patient with congestive heart failure and a patient with severe ventricular dysrhythmias no longer required cardiac medication after 12 to 24 months of chelation therapy . Three episodes of bacteremia and three episodes of cellulitis accounted for a catheter-related infection rate of 0.14 per 100 patient-days . The catheter removal rate was 0.20 per 100 patient-days . No patient experienced serious visual, auditory, or other toxicities . We conclude that in some patients receiving regular erythrocyte transfusions, high-dose intravenous chelation therapy with deferoxamine is superior to conventional subcutaneous treatment.

Diagn Microbiol Infect Dis, 1989 Jul-Aug, 12(4), 309 - 13
Comparison of three techniques for concentrating positive BACTEC 13A bottles for mycobacterial DNA probe analysis; Conville PS et al.; Three methods of concentrating 1 ml aliquots from BACTEC 13A bottles containing patient blood samples were evaluated for testing with the Gen-Probe Rapid Diagnostic System for Mycobacteria avium complex: 1 . using no reagents, 2 . using both lysing and wash reagents; and 3 . using lysing reagent only . Aliquots from 13As containing human blood and seeded with eight mycobacterial species were also concentrated directly and using both reagents . Results for samples containing M . avium were as follows: 1 . using the direct concentration technique 34 of 47 samples (72%) gave unequivocally positive results; 2 . 43 of 47 samples (92%) concentrated using both reagents gave positive results; 3 . the technique using lysing reagent only was not found useful . There were no false positives with any of the seeded specimens . We were also able to define the minimum Growth Index necessary to ensure un-equivocally positive results for each concentration technique . For those samples containing M . avium these values were 42 for the technique using both reagents and 86 for the direct technique . Direct or reagent concentration of 13A aliquots for testing with Gen-Probe DNA probes provides a rapid, sensitive, and specific means for the identification of M . avium complex bacteremia.

Infect Immun, 1989 Jul, 57(7), 2141 - 8
General method for site-directed mutagenesis in Escherichia coli O18ac:K1:H7: deletion of the inducible superoxide dismutase gene, sodA, does not diminish bacteremia in neonatal rats; Bloch CA et al.; A defined deletion in the Escherichia coli K-12 sodA gene (encoding manganese-superoxide dismutase) linked to a nontransposable selectable marker was generated by transposon Tn5 insertion in combination with in vitro mutagenesis . This mutant allele was used to replace the wild-type sodA gene in an E . coli clinical isolate of serotype O18ac:K1:H7 by bacteriophage P1 transduction . The O18ac:K1:H7 sodA mutant contained no manganese-superoxide dismutase and no hybrid manganese-iron-superoxide dismutase . The sodA mutant was more sensitive to paraquat toxicity than were the parental strain and an isogenic mutant bearing an analogously constructed sodA+ Tn5 insertion allele . In a suckling rat model for bacteremia following oral inoculation of E . coli K1, the sodA mutant was undiminished in its capabilities both to colonize the gastrointestinal tract and, surprisingly, to cause bacteremia . In conjunction with the rat model for E . coli K1 pathogenesis, the method for site-directed mutagenesis described in this paper permits determination of the role played in colonization and bacteremia by any K1 gene which either has a homolog in E . coli K-12 or can be cloned and manipulated therein.

G E N, 1989 Jul-Sep, 43(3), 185 - 93
{Factors involved in bacterial translocation in an experimental model of intestinal obstruction}; Zapata-Sirvent RL et al.; We designed a model of intestinal obstruction (IO) to study the histological alterations in the intestinal wall and the mesenteric lymph nodes (MLN) . Therefore we used 32 Sprague-Dawley rats and under anesthesia a laparotomy was performed and the distal ileum was ligated with 3-0 silk, producing a complete occlusion . At different interval (24, 48, 72 and 96 hours) the animals were sacrificed by cervical dislocation and were histologically analyzed . At 24 hours post IO, congestion, edema and a inflammatory infiltrate were observed at the level of the lamina propia and the MLN were reactive . At 48 hours the congestion and edema increased and the intestinal mucosa began to fragment, allowing the bacteria to translocate and getting to the lymph nodes in the intestinal wall . The reactivity at the MLN increased . The observation of bacterial translocation in IO widen the scope of the alterations in this pathology, were not only absorption of toxic products and endotoxin occurs in the compromise segment and this phenomenon could explain the incidence of bacteremia and sepsis in the IO patients.

Eur J Clin Microbiol Infect Dis, 1989 Jul, 8(7), 620 - 2
Evaluation of culture techniques for identification of catheter-related infection in hemodialysis patients; Rello J et al.; A prospective study was conducted over eight months to evaluate the usefulness of two culture techniques using different catheter parts for detection of bacterial colonization or catheter-related bacteremia in patients with jugular or subclavian hemodialysis catheters . A combination of semiquantitative culture of the external surface and quantitative culture of the intraluminal surface of the intradermal catheter segment provided the best means of detecting catheter colonization . For detection of catheter-related bacteremia, this combination had 100% sensitivity and a positive predictive value similar to the actual rate of catheter-related bacteremia.

Am J Epidemiol, 1989 Jun, 129(6), 1258 - 67
Hospital-acquired pneumonia . Attributable mortality and morbidity; Leu HS et al.; A total of 1,001 consecutive episodes of nosocomial pneumonia in 901 patients was identified by routine surveillance at the University of Virginia Medical Center between 1979 and 1983 (8.6 episodes/1,000 admissions) . When only initial episodes were examined, 890 patients comprised the study sample . The overall case fatality rate was 30% . Stepwise logistic regression indicated that time from admission to pneumonia (p = 0.0006), age (p less than 0.0001), prior use of mechanical ventilation (p = 0.0032), and neoplastic disease (p = 0.0062) were associated with mortality . Multiple regression analysis indicated that the factors associated with increased length of hospitalization included posttracheostomy status (p = 0.0001), prior mechanical ventilation (p = 0.0001), immunosuppressive or leukopenic status (p = 0.0009), nasogastric intubation (p = 0.0003), and prior bacteremia (p = 0.0127) . A sampled, individually matched cohort study (n = 74 pairs) was conducted to determine the proportion of mortality in cases that was attributable to infections (33%) and to determine excess hospital stay (seven days) among the patients with nosocomial pneumonia . Excess stay was statistically significant (p less than 0.0001), but proportional mortality was only marginally significant (p = 0.0892) . Our findings suggest that nosocomial pneumonia accounts for approximately 33% of the crude mortality and contributes significantly to the economic burden associated with prolonged hospitalization.

Infect Dis Clin North Am, 1989 Jun, 3(2), 275 - 87
Infections in breast implants; Freedman AM et al.; Infection following breast implants is an uncommon event . This is somewhat surprising, since the human breast is not a sterile anatomical structure . The flora found in the breast are derived from the nipple ducts and closely resemble those of normal skin . These organisms, predominantly S . epidermidis, may in some cases be responsible for firmness secondary to capsular contracture . Treatment of the periprosthetic infection usually involves implant removal, but salvage by systemic antibiotics is sometimes possible . Atypical mycobacteria are very rarely the cause of infection, but can be extremely difficult to eradicate when involved . Toxic shock syndrome has been reported to occur following breast implants and is a life-threatening problem requiring immediate removal of the implant . It may be significant that in some cases with effusion and infection occurring many months or years after implant placement, there has been a preceding event such as a laryngitis or flu-like illness . This suggests the possibility of a bacteremia being involved in the causation of the infection . If this were the case, then these patients should be handled in a fashion similar to those with prosthetic heart valves . Accordingly, in our own practice, we advise that penicillin "V" be given beforehand when a patient with breast implants is to have any dental procedure . It must be stressed that there is no statistical or scientific proof at the present time that this is of any value . In conclusion, when dealing with these large foreign bodies, absolute sterility is essential, and excellent surgical technique to obviate hematoma and the occurrence of tissue ischemia is mandatory . Evidence of severe infection necessitates implant removal, but in less severe cases a trial of intravenous antibiotics is permissible . Having removed an implant, further insertion should be deferred, preferably for 6 months . If the new implant can be placed in a different plane, that is, submuscular, this is desirable . Exposed implants can be salvaged but this requires considerable judgment and one should be prepared for re-exposure or frank infection.

Toxicology, 1989 Jun 1, 56(2), 179 - 95
Relationship of the hypothalamic-pituitary-adrenal axis with chemically induced immunomodulation . I . Stress-like response after exposure to T-2 toxin; Taylor MJ et al.; T-2 toxin (T-2), a trichothecene mycotoxin, produced by several members of the genus Fusarium is a cytotoxic feed contaminant and has been shown to by immunomodulatory . It is suspected that T-2 associated immunomodulation is mediated partly through the hypothalamic-pituitary-adrenal (HPA) axis . T-2, prepared in 4% ethanol/corn oil, was administered orally to male CD-1 mice . Endotoxemia was evident 24 h after a single, oral exposure to T-2 . Blood levels of corticosterone, indicative of the stress-response, increased 24 h after T-2 exposure . Hypothalamic norepinephrine and serum corticosterone levels increased in a dose-related manner after 2 weeks of T-2 exposure . Endotoxin, detected in the serum of animals exposed to 2.5 mg/kg T-2 for 1 week, was not associated with bacteremia . Neither endotoxin nor bacteremia were detectable after 2 or 4 weeks of T-2 exposure . Exposure to 2.5 mg/kg T-2 also affected several organs . The forestomach was ulcerated, with lymphocytic infiltration, epithelial proliferation, and hyperkeratinization . Increased spleen weight was associated with a proliferative red pulp . No histological changes were observed in the enlarged liver . Gastritis has been associated with increased corticosteroid production; cortical depletion and reduced mass of the thymus are phenomena attributable to increased corticosteroid levels . An increased corticosteroid level has been associated with thymic involution leading potentially to decreased T-dependent antibody response, a known effect of T-2.

J Clin Oncol, 1989 Jun, 7(6), 798 - 802
The safety of dental extractions in patients with hematologic malignancies; Williford SK et al.; Dental disorders have been recognized as major sources of infection in patients with hematologic malignancies (HM) . Management of severe dental infections usually includes dental extractions (DE), but the safety of extractions in patients with HM who are at risk for bleeding, sepsis, and poor wound healing has not been well established . In conjunction with an aggressive program of dental care, 142 DE were performed in 26 patients with acute leukemia, myelodysplastic syndromes, and myeloproliferative disorders . Granulocytopenia (less than 1,000 granulocytes/microL) was present during or within ten days following surgery in 14 patients . In these 14 patients (101 DE), the mean granulocyte count was less than 450/microL, with a median duration of granulocytopenia following surgery of 32 days (range, four to 169 days) . Thrombocytopenia (less than 100,000 platelets/microL) occurred during or within two days following surgery in 13 patients (80 DE), with a mean platelet count of 63,500/microL . Transfusions were given for platelet counts less than 50,000/microL . All DE were performed without significant complications . Bleeding was minor to moderate and easily controlled with local measures; no patient required transfusion due to hemorrhage . Average maximum temperature 24 hours after DE was 37.7 degrees C . No episodes of bacteremia were documented within ten days of DE . Minor delay in wound healing was observed in two patients . We conclude that DE can be safely performed in patients with HM in combination with aggressive supportive care.

Prakt Zubn Lek, 1989 May, 37(4), 104 - 8
{Diabetes mellitus in ambulatory stomatosurgical practice}; Vanek J et al.; The authors evaluated in 58 patients aged 27-65 years the pre- and postextraction bacteremia after a simple extraction at intervals of 5 minutes, 1 hour, 24 and 72 hours . From the group of 58 examined patients 35 suffered from diabetes mellitus--11 type 1, 24 type 2 . Before extraction bacteremia was not found in any of the examined patients . Five minutes after extraction bacteremia was recorded in 50% of the diabetic patients, more frequently in type 1 than type 2 . Bacteremia was found in 8% of patients with type 1 diabetes even after 24 hours . The authors recommend to assess in addition to the blood sugar level also so-called glycohaemoglobin which they began to assess regularly in diabetic patients.

Infect Immun, 1989 May, 57(5), 1568 - 72
Heterologous protection against invasive Escherichia coli K1 disease in newborn rats by maternal immunization with purified mannose-sensitive pili; Guerina NG et al.; Heterologous protection against Escherichia coli K1 bacteremia with antibody to purified mannose-sensitive (MS) pili was demonstrated in a neonatal rat model . The serological relatedness of purified MS pili from 17 E . coli K1 clinical isolates was examined by an enzyme-linked immunosorbent assay . Five pilus serogroups were identified, with the pili in each group showing 50% or greater cross-reactivity with the typing serum of the group . The MS pili from 12 of 17 (70%) strains belonged to just two serogroups . Pregnant Sprague-Dawley rats (dams) were immunized with purified pili, and their newborns (pups) were challenged with heterologous E . coli . Bacteremia was significantly reduced when the pili used for immunization were from the same serogroup as the pili expressed by the challenge bacteria . Thus, immunization with C94 pili and challenge with E03 (71% cross-reactivity) or E04 (50% cross-reactivity) resulted in bacteremia rates of 12 of 17 (17%) versus 51 of 79 (65%) in controls and 0 of 75 (0%) versus 28 of 70 (40%) in controls, respectively (P less than 0.001 for each comparison) . With lower cross-reactivity, less protection was observed (P less than 0.05 for 22 to 37% pilus serological relatedness) . No protection was seen in pups suckled by dams immunized with MS pili having only 5% serological relatedness to the pili on the challenge strain.

Acta Paediatr Scand, 1989 May, 78(3), 465 - 8
Branhamella catarrhalis bacteremia in children; Cimolai N et al.; Two cases of Branhamella catarrhalis bacteremia in childhood are presented . The literature is reviewed for this unusual cause of bacteremia.

Gastroenterol Clin Biol, 1989 Apr, 13(4), 335 - 9
{Can septicemia and ascitic fluid infections in cirrhotic patients be treated by the oral route alone?}; Silvain C et al.; The aim of this study was to determine the efficacy of oral antibiotics in the treatment of severe infections in cirrhosis . Twenty-two patients (17 males, 5 females) with spontaneous bacteremia (n = 7) or bacterial peritonitis (n = 15) were treated with oral pefloxacin 400 mg per 24 hr alone (n = 1) or in combination with another oral antibiotic, trimethoprimsulfamethoxazole (n = 13), amoxicillin (n = 6), cefadroxil (n = 2), or metronidazole (n = 1) . In patients with spontaneous bacteremia, all organisms were found to be sensitive to oral antibiotics, and a favorable response was elicited in 6 out of 7 (86 p . cent) within 3 days (mean) of treatment . In patients with spontaneous peritonitis, ascitic fluid cultures were positive in 11 cases, and organisms were sensitive to pefloxacin in 9 out of 11 cases . A favorable response was elicited in 13 out of 15 within 2 to 8 days of treatment . Fourteen patients died (64 p . cent), 3 of infection (bacteremia n = 1, peritonitis n = 2), and 11 patients of causes unrelated to infection, mainly variceal hemorrhage, hepatorenal syndrome or hepatocellular carcinoma, although the clinical symptoms of infection were controlled . One-year survival was 57 p . cent in patients with bacteremia and 33 p . cent in those with bacterial peritonitis . Oral treatment was well tolerated in all patients . We suggest that most bacteremia and spontaneous bacterial peritonitis in cirrhotic patients can be treated with oral antibiotics . In some patients, this may be accomplished on an out patient basis.

Am J Infect Control, 1989 Apr, 17(2), 69 - 76
Sporadic bacteremia complicating central venous catheter use in a community hospital: a model to predict frequency and aid in decision-making for initiation of investigation; Ehrenkranz NJ et al.; Sporadic bacteremia complicating single-lumen central venous catheter (CVC) use was prospectively recorded in a community hospital in 1981 and 1982 . Sixty-four of 1258 (5.1%) patients had definite bacteremia . A nested case-control study was then undertaken to identify predictive risk factors . Fifteen statistically significant factors found in the 1981 cohort were tested in the 1982 cohort, and four remained significant for both years . Univariate and multiple logistic regression analysis on both years' findings, separately and together, identified two independently associated factors: diagnosed respiratory colonization/infection (p less than 0.0001) and serum albumin level (p less than 0.001) . Based on these factors, an equation was developed to express the probability of bacteremia . Solving this equation provides an infection control practitioner with an expected rate of bacteremia that complicates CVC use and provides an aid for decision-making for investigation in the absence of clusters.

Ann Cardiol Angeiol (Paris), 1989 Apr, 38(4), 225 - 9
{Mycotic aneurysms}; Chevalier P et al.; Mycotic aneurysms are aneurysms infected by bacteria or fungi . These may be secondary to an endocarditis, or they may be primary, and then are developed from a septicemia or bacteremia . The diagnosis, often difficult, is sometime only made during complications, the most severe of which is rupture . This diagnosis must be aided by new imaging techniques such as ultrasonography, tomodensitometry, magnetic resonance imaging . The treatment is medical (antibiotics) and surgical.

Crit Care Clin, 1989 Apr, 5(2), 255 - 69
Oxygen delivery and uptake by peripheral tissues: physiology and pathophysiology; Schumacker PT et al.; When oxygen availability to tissues becomes limited, several mechanisms interact to maintain a supply-independent O2 uptake by tissues . Among tissues, adrenergic vasoconstriction prevents a vascular steal of a limited O2 supply by tissues with low metabolic demands . Within tissues, increases in perfused capillary density facilitate an increase in the extraction ratio for oxygen ({CaO2-CvO2}/CaO2) . Factors that disrupt the physiologic balance between sympathetic-mediated vasoconstriction and local metabolic vasodilation may impair the ability of the organism to adjust the regional extraction of oxygen in response to changes in O2 delivery, resulting in a pathologic dependence of O2 uptake on supply . Patients with ARDS have demonstrated such an O2 extraction defect, although the mechanism is not fully understood . Although a tissue mitochondrial abnormality could explain these findings, experimental studies of endotoxemia and bacteremia demonstrate a peripheral O2 extraction defect similar to that seen in patients . This defect has been found at the whole body level and within intestine, but not within skeletal muscle . Evidence points to a defect in microvascular control as the mechanism responsible for the defect . Other evidence suggests that damaged peripheral endothelial cells may mediate the loss of vascular control . Hence, in patients with ARDS a damaged endothelium in the pulmonary circulation contributes to the lung edemagenesis, and damaged peripheral endothelium may mediate the defect in microvascular control, leading to the pathologic dependence of oxygen uptake on delivery.

J Clin Microbiol, 1989 Apr, 27(4), 768 - 9
Diagnosis of Mycobacterium bacteremia in patients with acquired immunodeficiency syndrome by direct examination of blood films; Eng RH et al.; Thirty acquired immunodeficiency syndrome patients with mycobacterial bacteremia documented by Du Pont Isolator (Du Pont Co., Wilmington, Del.) blood cultures underwent microscopic examination of buffy coat blood smears . Of 30 patients, 14 were culture positive for Mycobacterium avium-Mycobacterium intracellulare complex and 1 was positive for M . tuberculosis . Of 15 culture-positive patients, 13 had identifiable organisms on Kinyoun- or auramine-stained direct blood smears.

Toxicology, 1989 Apr, 55(1-2), 239 - 46
A unique case of intravenous injection of fungal "pancreatic" enzymes causing shock and proteolysis of haemostatic proteins; Seitz R et al.; A 20-year-old man on oral substitution of pancreatic enzymes after hemipancreatectomy injected an enzyme preparation of fungal origin intravenously after dissolving it in water . Within a few hours chills, headache, nausea and vomiting, fever of 40.8 degrees C, and shock occurred . The acute illness might have been caused by bacteremia, an anaphylactic reaction, or by direct activation of humoral or cellular mediators by the fungal enzymes . A haemostatic disturbance, particularly a drop in plasminogen, was observed . In vitro, the fungal enzyme preparation stimulated elastase release from isolated neutrophils and eliminated plasmatic inhibitors and plasminogen in normal plasma and whole blood . Human neutrophil elastase complexed to alpha 1-antitrypsin was increased in the patient's plasma, while the levels of the complexes thrombin-antithrombinIII and plasmin-alpha 2-antiplasmin, indicating recent coagulation or fibrinolysis, respectively, were not elevated . Thus, an activation of the neutrophils with release of elastase might have contributed to the observed coagulation disturbances.

Wien Klin Wochenschr, 1989 Mar 31, 101(7), 241 - 4
{High-dose short-term antibiotic therapy in bacteremia and infection in severely burned patients}; Stuffer M et al.; 60 to 70% of all late deaths in patients with severe burns are due to sepsis . Thus, treatment with antibiotics is essential in the overall management of such patients, which in our hospital is carried out according to the following principles: 1 . No prophylactic antibiotic treatment . 2 . Careful evaluation of the bacterial spectrum of the burns, nasopharyngeal area, anal region, sputum and blood cultures . 3 . In case of bacteriaemia we start high-dose combination therapy with two different, specific chemotherapeutic agents, given alternately every 4 to 6 hours . 4 . In concordance with the clinical picture antibiotic therapy is discontinued as soon as three subsequent blood cultures remain sterile . Since 1980, 58 patients with severe burns (extent: 20 to 90% of body surface) have been treated according to these principles . Mortality due to sepsis was low, namely 9.5% (2 out of 21 patients presenting with bacteriaemia), so that our method of treatment has proven to be effective.

Schweiz Med Wochenschr, 1989 Mar 18, 119(11), 344 - 6
{Intravascular catheter: prevention and therapy of infection}; Zimmerli W; Intravascular devices are widely used . If certain precautions are taken, catheter-related infections, and especially bacteremia, are infrequent . Special attention should be paid to the correct access (peripheral versus V . subclavia or V . jugularis interna), immediate stabilization of the position, the choice of dry dressings (transparent plastic dressings should be avoided on newly inserted or arterial catheters, as well as on damp wounds), and regular changing of peripheral lines . In the febrile patient with vascular access the infective source should be sought . If the insertion site shows signs of inflammation, or if septicemia occurs, catheters must be removed . In patients with peripheral suppurative thrombophlebitis, surgical excision of the vein must be considered . In contrast, in septic thrombophlebitis of a central vein, removal of the catheter and antibiotic and anticoagulation therapy may be sufficient.

Cancer, 1989 Mar 15, 63(6), 1055 - 9
High-dose cytosine arabinoside and daunorubicin as primary therapy in elderly patients with acute myelogenous leukemia . A phase I-II study of the Southeastern Cancer Study Group; Lazarus HM et al.; We undertook a phase I-II trial in elderly (age greater than or equal to 60 years) untreated acute myelogenous leukemia (AML) patients using brief, intensive therapy to improve induction rates and overall survival in older AML patients . Twenty-one patients ranging in age from 60 to 81 years (median, 66 years) were treated using either a 4- or 5-day course of high-dose cytosine arabinoside, 3 g/m2 intravenously (IV) every 12 hours; followed by daunorubicin, 45 mg/m2/d IV bolus for 3 consecutive days . Thirteen patients were entered at the first dose level (a 4-day course or eight doses of cytosine arabinoside), whereas eight patients underwent therapy at the second dose level (a 5-day course or ten doses) . Patients who achieved a complete remission received a repeat course of high-dose cytosine arabinoside and daunorubicin within 4 weeks of attaining remission . Seven patients had an antecedant history of a myelodysplastic syndrome . Infection was the major complication experienced by this elderly patient group, and included ten episodes of bacteremia or fungemia (four of which were fatal) and five cases of pneumonia (one fatality) . Nine of the 21 patients (three of 13 at the first dose level and six of eight at the second dose level) achieved a complete remission . Median remission duration was 9 months (range, 4-19+ months) . Although high-dose cytosine arabinoside plus daunorubicin was an effective antileukemic therapy, it is too toxic to recommend for most elderly leukemic patients.

Am J Obstet Gynecol, 1989 Mar, 160(3), 647 - 50
Postpartum bacteremia and placental colonization with genital mycoplasmas and pregnancy outcome; Naessens A et al.; The influence of placental colonization and postpartum bacteremia with genital mycoplasmas on the course of delivery and the immediate postpartum period was evaluated in 511 women who gave birth to live infants of at least 26 weeks' gestation . Genital mycoplasmas were isolated from the placenta in 153 patients (29.9%) and from blood in four patients (0.8%) . These four isolates were all Ureaplasma urealyticum . Patients with genital mycoplasmas isolated from the placenta were delivered of infants with birth weights and gestational ages similar to those of infants of patients who did not have genital mycoplasmas in the placenta (3260 gm and 39.2 weeks versus 3272 gm and 39.3 weeks) . No adverse effects of maternal postpartum bacteremia with genital mycoplasmas were observed, either in the mother or in the baby . We conclude that, whereas genital mycoplasmas frequently can be isolated from the placenta, there is no evident relationship between the presence of genital mycoplasmas and pregnancy outcome . In a few instances U . urealyticum has been isolated from the blood of afebrile postpartum women . In these women the presence of this bacteria is probably related to the birth process . This bacteremia does not precede an infectious complication.

Am J Med Sci, 1989 Mar, 297(3), 149 - 52
Serial bilirubin determinations as a prognostic marker in clinical infections; Franson TR et al.; Patients with documented serious infection and total bilirubin values of greater than 2 mg/dl were surveyed for serial changes in bilirubin and other laboratory and clinical features . Of 19 patients studied, 12 (Group A) had persisting or increasing hyperbilirubinemia, and 7 (Group B) had decline in bilirubin after infection onset . None demonstrated marked changes in other liver tests . Only one patient had infection directly involving the hepatobiliary system . There were no significant differences between the two groups with respect to underlying illnesses, active hepatobiliary diseases, pathogens, bacteremia, or administration of cholestatic drugs . All Group A patients died because of uncontrolled infections, whereas all Group B patients survived with resolution of infection (p less than .001) . Ten of 15 patients with available preinfection liver tests demonstrated serial bilirubin increases without marked changes in other liver tests prior to clinical recognition of infection . These findings demonstrate that hyperbilirubinemia disproportionate to increases in other tests may manifest before recognition of infection and that persistent or progressive hyperbilirubinemia is indicative of ongoing active infection.

Am J Gastroenterol, 1989 Mar, 84(3), 311 - 2
Prosthetic endocarditis after endoscopic variceal sclerotherapy: a failure of antibiotic prophylaxis; Baskin G; Bacteremia after esophagogastroduodenoscopy and endoscopic procedures such as esophageal variceal sclerotherapy is well recognized . The theoretical risk of endocarditis has led the American Heart Association and other authorities to recommend antibiotic prophylaxis for these procedures . However, no well-documented episodes of endocarditis associated with endoscopy have been reported . The current case of prosthetic valvular endocarditis is clearly linked to endoscopic sclerotherapy and occurred despite such antibiotic administration . This failure of prophylaxis may be due to factors specific to this patient; however, the efficacy of prophylaxis remains to be proven.

Rev Infect Dis, 1989 Mar-Apr, 11(2), 319 - 24
Lemierre's disease: postanginal bacteremia and pulmonary involvement caused by Fusobacterium necrophorum; Moreno S et al.; The combination of acute pharyngotonsillitis, neck pain, fever, and pulmonary septic emboli caused by Fusobacterium necrophorum in a healthy young person is extremely rare . The entity was described by Lemierre in 1936 as a typical syndrome easy to recognize and diagnose exclusively on clinical grounds . A case of Lemierre's disease is reported, and 10 other cases found in the medical literature are reviewed.

Am J Physiol, 1989 Mar, 256(3 Pt 2), R716 - 21
Effect of diltiazem on skeletal muscle 3-O-methylglucose transport in bacteremic rats; Westfall MV et al.; This study examined whether alterations in cellular Ca2+ regulation contribute to previously observed changes in skeletal muscle sugar transport during bacteremia . Fasted male rats received saline (control) or bacteria (4 X 10(10) Escherichia coli/kg) intraperitoneally . Twelve hours later, basal and insulin-mediated 3-O-methylglucose (3MG) transport was measured in isolated soleus muscles . Measurements of 3MG transport in the presence of cytochalasin b or at a low temperature (0.5 degree C) indicated that altered sugar transport in bacteremic rat muscles was not due to nonspecific membrane permeability changes . To determine the role of Ca2+ in the pathogenesis of altered sugar transport during bacteremia, rats were treated with the Ca2+ antagonist diltiazem (DZ, 0.6-2.4 mg/kg) at various times (0, 0 + 7.5, 10 h) after saline or bacterial injection . In bacteremic rats given 2.4 mg/kg DZ at 10 h, basal and insulin-mediated transport were similar to control values . This dose of DZ had little effect on control muscles . The addition of 20 microM DZ to the incubation media did not affect basal or insulin-mediated 3MG transport in bacteremic rat muscles . Addition of the Ca2+ agonist BAY K 8644 to the incubation media had no effect on sugar transport in bacteremic rat muscles but caused alterations in control rat muscles that were comparable to those observed in bacteremia . These results suggest that alterations in Ca2+ regulation could contribute to the previously observed changes in sugar transport in skeletal muscles from bacteremic rats.

Pediatr Dent, 1989 Mar, 11(1), 37 - 42
Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population; Raether D et al.; Disruption of the oral mucosal lining and the lack of normal defense mechanisms predispose bone marrow transplant (BMT) patients to life-threatening infections, often caused by oral flora . Chlorhexidine, used as an oral antiseptic, appears promising in limiting oral bacteria and fungi, and therefore, may decrease oral complications associated with BMT . The purpose of this study was to determine in pediatric BMT recipients if a 0.12% chlorhexidine mouthrinse, used as an adjunct to normal in-hospital oral care regimens, would decrease the severity of oral mucositis as measured by oral ulcerations, bacteremia, and length of hospital stay . Forty-seven pediatric BMT subjects were included in this double-blind study . Subjects were instructed to use 15 ml of a mouthrinse 3 times daily to be swished and gargled for 30 sec . Each subject had 7 oral sites scored for the percentage of ulcerated mucosa twice weekly until day +35 or hospital discharge or death . Blood was cultured daily during neutropenia . Additionally, the number of days from onset of cytoreduction to hospital discharge or death was recorded for each subject . Alpha was set at .05 . There was no significant difference in the severity of oral ulceration between the chlorhexidine and placebo groups (P = .18) . Chlorhexidine did not reduce the development of bacteremia (P greater than .5), nor did it significantly decrease the length of hospital stay (P = .68).(ABSTRACT TRUNCATED AT 250 WORDS)

Ugeskr Laeger, 1989 Feb 6, 151(6), 374 - 6
{Serious infections in alcoholics . 1 . Bacteremia, lobar pneumococcal pneumonia and pneumococcal meningitis in alcoholics 1974-1987}; Siboni A et al.; During the period 1974-1987, the frequency of infections in alcoholics discharged from hospitals in Funen showed an increase of 5.53 +/- 3.38 (p = 0.0039) per 10,000 alcoholics discharged per year . The frequency of discharged alcoholics increased by 3.72 +/- 0.60 per 10,000 discharged patients per year . Infections were diagnosed in 0.48 per cent of the discharged alcoholics and in 0.18 per cent of the discharged non-alcoholics (p less than 0.00001) . Pneumococcal infections were relatively more frequent in alcoholics (p less than 0.05).

J Am Dent Assoc, 1989 Feb, 118(2), 169 - 73
Physician and dentist compliance with American Heart Association guidelines for prevention of bacterial endocarditis; Nelson CL et al.; To determine the rate of physician and dentist compliance with the American Heart Association's (AHA) recommendations for prophylaxis against bacterial endocarditis--considered the standard of care--questionnaires were mailed to 1,131 dental and medical practitioners . They were asked to identify various cardiac conditions requiring prophylaxis and dental procedures that would cause a bacteremia, and to write prescriptions for prophylactic antibiotics for five different scenarios . Both groups had low compliance with AHA recommendations (32.9% collectively) when prescribing appropriate antibiotic regimens for bacterial endocarditis prophylaxis.

Circ Shock, 1989 Feb, 27(2), 111 - 22
Hypoperfusion of the intestinal microcirculation without decreased cardiac output during live Escherichia coli sepsis in rats; Whitworth PW et al.; In order to determine the intestinal microvascular responses to normotensive, high cardiac output (CO) bacteremia, we measured vascular diameters and blood flow at different levels of the intestinal microcirculation during live E . coli bacteremia in male Sprague-Dawley rats (n = 16) . Precollicular brainstem transection was used to allow study free of drug anesthesia . The microcirculation of a loop of small intestine (with intact neurovascular connections) was observed by in vivo video microscopy and optical Doppler velocimetry at a magnification of x1,500 . Intraluminal microvessel diameters and red cell velocity were measured in successive branches until the vessel entered a villus . CO was measured by transpulmonary thermodilution . Intravenous infusion of 1 x 10(9) live E . coli caused a 20% increase in CO at 50 min and a 14% decrease in systemic vascular resistance . However, microvascular blood flow to the small intestine decreased by 27% at 1 hr and by 56% at 2 hr . Progressive arteriolar constriction (25-50%, P less than .05) occurred at all levels of the intestinal microcirculation . These data indicate that intestinal hypoperfusion caused by arteriolar constriction occurs during high CO bacteremia . This hypoperfusion could contribute to mucosal injury and intestinal mucosal barrier dysfunction during sepsis.

J Surg Res, 1989 Feb, 46(2), 108 - 17
Hypertension alters microvascular responses in skeletal muscle to hyperdynamic bacteremia and hypodynamic Escherichia coli sepsis; Lubbe AS et al.; Altered vascular reactivity to numerous vasoactive substances in hypertension formed the basis for studying the in vivo microcirculation of skeletal muscle tissue during high cardiac output bacteremia and low cardiac output sepsis . Large and small arteriole and venule diameters of the cremaster muscle were measured via videomicroscopy in normotensive and 1K-1C-renovascular hypertensive rats before and after the infusion of live Escherichia coli bacteria . During hyperdynamic bacteremia and during hypodynamic sepsis, large arterioles constricted and small arterioles dilated in normotensive animals . During hyperdynamic bacteremia, this differential arteriolar response was blunted in hypertension . In hypodynamic sepsis, large arterioles did constrict in the hypertensive animals, but small arteriolar dilation was still blunted . Sodium-nitroprusside, a postreceptor acting agent applied locally, maximally dilated small arterioles to the same level in all groups to indicate that the ability of vascular smooth muscle to relax is intact in hypertension . We conclude that the failure of the small arterioles to dilate during sepsis in hypertension is not due to a loss of vascular smooth muscle function, but that hypertension may functionally alter arteriolar reactivity at the receptor and/or endothelial level to interfere with E . coli-mediated responses in the skeletal muscle microvasculature.

Am J Surg, 1989 Feb, 157(2), 210 - 4
Impaired clearance of Escherichia coli bacteremia in early biliary obstruction; Scott-Conner CE et al.; Adult male rats underwent common bile duct ligation or sham celiotomy . At intervals of 7 and 14 days postoperatively, bacteremia was induced by intravenous injection of 10(9) Escherichia coli or intraperitoneal injection of 10(6) E . coli . Serial quantitative blood cultures and quantitative whole organ cultures were obtained . One week after surgery, clearance of bacteremia was impaired in all of the animals . Clearance of intraperitoneally injected E . coli was less efficient in the duct ligation rats . Fourteen days postoperatively, clearance of bacteremia induced by intravenous or intraperitoneal injection had improved in the sham celiotomy rats but was still significantly impaired in the duct ligation rats . An increased number of viable E . coli were recovered from the lungs of duct ligation rats after intravenous administration . We found that rats with obstructive jaundice do not respond normally to a bacteremia challenge . This impairment in reticuloendothelial function can be noted as early as 1 week after common duct ligation.

J Infect Dis, 1989 Feb, 159(2), 310 - 9
A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters; Conly JM et al.; Patients having central venous catheters for three or more days were prospectively randomized to receive a transparent (n = 58) or gauze (n = 57) dressing to compare the incidence of insertion site colonization, local catheter-related infection, and catheter-related sepsis . Quantitative cultures of the catheter insertion site (25 cm2) revealed significantly greater colonization (P less than or equal to .009) after 48 h in the transparent versus the gauze dressing group . Local catheter-related infection occurred significantly more often (P = .002) in the transparent (62%) than in the gauze group (24%) . Seven episodes of catheter-related bacteremia occurred in the transparent group (16.6%) and none in the gauze group (P = .015) . Stepwise logistic regression analysis revealed that cutaneous colonization at the insertion site of greater than or equal to 10(3) cfu/mL (relative risk, 13.16) and difficulty of insertion (relative risk, 5.39) were significant factors for catheter-related infection . These data suggest that transparent dressings are associated with significantly increased rates of insertion site colonization, local catheter-related infection, and systemic catheter-related sepsis in patients with long-term central venous catheters.

Eur J Clin Microbiol Infect Dis, 1989 Feb, 8(2), 146 - 50
Isolation of Francisella tularensis biovar palaearctica from human blood; Tarnvik A et al.; Francisella tularensis septicemia has previously been reported in the USA, where Francisella tularensis biovar tularensis (type A) occurs endemically . The present report describes two cases of septicemia caused by the Euro-Asian Francisella tularensis biovar palaearctica (type B) . The patients lived in an endemic region of Sweden and presented with high fever and pneumonia . Both patients recovered . The ability of Francisella tularensis biovar palaearctica to cause bacteremia has consequences for laboratory safety.

Am J Physiol, 1989 Jan, 256(1 Pt 2), R201 - 6
Skeletal muscle calcium uptake in bacteremic rats; Westfall MV et al.; To determine whether cellular Ca2+ regulation is altered in bacteremic rat skeletal muscle, 45Ca2+ uptake was measured in soleus muscles 12 h after an intraperitoneal bacterial (Escherichia coli) injection . Some rats received diltiazem (2.4 mg/kg iv) 10 h after bacterial injection to determine whether calcium blockers could inhibit changes in Ca2+ regulation . Cellular exchangeable Ca2+ was measured in soleus muscles incubated for 5 min to 4 h in Krebs-Ringer bicarbonate (KRB) media (pH 7.4) containing 45Ca2+ (1.5 muCi/ml) and subsequently "washed" in La3+-containing, Ca2+-free KRB media . Bacteremia had no effect on steady-state exchangeable Ca2+, but it significantly reduced the time required to reach half-maximal uptake compared with controls . Diltiazem treatment returned the half-maximal Ca2+ uptake toward control values in bacteremic rat muscles . Depolarization of soleus muscles with high K+ (60 mM) transiently increased Ca2+ uptake in control and bacteremic rat muscles, although the increase was significantly greater (P less than 0.05) in bacteremic rat muscles . The altered skeletal muscle Ca2+ regulation may be due to excessive stimulation of Ca2+ messenger systems, sarcolemmal Ca2+ channels, and/or Ca2+ release from the sarcoplasmic reticulum in response to bacteremia.

J Med Assoc Thai, 1989 Jan, 72 Suppl 1, 133 - 8
Results of the splenectomy in children with thalassemia; Hathirat P et al.; Sixty-nine children with beta-thalassemia/E disease, hemoglobin H disease and beta-thalassemia major who were followed for at least 2 years before and after splenectomy were studied retrospectively for the results of the splenectomy . It was found that . 1 . The hematocrit increased significantly in beta-thalassemia/E from 18 to 22 per cent, in hemoglobin H disease from 21 to 34 per cent and in beta-thalassemia major from 14-15 to 18-19 per cent . 2 . The requirement of blood transfusions per year decreased significantly from 6 to 2 times in beta-thalassemia/E, 10 to 4-5 times in beta-thalassemia major and no transfusion was needed in hemoglobin H disease . 3 . Postoperatively, there was a significant increase (p less than 0.05) in the liver size by the third year in beta-thalassemia/Hb E disease, and in the first year in beta-thalassemia major but the liver-size was decreased significantly by the fourth year in hemoglobin H disease . 4 . Within 2 years postoperatively, the growth velocity in height kept up with their presplenectomy period in hemoglobin H and beta-thalassemia major (except two cases) . The growth in weight kept up with their presplenectomy period in 40/49 cases (81.63%) in beta-thalassemia/Hb E but there was no change in the weight velocity in hemoglobin H and beta-thalassemia major . 5 . There were 5 cases with immediate postoperative complications . Three cases had pneumonia, one case had septicaemia and one case had bleeding at the operative wound . Episodes of URI decreased in the post-operative period . Five cases of bacteremia developed within 6 years post-splenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adv Exp Med Biol, 1989, 247B, 389 - 93
The hypotensive response to des-Arg9-bradykinin increases during E . coli septicemia in the pig; Siebeck M et al.; The sensitivity to des-Arg9-bradykinin of the cardiovascular system was largely increased in piglets with E . coli bacteremia . However, the sensitivity to bradykinin was unchanged under the same condition . These findings indicate the appearance of the kinin B1-receptor in the systemic circulation of the pig during septicemia . Bradykinin induced responses suggest a stable effect mediated by the classical B2-receptor.

Ann Biol Clin (Paris), 1989, 47(6), 311 - 6
{Comparison of 2 systems of blood culture: Signal and Bactec}; Croize J et al.; Two Bactec bottles (aerobic and anaerobic) and one single bottle Signal were used for detecting bacteremia in 405 patients (47 children and 358 adults) . The two blood culture Signal and Bactec aerobic were continuous shaking for up to 24 hours . 10.3 p . cent of patients had positive cultures (62.3 p . cent Gram +, aero-anaerobic bacteria) . Nine bacteremia were detected by only one system (4 for signal, 4 for Bactec) 77.1 p . cent of 83 strains were positive on the two systems together, but 7.2 p . cent only in the Bactec and 15.6 p . cent only in the Signal . The delay of growth give an advantage to the Bactec (67 p . cent in 24 hours) . The advantages and the disadvantages of the two systems were analysed.

J Surg Res, 1989 Jan, 46(1), 9 - 15
Assessment of the early cellular membrane response to live Escherichia coli bacteremia; Shiono S et al.; Alterations in skeletal muscle cellular function during septic shock have been previously demonstrated . However, whether these alterations represent a specific response to the septic state or are simply a consequence of low flow is uncertain . The present study was designed to evaluate the cellular membrane response to the early bacteremic state, prior to the onset of hemodynamic compromise . A clinically relevant model of sepsis was achieved in six mongrel dogs by intraarterial infusion of live Escherichia coli organisms and concurrent volume loading with lactated Ringer's solution . Four sham-treated dogs served as controls . Forty-eight hours after induction of sepsis, resting transmembrane potential (Em) was measured in a hindlimb adductor muscle . Contemporaneous muscle biopsy was performed for determination of transmembrane water and electrolyte distribution . The bacteremic state was associated with depolarization of Em to -79.7 +/- 1.2 mV from a basal value of -89.3 +/- 0.2 mV (P less than 0.01), while Em in the sham-treated group remained unchanged over the same time course . In addition, there was a significant increase in the calculated intracellular Na+ and Cl- concentrations in the septic group (P less than 0.02), while intracellular K+ was unchanged . These data are consistent with a selective increase in cell membrane permeability to Na+ and indicate that cellular alterations in skeletal muscle occur early in the septic course, in the absence of hemodynamic compromise . This alteration in membrane permeability appears to be common to cells of disparate organ systems in response to sepsis, and may represent a protean manifestation of cellular injury.

Rev Odontostomatol (Paris), 1989 Jan-Feb, 18(1), 63 - 7
{Infectious foci of dental origin . Presentation of a diagnostic form}; Sentilhes C et al.; The diagnosis report for investigation of focal infections from dental origin permits a dialogue between the demanding physician and the dental practitioner, in order to take a unique therapeutic decision after evaluating the infections potential which will be more risky than the disease to treat . Every information is mentioned on this document: the missing teeth, the vital and non vital teeth, and the risk of bacteremia for each lesion . Some modalities of treatment are proposed by the dentist that the physician will be able to modulate according to the severity of the disease.

Ann Med Interne (Paris), 1989, 140(7), 561 - 5
{Transesophageal echography . Value of the technic apropos of a preliminary experiment in 320 patients (385 examinations)}; Cormier B et al.; The authors discuss the clinical utility and feasibility of trans-esophageal echocardiography . Between April and October 1988, 385 examinations were performed in 320 patients (mean age: 54 yr, range: 17-89) . In 9 patients (2.4 p . 100), the transesophageal transducer could not be introduced . The only complication was one case of bacteremia without sequela, that occurred early in our use of this technique . Transesophageal echocardiography proved to be useful in the following indications: mitral stenosis (n = 50), mainly by detecting thromboses of the left atrium (n = 5); infectious endocarditis (n = 21), especially for diagnosing aortic ring abscesses (n = 3); severe mitral insufficiency (n = 26), to assess the mechanism of regurgitation and to visualize chordal rupture (n = 13) . We conclude from this preliminary study that transesophageal echocardiography is particularly useful in the pathologies described above as a complementary procedure to conventional echocardiography.

Am J Kidney Dis, 1988 Dec, 12(6), 492 - 8
Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access; Moss AH et al.; Polyurethane and Teflon subclavian vein catheters have been widely used for temporary vascular access for hemodialysis, but their use has been associated with a significant complication rate . A silicone dual-lumen catheter with a Dacron cuff placed in the internal jugular or subclavian vein was evaluated as a means of obtaining short-term vascular access . Sixty-two catheters in 54 patients provided a cumulative experience of 206 patient-months . Blood flow rates greater than or equal to 200 mL/min were achieved, with a mean recirculation of 2.1% . Catheter function was better with placement on the right side . Exit-site infections developed in nine patients, for a rate of 5.3 episodes per 100 patient-months; all resolved with antibiotics . Catheter-related bacteremia occurred in one patient, for a rate of 0.49 episodes per 100 patient-months, a rate much lower than rates reported for polyurethane and Teflon catheters . Clotting occurred in 24.5% of catheters, and thrombolytic therapy was always successful in restoring function . Because of the lower rate of complications, the silicone dual-lumen catheter with a Dacron cuff provides a safer alternative for short-term hemodialysis vascular access than the Teflon and polyurethane catheters.

Chest, 1988 Nov, 94(5), 1031 - 3
Serum lactate dehydrogenase activity in patients with AIDS and Pneumocystis carinii pneumonia . An adjunct to diagnosis; Kagawa FT et al.; We investigated whether serum lactate dehydrogenase activity (LD) is significantly elevated in patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) when compared to patients with non-Pneumocystis pneumonia . We measured LD (U/L), blood total lymphocyte count (1,000/cu mm), and alveolar-arterial oxygen tension difference P(A-a)O2 (mm Hg), in 30 patients with AIDS and PCP (group 1), four patients with AIDS or AIDS-related complex (ARC) and non-Pneumocystis pneumonia (NPCP) (group 2), and seven patients with pneumococcal pneumonia and bacteremia (PPB) (group 3) . In patients with AIDS and PCP, LD was 509 +/- 35 (mean +/- SE), which was significantly elevated in comparison to both AIDS/ARC patients with NPCP (228 +/- 21) (p less than .001), and patients with PPB (211 +/- 21) (p less than .001) . There was a significant positive correlation between LD and P(A-a)O2 (r = .51, p = 0.01) . P(A-a)O2 was markedly elevated in both AIDS patients with PCP (48 +/- 3), and patients with pneumococcal pneumonia (44 +/- 3), but only moderately elevated in AIDS/ARC patients with NPCP (29 +/- 6) . These results suggest that measurement of LD may be useful in differentiating Pneumocystis pneumonia from non-Pneumocystis pneumonia . In addition, the increase in LD correlates with the degree of pulmonary oxygen transfer abnormality.

Zh Mikrobiol Epidemiol Immunobiol, 1988 Nov, (11), 75 - 9
{Characteristics of the immunity in typhoid infection associated with opisthorchiasis}; Obgol'ts AA et al.; Typhoid infection developing in persons with opisthorchiasis is characterized by the appearance of pronounced systemic immunity, that ensures a more favorable clinical course of this infection and promotes a decrease in the occurrence of diarrheal phenomena and bacteremia . At the same time, in typhoid patients, simultaneously affected by opisthorchiasis, a more intensive release of the infective agent into the environment is observed . This seemingly demonstrates the presence of disturbances in the local protective mechanisms regulating the process of the release of bacteria on the level of the gastrointestinal tract.

Acta Paediatr Scand, 1988 Nov, 77(6), 940 - 3
Severe child abuse presenting as polymicrobial bacteremia; Koch C et al.; Life-threatening polymicrobial bacteremia in a 7 1/2-year-old boy, was found to be caused by willful contamination of i.v . drips by the mother . The boy, as well as his diseased twin sister, had histories of long-lasting chronic otitis of unknown etiology . The importance of obvious pathologic psycho-social factors was overlooked, and diagnosis was only reached by close collaboration with clinical microbiologists.

Arch Surg, 1988 Nov, 123(11), 1415 - 9
Metabolic interaction between skeletal muscle and liver during bacteremia; Harkema JM et al.; To study the effects of bacteremia on skeletal muscle leucine (LEU) metabolism, mongrel dogs were infused with normal saline or Escherichia coli (10(9)/kg) . After a bolus dose (3.6 microCi), L(1-carbon 14) LEU (0.3 microCi/min) was infused directly into the isolated, constant-flow, in vivo gracilis muscle . Arteriovenous differences for amino acids, labeled and unlabeled LEU and alpha-ketoisocaproic acid (KIC), and labeled carbon dioxide were measured at ten-minute intervals for one hour . Bacteremia increased the net release of amino acids and total N2 from muscle . Moreover, plasma LEU that was deaminated and released as KIC was increased, and there was also an increase in decarboxylated plasma LEU during bacteremia . Despite the marked increase in KIC release from skeletal muscle during bacteremia, arterial concentrations were not significantly different from those of controls . An unchanged arterial plasma KIC concentration associated with a marked increase in KIC released from skeletal muscle indicates an increase in LEU metabolism, most likely in the liver . Thus, the increased skeletal muscle catabolism is not a futile cycle but rather an essential event to meet the increased metabolic needs of the body during bacteremia.

Jpn J Antibiot, 1988 Oct, 41(10), 1385 - 9
A clinical index for the timing of blood cultures in febrile patients with acute leukemia; Funada H et al.; In an attempt to define a clinical index for the timing of blood cultures in febrile patients with acute leukemia, subjective symptoms at onset of bacteremia were investigated in a total of 109 consecutive episodes . General malaise, chills, and nausea and vomiting were most frequently observed (66%, 59%, and 50%, respectively) . The gastrointestinal (GI) symptoms including nausea and vomiting, abdominal discomfort and fullness, abdominal pain, and diarrhea were encountered in 72% of all the episodes, forming the second largest group next to those closely associated with high fever . These GI symptoms were usually mild and of brief durations, and their occurrence had no relation to sites of infections or etiology of bacteremia . In some cases, nausea and vomiting were aggravated by intensive antileukemic chemotherapy or massive GI bleeding . It was thus suggested that GI symptoms, particularly nausea and vomiting, concomitant with a remarkable, sometimes abrupt rise in temperature during granulocytopenia may serve as a useful index for the timing for blood collection for culture to improve the probability of detection of bacteremia.

Am J Physiol, 1988 Oct, 255(4 Pt 2), H699 - 703
Inotropic sensitivity to beta-adrenergic stimulation in early sepsis; Smith LW et al.; In early sepsis, maintenance of in vivo cardiovascular performance is at least partly dependent on sympathetic support to hearts with intrinsic contractile defects . Yet prolonged sympathetic stimulation, as occurs in sepsis, would be expected to alter the heart's ability to respond to this stimulation . We have investigated myocardial inotropic sensitivity to beta-adrenergic stimulation in a model of sepsis in which animals, at the time studied, exhibited bacteremia, normal arterial blood pressure and cardiac output, elevated heart rate, and elevated plasma catecholamines . Intrinsic myocardial contractile function, as assessed by the maximal rate of left ventricular pressure development (LV dP/dtmax) in an isovolumically contracting heart preparation, was significantly depressed in septic animals . To determine whether hearts from septic animals could respond normally to beta-adrenergic stimulation, we studied inotropic response to a bolus of isoproterenol in these isolated hearts . With maximal isoproterenol stimulation, hearts from septic animals were able to attain the same dP/dtmax as were hearts from control animals . With lower levels of isoproterenol, there was also no difference in inotropic indexes between the two groups when response was expressed as a percent of the maximal increase in dP/dtmax achieved with isoproterenol . These results suggest that in early sepsis, despite intrinsic myocardial contractile dysfunction, the ability of the heart to modulate its inotropic state in response in beta-adrenergic stimulation is intact.

Circ Shock, 1988 Oct, 26(2), 127 - 37
Effect of bacteremia on skeletal muscle glucose transport in fed rats; Westfall MV et al.; Basal and insulin-stimulated membrane glucose transport was studied in soleus muscles from fed rats given Escherichia coli intraperitoneally (ip, 4 X 10(10) colony forming units (CFU)/kg) or saline . Glucose transport was measured in muscles by evaluating the fractional efflux (lambda, min-1) of {14C}3-O-methylglucose (14C-3MG) after "loading" muscles with 14C-3MG . Basal glucose transport was similar in muscles from 8-hr bacteremic (B) and time-matched control (C) rats, but it was elevated significantly in muscles 12 hr after bacterial injection (B lambda = 0.0227 +/- 0.0010, n = 41, C lambda = 0.0159 +/- 0.0008, n = 42; P less than .05) . The effect of insulin on transport was determined from the peak response and from the percent increase in transport for each insulin dose . At low insulin concentrations, peak glucose transport was increased in muscles from 8-hr bacteremic rats compared to controls, while the response to 10.0 mU/ml of insulin was similar in bacteremic and control rat muscles . The maximum percent increase in transport and the EC50 for insulin-mediated 3MG transport were not different in muscles from 8-hr bacteremic and time-matched control rats . Twelve hr after bacterial injection, low insulin doses stimulated sugar transport to greater peak values in bacteremic rat muscles compared to time-matched control values . However, peak 14C-3MG transport with 10.0 mU/ml of insulin was attenuated in bacteremic rat muscles compared to controls . An attenuated maximum response and slightly diminished EC50 were evident in muscles from 12-hr bacteremic rats compared to controls when the percent increase in transport at each insulin concentration was analyzed . The results of the current study were similar to results obtained in fasted rats {1} which indicates that alterations in muscle glucose transport during bacteremia are independent of dietary state.

Am J Dis Child, 1988 Oct, 142(10), 1073 - 6
Occult bacteremia in children with simple febrile seizures; Chamberlain JM et al.; The controversy surrounding the diagnostic workup for simple febrile seizures has centered around the lumbar puncture . This focus has obscured the potential importance of other tests . A retrospective study was performed to determine the frequency of occult bacteremia in simple febrile seizures . In a pediatric emergency department, we identified 115 cases of simple febrile seizures in children treated as outpatients . Blood cultures were performed in 93 (81%) of 115 patients; five (5.4%) were positive . Children were less likely to have blood cultures performed if they were older than 24 months or had a medical history of simple febrile seizures . However, neither age nor history of febrile seizures affected the risk of bacteremia . These data suggest that patients with simple febrile seizures are at approximately the same risk for bacteremia as children with fever alone . Patients with simple febrile seizures should be treated in the same manner as other patients of the same age with regard to the performance of blood cultures.

Oral Surg Oral Med Oral Pathol, 1988 Oct, 66(4), 445 - 7
The prevalence of mitral valve prolapse in patients with Down's syndrome: implications for dental management; Barnett ML et al.; Eighty-three noninstitutionalized patients with Down's syndrome, aged 9 to 55 years, were randomly selected to receive echocardiograms . Forty-one patients had echocardiographic findings indicative of mitral valve prolapse, and 15 of these patients lacked associated auscultatory findings . Because mitral valve prolapse can predispose patients to bacterial endocarditis after bacteremia-producing dental procedures, these findings suggest that if auscultatory findings alone are used, a significant number of patients with Down's syndrome who are at risk for endocarditis may not be currently identified in the course of routine clinical practice.

Circ Shock, 1988 Sep, 26(1), 71 - 88
Prostaglandins maintain renal microvascular blood flow during hyperdynamic bacteremia; Cryer HM et al.; Any beneficial effects of prostaglandin synthesis inhibitors on systemic hemodynamic derangements during sepsis may be offset by the effect of these inhibitors to reduce renal blood flow . To determine the specific role of prostaglandins in maintaining renal perfusion during hyperdynamic live Escherichia coli bacteremia in rats, we used in vivo video-microscopy and optical doppler velocimetry to quantitate changes in renal microvascular blood flow, and to determine if endogenous prostaglandins participate in these responses . E . coli infusions constricted preglomerular arterioles and decreased renal microvascular blood flow in decerebrate animals without drug anesthesia but dilated pre- and postglomerular arterioles in urethane-anesthetized rats . Local inhibition of renal prostaglandin production with mefenamate after E . coli infusion caused renal arteriolar constriction in both groups and decreased renal blood flow to indicate that renal prostaglandin production is an important mechanism for maintenance of renal microvascular blood flow during high cardiac output sepsis.

Circ Shock, 1988 Sep, 26(1), 27 - 40
Cardiopulmonary function as related to thromboxane A2 synthesis in experimental septic shock; Schutzer KM et al.; The aim of the present study was to explore the possible involvement of thromboxane A2(TxA2) in the development of cardiopulmonary dysfunction in experimental septic shock . Sepsis was induced in anesthetized cats by intravenous (i.v.) infusion of live Escherichia coli . One series (No . = 12) was pretreated with a specific TxA2 synthetase inhibitor, dazmegrel; another (No . = 8) served as a septic control series . In both series a systemic arterial hypotension developed after 2 hr; no differences in cardiac function were detected . After 2 hr bacteremia cardiac preload was increased by a rapid infusion of dextran . This showed that cardiac function was significantly more preserved in dazmegrel-pretreated cats compared with septic controls . Pretreatment with dazmegrel totally prevented the pulmonary vascular response to bacterial infusion . The pulmonary compliance decreased to 40% in controls but to only 75% in the dazmegrel series, and airway resistance increased to 300% and 140%, respectively . The ventilation-perfusion ratio was less impaired in the pretreated series . Pretreatment with dazmegrel abolished the increase in thromboxane B2 (TxB2), the stable metabolite of TxA2, seen in the untreated series . The rise in 6-keto-prostaglandin F1a (6-keto-PGF1a), the stable metabolite of prostaglandin I2PGI2, was evident in both series . We concluded that TxA2 is important for the impaired cardiac performance in septic shock . Furthermore, TxA2 is involved, but not as the only factor, in the development of pulmonary dysfunction.

Blood Rev, 1988 Sep, 2(3), 178 - 85
Cyclic neutropenia: a clinical review; Dale DC et al.; Cyclic neutropenia is a benign, hematologic disorder characterized by recurrent episodes of severe neutropenia at 21 day intervals . There are associated cyclical variations in other blood cells . Patients with this disease have malaise, stomatitis, cervical lymphadenopathy and fever during the recurrent neutropenic periods . The exact cause of cyclic neutropenia is unknown . About one third of human cases appear to be inherited in an autosomal dominant pattern . In the other cases, the disease appears to arise spontaneously with symptoms usually beginning in infancy or early childhood . In adult patients, the disease may be acquired and occur in association with a clonal proliferation of large granular lymphocytes . Clinical studies in man and investigations in grey collie dogs, which have a very similar disease, strongly suggest that cyclic neutropenia is due to an abnormality in the regulation of early hematopoietic precursor cells . Therapy for cyclic neutropenia involves local and symptomatic therapy for the recurrent mouth ulcers and pharyngitis, and antibiotics for episodes of sinusitis, pneumonia, peritonitis, or bacteremia . Therapy with glucocorticosteroids, androgens, and plasmapheresis has been efficacious in a few adult patients, but no therapy has been proven to alter the cycling of blood counts in children . Despite their repetitive illnesses, patients with cyclic neutropenia grow and develop normally . With the help of attentive physicians and dentists, their quality of life and life expectancy are good . Current research on hematopoietic growth factors offers promise of new approaches to therapy.

J Fam Pract, 1988 Sep, 27(3), 305 - 12
Fever in children younger than three months of age . A pooled analysis; Gehlbach SH; Concern that febrile infants younger than 3 months of age are at high risk of serious infection has prompted a management policy of routine hospitalization with antibiotic administration . Ten published studies of febrile infants younger than 3 months of age were reviewed, and data were statistically combined to develop estimates of the risk of bacteremia and serious infection . Factors that predicted increased risk were similarly evaluated . Mean and median risk estimates included, respectively, 3.0 and 3.4 percent for bacteremia, 1.3 and 1.0 percent for septic meningitis, and 5.0 and 7.0 percent for pneumonia . These were no higher than comparable estimates for older infants . Clinical appearance was 92 percent sensitive in predicting bacteremia in 500 infants (23 of 25 cases) . Younger age, higher fever, and elevated white blood cell count were associated with increased risk of serious infection . Data from these studies do not support the belief that febrile infants younger than 3 months are uniformly at greater risk of serious infection than older infants . Judicious evaluation of younger infants could lead to more selective, cost-efficient managementPublication Types:

	Review
	Review, Multicase

What Is Bioengineering?, What Is Cell Biology?, What Is Anthrax?, What is Food Microbiology?, What Is Biotechnology?, o, Microorganism, o, Bacterium, a, Bacteria, c, Microbiology, a, Microbe, n, Salmonella typhimurium, n, Bacillus subtilis, n, Bacteria, e, Antibiotics, o, Escherichia coli, a, Escherichia coli, s, Fermentations, c, B. anthracis, a, Yeasts, i, Bacillus, e, Escherichia coli, n, Eutrophicated, c, Bacillus subtilis, c, Cryptococci, o, Prokaryotes, a, Escherichia coli, c, Bacteriophages, o, Anaerobes, c, Growth media, a, Streptococci, c, Pseudomonas

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005