Thorac Cardiovasc Surg, 1984 Feb, 32(1), 45 - 8 Fever, leucocytosis and infection after open heart surgery . A log-linear regression analysis of 115 cases; Miholic J et al.; A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass . A log-linear model analysis of a multiway frequency table was used for statistical evaluation . The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge . Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one . No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197) . After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients . However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection . The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001). Schweiz Med Wochenschr, 1984 Jan 21, 114(3), 73 - 7 {Endocarditis prevention and therapy}; Mombelli G; The use of antibiotics to prevent infective endocarditis is accepted medical practice in risk patients . The author discusses some basic problems surrounding the development of endocarditis following interventions likely to produce bacteremia, and indicates guidelines for the prevention of this infection . Antibiotic regimens for the usual forms of endocarditis are summarized, and the role of surgery in active infection is discussed. Cancer, 1984 Jan 15, 53(2), 342 - 5 Distant metastases from head and neck cancer; Papac RJ; Distant metastases were detected in 52 (30.7%) of 169 patients with advanced head and neck cancer observed from 1968 until 1982 . Both clinical and autopsy findings are included in the assessment . The occurrence of distant metastases was related to primary disease site, stage of disease at presentation, and development of infectious complications during the course of the disease . The duration of survival was unrelated to the development of metastases . The incidence of distant spread was low for patients with floor-of-mouth lesions (11.8%) and high for patients with advanced disease arising in some regions of the larynx (58.6%) . Patients who experienced wound infection, pneumonia, or bacteremia had infrequent development of metastatic disease. Acta Pathol Jpn, 1984 Jan, 34(1), 191 - 9 Endotoxemia-induced diffuse myelitis and extensive patchy necrosis of the liver; Tange T et al.; An autopsy case with endotoxemia-induced diffuse myelitis and extensive, grossly patchy necrosis of the liver occurring in a 70-year-old female was examined histopathologically and electron microscopically . Leucopenia with prominent leukemoid reaction (myeloblasts 20%) preceded the terminal fulminant hepatitis by two weeks . Soon after the terminal event, bacteremia and endotoxemia were detected and negativity for HB antigen was proved . Diffuse myelitis was characterized by devastation of hyperplastic bone marrow structure mottled with destructed sinus architecture and scattered exudative necrosis, resulting in the loss of mature granulocytes and erythropoiesis . Regenerative clusters of myeloblasts and prominent increase of megakaryocytes were observed . Electron microscopically, the bone marrow contained fibrin and platelets within the exudate of the marrow stroma . Extensive, grossly patchy necrosis of the liver microscopically consisted of well demarcated coagulation necrosis of hepatic parenchyma with scattered fibrin thrombi in the sinusoids at the boundary . There were no definite thrombi but occasional fibrin accumulation in the small blood vessels of the liver . Both extensive diffuse myelitis and extensive, patchy necrosis of the liver seemed to be quite rare in incidence . The pathogenesis of these combined lesions was discussed in relation with endotoxemia. Hepatology, 1984 Jan-Feb, 4(1), 53 - 8 Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis; Rimola A et al.; The reticuloendothelial system phagocytic activity, estimated by the plasma elimination rate constant of 99mtechnetium-sulfur colloid, was studied in 41 decompensated cirrhotics and 10 normal subjects . The results were related to the incidence and type of bacterial infections occurring during hospitalization and follow-up, and to survival . The elimination rate constant of 99mtechnetium-sulfur colloid was lower in cirrhotic patients (0.168 +/- 0.007) (means +/- S.E.) than in normal subjects (0.220 +/- 0.005) (p less than 0.01) . Cirrhotics were divided into two groups . Group I (16 patients) and Group II (25 patients) had normal or reduced elimination rate constant of 99mtechnetium-sulfur colloid, respectively . Both groups were similar in relation to clinical and biochemical data, hepatic blood flow, and wedged hepatic venous pressure . However, the liver scan and the elimination rate constant of indocyanine green were more altered in Group II . Patients in Group II developed acute bacterial infections more frequently than did patients in Group I . During hospitalization (24 +/- 2 days), bacteremia occurred in six patients in Group II and in none in Group I (p less than 0.05) . During follow-up (28 +/- 3 months), 5 patients in Group II and none in Group I developed bacteremia (p less than 0.05) . The cumulative survival rate of Group I patients was higher (p less than 0.05) than that of Group II patients at 3 months (100 vs . 80%), 6 months (94 vs . 68%), 24 months (74 vs . 42%), and 48 months (68 vs . 34%) . We suggest that decompensated cirrhotics with depressed reticuloendothelial system phagocytic activity are at great risk to acquire bacteremia, and that reticuloendothelial system phagocytic activity has prognostic value in cirrhosis. Eur J Nucl Med, 1984, 9(6), 286 - 8 Adult polycystic disease of kidneys: a potential cause of false-positive 67Ga images; Shih WJ et al.; A 56-year-old man with adult polycystic disease of the kidneys complicated by renal failure, hypertension, and bacteremia underwent bilateral nephrectomy because the enlarged kidneys compromised his gastrointestinal function and respiratory capacity . A scan using 99mTc-methylene diphosphonate demonstrated nonfunctioning kidneys, bilaterally . An unusual radioactivity pattern in the bowel in 67Ga scintigraphy was due to extreme renal enlargement and should be kept in mind to avoid misinterpretation. AIDS Res, 1984-85, 1(6), 379 - 93 Community-acquired bacterial pneumonias in homosexual men: presumptive evidence for a defect in host resistance; Murata GH et al.; Over a three year period, we encountered seven homosexual men who developed pneumonias due to S . pneumoniae or H . influenzae in the absence of apparent risk factors . When compared to heterosexual controls, the homosexual group had a much higher frequency of bacteremia, complicated primary infections, multilobar involvement, required longer antibiotic therapy, and took longer to defervesce . Three of our seven homosexual patients fulfilled criteria for the acquired immunodeficiency syndrome (AIDS); two of the others had generalized lymphadenopathy and the other two likely AIDS-related abnormalities . Overall they presented with a spectrum of clinical findings . Two of the patients developed other opportunistic infections associated with AIDS . Since recovery from these pyogenic pneumonias requires an appropriate antibody response, our patients may have had a defect in B-cell function . Moreover, these observations suggest that functional B-cell abnormalities may occur in AIDS and syndromes premonitory of AIDS. Eur Surg Res, 1984, 16(4), 220 - 31 Effects of dihydroergotamine on the feline cardiovascular response to intravenous infusion of live Escherichia coli bacteria; Arvidsson S et al.; A septic shock state was induced in cats by intravenous infusion of live Escherichia coli bacteria . Cats pretreated with an unspecific 5-HT blocker, dihydroergotamine (DHE), or with a specific 5-HT blocker, ketanserin, were compared with a series receiving bacteria without pretreatment . DHE pretreatment prevented the reduction in systemic arterial blood pressure found in the other series during the 2-hour period of septic shock . Pretreatment could not influence the increased vascular resistance in the pulmonary vascular bed or the early increase in pulmonary arterial blood pressure . Peripheral blood flow distribution was studied using radioactive labelled microspheres . Compared to bacteremia without pretreatment, the 5-HT blockers increased CNS blood flow and ketanserin also prevented the reduction in pancreatic blood flow . Gastric blood flow and gastric mucosal blood flow remained unchanged in all series as did the small intestinal total blood flow . Small intestinal mucosal blood flow, however, was reduced after 2 h of bacteremia . Microscopy revealed no gastric epithelial damage while the jejunal mucosa was characteristically damaged . There was no correlation between the changes in the small intestinal blood flow and the degree of mucosal damage, however, supporting the countercurrent theory for the pathogenesis of these lesions. Ann Emerg Med, 1984 Jan, 13(1), 45 - 8 Occult bacteremia in the emergency department; Crocker PJ; The problem of occult bacteremia in infants and children has been reviewed . The condition is not uncommon and may occur in 3% to 10% of infants and children six months to two years of age who present with temperature greater than or equal to 38.3 C . Meningitis may complicate bacteremia in 4.5% to 8.5%, regardless of identification of a focus of infection . Early identification and proper therapy are essential and often incumbent on the emergency physician. Surgery, 1984 Jan, 95(1), 22 - 6 Comparison of infectibility of vascular prosthetic materials by quantitation of median infective dose; Bennion RS et al.; The current technique for investigating the response of vascular prosthetic material to infection is by challenge with a sublethal dose of bacteria, usually an intravenous infusion of 10(8) organisms in an animal model . This large bacterial inoculum, however, obscures any difference in the infectibility of prostheses that may be inherent in the material, its incorporation into host tissues, or its modification by antibiotic impregnation, all of which are clinically important in resistance to infection . We have developed a sensitive method for determination of the susceptibility to infection of vascular prostheses based on calculation of the number of bacteria required to infect a specific prosthesis in 50% of trials (ID50) . Following implantation of the prosthesis to be tested in the canine infrarenal aorta, a dose-response curve was calculated by the intravenous infusion of known inocula of S . aureus (at log intervals from 10(2) to 10(8) bacteria) . At 6 weeks, the prosthesis was harvested and cultured to document infection with S . aureus . A characteristic sigmoid curve Kesulted, from which the ID50 was determined . To test this method, a comparison was made between commercial human umbilical vein graft (HUVG), HUVG impregnated with silver sulfadiazine, and double-velour Dacron in 60 dogs . Although all prostheses were infected by the standard 10(8) inoculum, an approximately tenfold increase in the resistance to infection between treated and untreated HUVG (less than 10(2) to 10(2.8) and a fourfold increase in resistance between treated HUVG and double-velour Dacron (10(2.8) to 10(3.2} was demonstrated in the dose-response curves . Since the number of bacteria in postimplant bacteremia rarely exceeds 10(2) organisms/ml, such differences in infectibility can be clinically significant . ID50 determination provides a sensitive, reproducibleble method for quantitating resistance to infection in vascular prostheses. Acta Chir Scand, 1984, 150(7), 541 - 7 Acute gastric mucosal ulceration in septic shock . An experimental study on pathogenic mechanisms; Arvidsson S et al.; Intravenous infusion of live . E . coli bacteria in cats did not induce microscopic damage to the gastric mucosa within 3 hours . However, if the cats before the induction of bacteremia were given 80 mM HCl and 0.6 ml gallbladder bile/kg b.w . microscopic mucosal damage developed regularly in the corpus-fundus area of the stomach . The gastric mucosal damage was not associated with significant decrease of total gastric blood flow as measured continuously electromagnetically or decreased gastric mucosal blood flow measured early and late during sepsis using radioactively labelled microspheres . Neither was the development of gastric mucosal damage associated with reduced gastric wall collagen concentration nor in RNA, DNA concentrations or RNA/DNA ratio in the gastric mucosa. Hepatogastroenterology, 1983 Dec, 30(6), 240 - 2 Incidence of endotoxemia in pigs with ischemic hepatic necrosis treated by hemodialysis . Prevention of endotoxemia with lactulose; de Groot GH et al.; The incidences of endotoxemia and bacteremia were evaluated in 30 pigs with ischemic hepatic necrosis treated by hemodialytic procedures . Prior to induction of hepatic ischemia, ten pigs underwent bowel cleansing by means of an oral dose of magnesium sulfate, and 20 received a combination of magnesium sulfate and lactulose . Endotoxemia and bacteremia seldom occurred during the development of hepatic encephalopathy, but the incidence of both increased markedly shortly before death . Pigs pretreated with magnesium sulfate and lactulose however did not develop preterminal endotoxemia . A significant relation between endotoxemia or bacteremia and survival was not found, irrespective of pretreatment with lactulose . Of the positive limulus tests, 67% were accompanied by a positive blood culture, while 42% of all positive blood cultures were associated with a positive limulus test . Dialysis with dialysates contaminated with endotoxins did not increase the risk of endotoxemia . It is concluded that in an animal model of ischemic hepatic necrosis (1) endotoxemia and bacteremia appear mainly in the preterminal stage, but do not influence the duration of survival significantly; (2) lactulose prevents endotoxemia and (3) dialytic procedures do not increase the risk of endotoxemia and bacteremia. Am J Epidemiol, 1983 Dec, 118(6), 839 - 51 An epidemiologic study of the risks associated with peripheral intravenous catheters; Tager IB et al.; As part of a standardized, multi-hospital prospective surveillance system for nosocomial infections in Rhode Island, an analysis was undertaken in March 1980-February 1982 to determine the interplay of factors that contribute to the risk of phlebitis in peripheral, non-steel, non-butterfly intravenous catheters . The authors studied 3094 patients with 5161 total episodes of peripheral intravenous catheters from day of admission until day of discharge . The overall rate of phlebitis was 2.3% (118 episodes), and the rate of intravenous catheter-associated bacteremia was 0.08% (1 definite episode, 3 possible episodes) . Factors significantly associated with the occurrence of phlebitis were: underlying risk for any nosocomial infection, duration of the catheter episode, chronological order of the episode and an interaction between the latter two variables . Analysis of day-specific risk of phlebitis indicated that, for patients with low risk diagnoses, initial peripheral intravenous catheters might be left in place with relative safety for up to 96 hours . Over this time period, the day-specific risk for such patients ranged between 0.8% and 1.4%, exclusive of the first day . In all other circumstances, the current recommendation of 48-72 hours seems appropriate. Am J Gastroenterol, 1983 Dec, 78(12), 810 - 4 Lethal pancreatitis; Buggy BP et al.; Thirty-two patients died of pancreatitis and its complications over a 10-year period . Infection (bacteremia, fungemia, or pancreatic abscess) was the major cause of death in 80% . In the remaining 20%, refractory hypotension or respiratory failure were the lethal mechanisms . In only 78% of patients was the correct diagnosis made before death . Ninety-four percent of those who died did so during their first clinical episode of pancreatitis . Prophylactic antibiotics did not prevent the development of pancreatic abscesses and organisms resistant to the antibiotics used often became the primary pathogens . Certain prognostic factors reliably separated those who died from those who lived . Peritoneal lavage and dialysis may be helpful in both the early diagnosis and therapy of severe acute pancreatitis. Ann Intern Med, 1983 Dec, 99(6), 786 - 9 Mycobacteremia and the new blood culture systems; Pierce PF et al.; Clinical and microbiologic aspects of mycobacteremia occurring in 11 patients are presented . Ten of the 11 patients were immunosuppressed . Disseminated disease was shown in 7 patients, transient bacteremia in 2, and endocarditis in 1 . Blood cultures were positive in 11 blood culture systems . Newer blood culture systems appear to provide more rapid detection of mycobacteremia. Ann Intern Med, 1983 Dec, 99(6), 782 - 5 Bacteremia due to Mycobacterium avium-intracellulare in the acquired immunodeficiency syndrome; Macher AM et al.; The presence of Mycobacterium avium-intracellulare has frequently been demonstrated in tissue specimens from patients with the acquired immunodeficiency syndrome . The importance of this mycobacterium as a cause of constitutional symptoms and organ dysfunction has been unclear, however, because of the sparse inflammatory response evoked and the frequent concurrence of other pathogenic organisms . We detected M . avium-intracellulare in blood samples from eight patients with the acquired immunodeficiency syndrome, seven of whom had a previously recognized M . avium-intracellulare infection . Blood cultures were positive on 1 to 14 occasions over 135 days using the Dupont isolator system or the Bactec 12B medium system . Cultures were positive within 14 to 51 or 7 to 14 days with the respective techniques . The ability to rapidly isolate M . avium-intracellulare from blood may provide a useful diagnostic technique for detecting disseminated mycobacterial disease in patients with the acquired immunodeficiency syndrome as well as in other patient populations . This technique may also be useful for assessing the efficacy of drug therapy. Arch Surg, 1983 Dec, 118(12), 1388 - 94 Percutaneous transhepatic drainage . Risks and benefits; Stambuk EC et al.; We evaluated the risks and benefits of percutaneous transhepatic biliary drainage (PTD) in 44 patients . Patients were divided into two groups, palliative and preoperative, each of which had 22 patients . Major complications included bacteremia, hemobilia, and liver abscess and occurred in ten patients (23%) . A liver abscess along the catheter tract may have contributed to the death of one patient with an advanced malignant neoplasm . Major complications were more likely to develop in palliative-group patients (36% v 9%) and those patients were more likely to die within 30 days of the procedure (27% v 0%) . Four (57%) of seven palliative-group patients and none of six preoperative-group patients with pre-PTD bilirubin levels higher than 20 mg/dL died within 30 days after PTD . Liver function test results improved within seven days in approximately 85% of the patients . Twenty-one patients (95%) in the preoperative group survived surgery . We concluded that the risk of PTD may outweigh the benefit in the subset of patients with advanced malignant neoplasms and a bilirubin level higher than 20 mg/dL . Even then, however, PTD may be justified if pruritus is incapacitating . Pending results of further randomized trials, we have continued performing PTD preoperatively in patients whose bilirubin levels exceed 10 mg/dL. Pediatr Med Chir, 1983 Nov-Dec, 5(6), 607 - 8 {Glomerulonephritis caused by a shunt: description of a case}; Lupi L et al.; The authors report a case of shunt-nephritis due to bacteremia from Stafilococcus albus . Kidney biopsy, comprehensive of IF study allowed to assess the diagnosis of a disease from immunocomplexes . The Authors stress the importance of a close follow-up of patients who carry liquoral shunt for an early recognition of symptoms of glomerulopathy. Ann Surg, 1983 Nov, 198(5), 592 - 5 Indomethacin and the gastric mucosal blood flow changes of sepsis; Nilsson LO et al.; Recent evidence suggests that sepsis results in increased gastric mucosal blood flow (GMBF) . To investigate the possible role of prostaglandins in mediating this response, the GMBF was measured in the fundus, corpus, and antrum of pig stomachs with and without pretreatment with indomethacin, an inhibitor of prostaglandin synthesis, before and after the induction of bacteremia . The studies were done in 22 piglets (seven sepsis controls, seven indomethacin controls and eight experimental {indomethacin pretreated sepsis} ) . Sepsis was produced in piglets by bolus intravenous injection of 10(9) live Escherichia coli followed by an infusion of 10(9) E . coli/hr . Cardiac output (C.O.) was measured by thermodilution . GMBF was measured by microsphere trapping . Following sacrifice, hyperemia was noted in the sepsis group but not in the other groups . GMBF was determined by standard techniques (expressed as ml/min/100 gm tissue) . There were significant (p less than 0.05) increases in gastric mucosal blood flow to the fundus (+47%), corpus (+50%), and antrum (+101%) at 15 minutes following the onset of E . coli infusion . At 135 minutes, the increase was only significant in the antrum . GMBF, however, did not change in the indomethacin control or indomethacin pretreated sepsis groups . These data demonstrate GMBF in the stomach following sepsis . The changes were not present in the indomethacin control or in the indomethacin pretreated sepsis groups . Since indomethacin is an inhibitor of prostaglandin synthesis, the results suggest that the GMBF may be a prostaglandin mediated response. Schweiz Med Wochenschr, 1983 Oct 22, 113(42), 1534 - 9 {Factitious fevers as a cause of prolonged fevers . Apropos of 5 clinical cases}; Potin M et al.; Among the numerous causes of prolonged fever of unknown origin, the factitious fevers are frequently considered last after much diagnostic and therapeutic effort . Five observations of factitious fever are presented including 2 cases of thermometer manipulation in men aged 45 and 80 . The latter patient is the oldest in whom such a case has been reported . In the first case the prolonged fever led to exploratory laparotomy with splenectomy followed by antilymphoma chemotherapy before the thermometer manipulation was discovered . This patient had previously been treated successfully for stage Ib Hodgkin lymphoma . In the other case hospitalization had lasted several weeks, and much antibiotic and steroid treatment had been administered, before the manipulation was suspected . A third case of thermometer manipulation was observed in a 57-year-old woman who had been presenting with factitious symptoms for over 10 years . Two other cases of factitious fever due to self-induced infections have been observed in two young women aged 23 and 27, both in paramedical professions . These self-induced infections led to polymicrobial bacteremia, exploratory laparotomy and hemicolectomy in one case, and to probable bacterial meningitis in the other . Certain aspects of these cases agree well with the diagnostic criteria of factitious fever described in the literature . We feel it is important to recognize this cause of febrile states, even if there is an apparent etiology, in order to avoid much vain investigation and prolonged hospitalization. Sex Transm Dis, 1983 Oct-Dec, 10(4 Suppl), 382 - 5 Treatment of extragenital infections caused by Mycoplasma hominis; Myhre EB et al.; Extragenital infections caused by Mycoplasma hominis and the indications for antibiotic treatment of such infections were reviewed . Invasion of the bloodstream in conjunction with urologic disease or trauma and metastatic spread of M . hominis to the central nervous system or the joints must be treated with effective drugs . In contrast, M . hominis bacteremia in women with febrile abortion and postpartum fever is often transient and self-limiting and does not generally require treatment . A tetracycline is generally the drug of choice in extragenital M . hominis infections . Although the various tetracycline analogues differ in their in vitro activity against M . hominis, they are all clinically effective . Clindamycin is an alternative to the tetracyclines . Clinical experience with the treatment of extragenital infections caused by M . hominis is still limited . The optimal duration of antibiotic therapy has not been established, but a review of the literature suggests a duration of 10-14 days . Sulfonamides, beta-lactam antibiotics, chloramphenicol, and aminoglycosides do not elicit a clinical response in patients with extragenital M . hominis infections. Crit Care Med, 1983 Oct, 11(10), 807 - 12 The risk of infection related to radial vs femoral sites for arterial catheterization; Thomas F et al.; To evaluate risk factors for infections associated with indwelling arterial catheters, 186 catheters were randomly allocated for either femoral or radial insertion in 155 critically ill patients . Femoral catheters were easier to insert and it was easier to obtain blood specimens from them . Rates of local infection at the insertion sites and rates of positive catheter-tip cultures were similar for femoral and radial catheters . Evidence of local infection was not predictive of a positive catheter-tip culture . Percutaneously inserted femoral and radial artery catheters had a similarly low incidence of catheter-associated infections . There was only one catheter-related infection, and no cultured catheter was judged the cause of bacteremia . Routine prophylactic replacement of arterial catheter systems may be unnecessary in critical care units where rates of arterial catheter-associated infections are low. Arch Intern Med, 1983 Oct, 143(10), 1878 - 81 Pneumococcal vaccine in the hospital . Improved use and implications for high-risk patients; Klein RS et al.; A randomized trial of a program to improve pneumococcal immunization was undertaken . Also studied were the prevalence of high-risk conditions for serious pneumococcal disease among hospital admissions and prior hospitalization of patients with pneumococcal bacteremia . During two successive winters, 56% of 1,062 medical patients were identified by admission diagnosis or age as having a high-risk condition . None had received prior vaccination . During the trial period, identifying candidates for vaccination increased immunization from two (2.1%) of 95 to ten (10.4%) of 96 in year 1 and from two (2.1%) of 96 to 19 (20%) of 95 in year 2 . Among adults with pneumococcal bacteremia, 33 (54%) of 61, including 32 (64%) of 50 with high-risk conditions, had documentation of prior hospitalization within five years . A hospital-based program can increase pneumococcal immunization rates and would be directed at patients in whom serious pneumococcal disease is likely to develop. J Pediatr, 1983 Sep, 103(3), 352 - 8 A comparative study of the prevalence, outcome, and prediction of bacteremia in children; Dershewitz RA et al.; We undertook a prospective, concurrent comparison of the prevalence, predictability, and outcome of bacteremia in children from 3 to 24 months of age with temperatures greater than or equal to 39.5 degrees C in three diverse clinical settings: primarily black lower-class children at an inner-city hospital (n = 532), primarily white middle-class children at a suburban hospital (n = 160), and primarily white middle-class children in offices of pediatricians in private practice (n = 94) . The prevalence of bacteremia for the entire study sample (3.1% to 7.4%) and outpatients only (1.9% to 5.9%) was not statistically different among the three groups . There were no statistically significant differences among the three groups in identifying children with bacteremia (P greater than 0.05) . There was no racial, geographic, or socioeconomic predilection for bacteremia in infants . At the first visit, antibiotics were prescribed (most commonly for otitis media) for 23 of the 25 bacteremic patients who were not initially hospitalized . One patient with otitis media developed meningitis . The others had uncomplicated courses and were well by 96 hours (most by 48 hours) . In office settings, private practitioners were no better in predicting bacteremia in familiar patients than they were with first-time patients . Information from blood culture did not appear to alter patient management . We conclude, therefore, that routine blood cultures are unnecessary for all highly febrile infants given antibiotics. Clin Pediatr (Phila), 1983 Sep, 22(9), 608 - 11 Significance of neutrophils in cerebrospinal fluid samples processed by cytocentrifugation; Naqvi SH et al.; We reviewed medical records of 155 pediatric patients whose cerebrospinal fluid (CSF) samples contained an increased proportion of neutrophils when processed by cytocentrifugation, despite normal CSF total white blood cell count . It was determined that these CSF findings occurred more commonly in patients with bacteremia, peripheral leukocytosis, and increased numbers of red blood cells in the CSF . Pulmonary infiltrates in infants and otitis media in children were also significantly associated . Cytocentrifugation allows the identification of neutrophils in the CSF, even in the absence of central nervous system infection . Infants and children with more than 10 per cent neutrophils in CSF require evaluations for focal and bacteremic infections. Endoscopy, 1983 Sep, 15(5), 289 - 90 The incidence of bacteremia after outpatient Hurst bougienage in the management of benign esophageal stricture; Yin TP et al.; Transient bacteremia occurs in a variety of gastrointestinal procedures . Of 13 patients with a benign esophageal stricture treated as out-patients by the passage of Hurst mercury bougies only one developed transient bacteremia which occurred five minutes after dilation . We do not therefore recommend routine antibiotic prophylaxis for patients undergoing this type of management . Attention should be given to the manner in which dilators are cleaned and stored. Am J Vet Res, 1983 Sep, 44(9), 1789 - 92 Comparative biological features of a rat liver abscess model induced with three Fusobacterium necrophorum strains; Scanlan CM et al.; Several biological features were compared in a rat liver abscess model, using intraportal inoculations with 3 bovine strains of Fusobacterium necrophorum which varied in virulence . Serum alanine aminotransferase activities were increased significantly (P less than 0.05) in rats inoculated with F necrophorum 2101 by postinoculation hours 6, 12, and 24 . Thereafter, alanine aminotransferase values returned to base line for the remainder of the experiment . Also, rats inoculated with F necrophorum 2101 had a significantly greater (P less than 0.05) weight loss than did the control rats during the first 5 postinoculation days and developed leukocytosis characterized by a neutrophilia with a left shift . The duration of the bacteremia was related directly to the virulence of the F necrophorum strain . Fusobacterium necrophorum 2101, a biotype A which was the most virulent, induced the most persistent bacteremia; F necrophorum 2035, a biotype B which was the least virulent, produced the shortest bacteremia; and F necrophorum 2030, a biotype AB which was of intermediate virulence, led to bacteremia of intermediate duration . Plasma endotoxin was demonstrated intermittently during the first 24 hours, but did not correlate with the bacteremia. Ann Intern Med, 1983 Sep, 99(3), 293 - 8 Multiple organ system failure and infection in adult respiratory distress syndrome; Bell RC et al.; Patients with the adult respiratory distress syndrome and multiple organ system failure have a high mortality rate despite extensive supportive therapy . We evaluated the role of multiple organ system failure and infection in 37 consecutive survivors of the syndrome, and 47 consecutive nonsurvivors on whom autopsies were done . Failure of the central nervous, coagulation, endocrine, gastrointestinal, and renal systems was common in all patients but was more frequent in those who died . Major infections occurred in 46 nonsurvivors and 22 survivors . All patients with bacteremia who had a clinically identified site of infection survived, whereas all patients with bacteremia without a clinically identified site of infection died . Autopsy results of the latter group showed infections requiring surgical drainage for complete therapy . Patients clinically septic but without bacteremia and without a clear site of infection were shown at autopsy to have pneumonia . Multiple organ system failure was more common in infected (93%) than noninfected (47%) patients . Vigorous evaluation and treatment of infection in patients with the adult respiratory distress syndrome may improve survival. Infection, 1983 Sep-Oct, 11(5), 243 - 50 Early infectious complications in allogeneic marrow transplant recipients with acute leukemia: effects of prophylactic measures; Buckner CD et al.; One hundred eighty-two patients with acute leukemia underwent allogeneic marrow transplantation and received one of two forms of infection prophylaxis: isolation and decontamination procedures in laminar air flow rooms (90 patients) or prophylactic granulocyte transfusion from a single family member (92 patients) . Infection acquisition and survival were analyzed from the time of admission to 100 days posttransplant . There were 20 major local infections in the laminar air flow group and 16 in the prophylactic granulocyte group . Of the patients in the laminar air flow group, 24 (27%) had 27 episodes of bacteremia, while 23 (25%) of the prophylactic granulocyte group had 25 episodes of bacteremia . There were no significant differences in infection acquisition between the two groups during the period of granulocytopenia or after engraftment . The mortality during the first 100 days was 28% for the laminar air flow group and 35% for the prophylactic granulocyte group . Thirteen patients (14%) in the laminar air flow group and five (5%) in the prophylactic granulocyte group died with bacterial or fungal infections . There were no statistically significant differences between the two groups in overall incidence of or mortality from interstitial pneumonitis which was the predominant cause of death . However, the subset of patients who were seronegative for cytomegalovirus antibody at the time of transplant and received granulocytes from seropositive donors had a significantly higher incidence of and mortality from cytomegalovirus interstitial pneumonitis. Am J Kidney Dis, 1983 Sep, 3(2), 124 - 8 Disseminated Mycobacterium chelonei infection following cadaveric renal transplantation: favorable response to cefoxitin; Mehta R et al.; This article describes a case of disseminated Mycobacterium chelonei infection in a renal transplant recipient . This patient, who underwent thoracic duct drainage prior to cadaveric renal transplantation, developed M chelonei bacteremia and numerous subcutaneous nodules a few weeks after transplantation . The M chelonei initially responded to amikacin and tetracycline . Because of side effects and bacterial resistance, however, these drugs had to be discontinued . Subsequent treatment with cefoxitin led to reduction in size of subcutaneous nodules, but control of the infection was not achieved until an intravascular nidus of infection at the anastomotic site of an arteriovenous fistula was removed. Mayo Clin Proc, 1983 Sep, 58(9), 613 - 6 Traveling toothpicks; Cockerill FR 3rd et al.; Although most ingested foreign bodies usually pass through the gastrointestinal tract uneventfully, such objects infrequently cause intestinal perforation and may even result in death . Herein we present five cases of gastrointestinal perforation caused by toothpicks . In one of these patients, the toothpick penetrated the inferior vena cava and caused overwhelming bacteremia and death . A major factor that contributes to the inability to identify foreign objects such as toothpicks in food is the wearing of dental plates, which precludes normal palatal sensitivity . Patients should be alerted to the potential hazards associated with the use of toothpicks. J Infect Dis, 1983 Sep, 148(3), 395 - 405 The role of pili and capsule in the pathogenesis of neonatal infection with Escherichia coli K1; Guerina NG et al.; The role of pili and capsule was studied in neonatal infection with Escherichia coli K1 . E coli strains were selectively cultured into three phases: mannose-sensitive (MS) piliated, non-mannose-sensitive (NMS) piliated, and nonpiliated . A high percentage of neonatal rats fed each phase of K1 strains developed bacteremia; there was no bacteremia with non-K1 strains or an acapsular mutant of K1 strain C94 (C94K-) . Oral cavity colonization was noted in nearly 100% of rats fed K1 strains, non-K1 strains, or C94K-, regardless of the phase of piliation at feeding . Only MS piliated bacteria were found on oral cavity culture, indicating a rapid shift of NMS piliated and nonpiliated bacteria to the MS piliated phase . Conversely, only nonpiliated bacteria were found on blood culture when neonatal rats were fed piliated bacteria . Colonization of ileal epithelium was not observed . Thus, in vivo phase variation may be important in colonization and bacteremia with E coli K1. J Clin Gastroenterol, 1983 Aug, 5(4), 325 - 9 Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP; Dutta SK et al.; To determine the frequency of bacteremia associated with endoscopic retrograde cholangiopancreatography (ERCP), we obtained blood cultures before, during, and after ERCP in 51 consecutive patients . Patients with radiographically demonstrated abnormalities in pancreatic and/or biliary ducts were routinely given antibiotic therapy after ERCP . Bacteremia after successful cannulation of the papilla of Vater was observed in only one patient with multiple strictures of the main pancreatic duct . No episodes of acute febrile illness was observed in any patient during the 48-hour follow-up period after ERCP . Our observations suggest that the risk of bacteremia from ERCP is minimal, and that any possibility of sepsis after ERCP in patients with abnormal pancreatic or biliary ducts may be prevented by administering appropriate antibiotics after the procedure. Am J Med, 1983 Aug, 75(2), 225 - 31 Bacteremia due to Fusobacterium species; Henry S et al.; Twenty-six patients were identified as having bacteremia with Fusobacterium species over a five-year period at Boston City Hospital . They represented 0.9 percent of bacteremic patients and were equally divided as to sex . Bacteremia with Fusobacterium occurred primarily in young adults and in patients over 60 years of age and was not observed in children . In 16 patients (62 percent), Fusobacterium was the only blood culture isolate . The most common primary foci of infection were the female genital tract, the upper respiratory tract, the oral cavity, and the lower respiratory tract . Five patients had primary foci of infection that were initially occult . Three of these patients were found to have unappreciated oral and pharyngeal lesions, and one had a liver abscess; no primary infection was established in the remaining patient . Shock related to bacteremia developed in six patients (23 percent), four of whom had Fusobacterium species as the only blood culture isolate . Death occurred in three patients (12 percent), all of whom were over 60 years old . Metastatic infection occurred in only one patient in whom hematogenous osteomyelitis developed . Postpartum fusobacterial bacteremia was uniformly benign . Evaluation of bacteremia with Fusobacterium species in nonpostpartum patients, without an overt focus of infection, should be directed to a search for occult abscess, especially of the upper respiratory tract and oral cavity. Am J Med, 1983 Aug, 75(2), 199 - 205 Effect of underlying disease and age on pneumococcal serotype distribution; Weisholtz SJ et al.; The hospital records of 264 patients with 277 episodes of pneumococcal bacteremia occurring at New York Hospital-Cornell Medical Center over the period 1970 to 1980 were examined to determine whether serotype distribution varied with the underlying disease or age of the patient . The patients were placed into three groups according to their underlying disease . Group A consisted of all patients with significant impairment of their immune system . Group B included those patients with underlying conditions that were not associated with immune deficiency . Group C comprised those patients considered to be normal hosts . Overall, 84 percent of blood isolates were serotypes included in the vaccine . In Group A, only 73 percent of these isolates were vaccine types, compared with 85 percent in Group B and 97 percent in Group C (differences significant at p less than 0.001) . Vaccine serotypes were more common in children than adults (92 versus 81 percent), but in analysis that controlled for underlying disease, the elderly did not differ from younger adults in serotype distribution . The apparent predilection of nonvaccine serotypes to cause bacteremia in immunocompromised patients may be one factor limiting vaccine efficacy in this high-risk population. Pediatrics, 1983 Aug, 72(2), 211 - 3 Polymicrobial bacteremia due to Polle syndrome: the child abuse variant of Munchausen by proxy; Liston TE et al.; Infectious disease due to multiple organisms results from underlying disease or invasive procedures and is uncommon in the pediatric age group . We report a case of polymicrobial bacteremia in an infant in whom no underlying disease was substantiated despite extensive evaluation . The presence of Polle syndrome--an adult-induced illness--was subsequently proved . This diagnosis should be considered early in the evaluation of children for whom repeated blood culturing indicates polymicrobial bacteremia. Aust N Z J Med, 1983 Aug, 13(4), 359 - 64 Serotypes in pneumococcal disease . A ten year study in Australia 1970 through 1979; Hansman D; During the ten year period 1970 through 1979, pneumococci from 1205 episodes of pneumococcal disease affecting children and adults in Australia were studied . These included 188 cases of bacteremic pneumonia (85% in adults), 103 cases of primary bacteremia (50% adults), 201 cases of meningitis (69% children), 13 cases of osteomyelitis and/or arthritis, and 13 cases of peritonitis . Otitis media (403 cases), conjunctivitis and sinusitis were predominant amongst 672 localised infections . Of 36 serotypes of pneumococci met with, the leading types were 19, 14, 6, 3 and 9: type 14 predominated in children with primary bacteremia, bacteremic pneumonia or meningitis, type 9 in adults with bacteremic pneumonia, and types 3 and 7 in adults with meningitis . In otitis media types 19 and 3 predominated, in conjunctivitis types 19 and 6, and in sinusitis types 6 and 19 . For bacteremic and meningeal infections the current (United States) vaccine provides 83% cover, deletion of the rare (in Australia) types 2, 12 and 25 and the substitution of types 11, 15 and 33 would increase cover by 5% to 88%. Am J Med Technol, 1983 Aug, 49(8), 589 - 91 Capnocytophaga: a review of the literature; Fung JC et al.; Capnocytophaga species are normal mouth flora but can be opportunistic pathogens causing juvenile peridontitis and bacteremia in the compromised host . Indole-negative fusiforms isolated anaerobically or in the presence of increased CO2 can presumptively be identified as Capnocytophaga species. Am J Obstet Gynecol, 1983 Aug 1, 146(7), 769 - 72 A double-blind, randomized comparison of moxalactam versus clindamycin-gentamicin in treatment of endomyometritis after cesarean section delivery; Gibbs RS et al.; A double-blind comparison of clindamycin plus gentamicin versus moxalactam plus placebo was performed for the treatment of endomyometritis after cesarean section delivery . Entry criteria were uterine tenderness, temperature greater than or equal to 101 degrees F, and leukocytosis . Uterine specimens were obtained for culture via a single-lumen transcervical catheter . Bacteremia occurred in 10% of patients . Among the 57 patients treated with clindamycin plus gentamicin, there were two clinical failures and four side effect failures (diarrhea in two, allergic reaction in two) . Among the 56 patients in the moxalactam group, there were four clinical failures and one side effect failure (diarrhea) . Both regimens had good cure rates, with no significant differences in cures or postoperative hospital stay. Am J Med, 1983 Jul 28, 75(1B), 19 - 25 Host factors in bacteremia; Cates KL; Host factors in bacteremia can be divided into nonspecific and specific immune responses . The main components of the nonspecific immune response of the host are phagocytes and complement, and those of the specific response are immunoglobulin and cell-mediated immunity . All of these factors work in concert to protect against bacteria in the bloodstream . Immunoprophylaxis and immunotherapy have come about as a result of growing awareness of the importance of natural host defenses in combating serious bacterial infections . Although the prognosis for patients with bacteremia has improved substantially with recent advances in antibiotic therapy and supportive care, morbidity and mortality rates remain significant . Modulation of the immune system appears to be a promising means of improving the survival rate of patients with bacteremia. Am Surg, 1983 Jul, 49(7), 373 - 8 Dual lumen catheters for angioaccess in patients with leukemia; Reed WP et al.; Dual lumen long-term indwelling right atrial catheters have been used to improve venous access in adult patients with leukemia . Twenty-eight such catheters have functioned for 1,895 days in 28 patients over the past eight months at the University of Maryland Hospital . Although insertion of the dual lumen catheter was more technically demanding than insertion of a single lumen catheter, the greater versatility in drug management (e.g., administration of two continuous infusions simultaneously or one continuous infusion leaving one line for platelets, blood, antibiotics or venous sampling) provided by the extra venous portal of entry more than compensated for any increased operative time (average, 58 vs 39 min/insertion) . Eight episodes of bacteremia (0.37/100 patient days) occurred in these patients, but only one of these was associated with an exit site infection: the remainder were secondary to infections remote from the catheter . No catheter was removed as a result of these episodes, nor was any removed for ante mortem mechanical failure . The dual lumen catheter is a safe reliable device for providing angioaccess in patients with leukemia and offers substantially greater flexibility than the single lumen catheter. Chest, 1983 Jul, 84(1), 48 - 50 Pericarditis associated with Hemophilus influenzae type B pneumonia and bacteremia in two adults; Graham BS et al.; Two cases of pericarditis associated with Hemophilus influenzae bacteremia and pneumonia are reported and the literature reviewed . Both patients were treated with antibiotics alone and had resolution of their illnesses without apparent adverse sequelae . Neither patient required pericardial drainage . It is suggested that there is a stage in the development of H influenzae pericarditis at which antibiotic treatment alone can be curative. J Clin Microbiol, 1983 Jul, 18(1), 208 - 10 Enhanced detection of polymicrobic bacteremia by repeat subculture of previously positive blood cultures; Hansen SL et al.; Blood subcultures repeated 3 days after the cultures were first identified as positives increased our detection of polymicrobic bacteremia in 9.1 to 27% of clinically significant patient episodes . Reincubation and repeated subculture of previously positive blood cultures had a direct impact on the therapeutic management of patients with polymicrobic bacteremia. Surg Gynecol Obstet, 1983 Jul, 157(1), 11 - 4 Prophylactic cefoxitin in cesarean section; Young R et al.; The effectiveness of prophylactic cefoxitin in preventing postcesarean section infection was studied in a high risk population . One hundred women were evaluated, and on a random double-blind basis 50 received placebo and 50 received cefoxitin . There were three doses of drug given intravenously, either placebo or 1 gram of cefoxitin at the time of cord clamping and again four and eight hours later . Those receiving cefoxitin had significantly less postoperative infections, fewer had bacteremia and there was less postoperative fever as measured by the fever index . The patient with the most protracted infection in this study received cefoxitin . Problems with the use of systemic antibiotic prophylaxis in preventing postcesarean section infection are discussed . Cefoxitin is an effective agent to use in patients undergoing cesarean section who are at high risk for infection. Ann Plast Surg, 1983 Jun, 10(6), 473 - 4 Bacteremia following cleft palate repair--a prospective study; Marzoni FA et al.; A prospective study of temperature patterns and blood cultures following cleft palate repair suggests that bacteremia in these cases is common . Twenty-seven years without serious complications supports the authors' view that antibiotic therapy is not indicated. Am J Surg, 1983 Jun, 145(6), 795 - 9 Rectal trauma . A retrospective analysis and guidelines for therapy; Grasberger RC et al.; Twenty patients seen at Boston City Hospital required general or spinal anesthesia for rectal injuries, and 17 required laparotomy . Findings on sigmoidoscopy were falsely negative in 4 of 13 patients examined . Diagnosis was delayed in two patients . Associated injuries occurred in 55 percent, with the lower genitourinary tract being the area most frequently injured . Complications occurred in eight patients (40 percent) . Abscess formation and bacteremia were the most common, but iatrogenic complications occurred in four patients . Pulmonary embolism occurred in two patients and was suspected in a third patient . Routine treatment included diverting colostomy with distal irrigation and adequate drainage . Repair of the injury was performed when possible . Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism . Rectal trauma continues to be a challenging injury. Diagn Microbiol Infect Dis, 1983 Jun, 1(2), 107 - 10 The importance of volume of blood cultured in the detection of bacteremia and fungemia; Ilstrup DM et al.; An analysis was made on the basis of 5,389 isolates from 5,008 positive blood cultures of the relative yields from 10, 20, and 30 ml of blood . Average yields from cultures of 20 and 30 ml of blood were, respectively, 38 and 61% greater than that from 10 ml of blood. Gastroenterol Clin Biol, 1983 May, 7(5), 518 - 22 {Do latent bacteremia and endotoxinemia exist in cirrhotics? A study of 48 patients}; Trinchet JC et al.; Forty-eight patients with alcoholic cirrhosis and absence of patent infection were assessed for asymptomatic bacteriemia and endotoxemia . 280 blood cultures have been performed and 190 serum samples collected for study by two different methods of the limulus test (LT) . Bacteriemia was found in 7 blood cultures from 3 patients . In these patients, occult infection was demonstrated in each case (cholecystitis, ulcerated rectal adenocarcinoma, cutaneous infection) . Sixteen LT from 14 patients were positive initially . Only one LT remained positive after control by two different methods . These results suggest that in patients with alcoholic cirrhosis and in the absence of patent infection: 1) bacteriemia is an infrequent feature and, if present, explained by other causes than cirrhosis . 2) LT is negative in systemic blood when rigorous controls are performed, and endotoxemia cannot be substantiated by this test. J Urol, 1983 May, 129(5), 998 - 1000 The cytological diagnosis of prostatic carcinoma by transrectal fine needle aspiration; Hosking DH et al.; During a 2-year period a prospective study was conducted, comparing the accuracy of transrectal fine needle aspiration with that of transperineal needle biopsy in the diagnosis of prostatic carcinoma . With increasing experience the accuracy of aspiration was found to be at least equal to that of biopsy . Blood cultures 1 hour postoperatively in 1 group and 5 minutes postoperatively in another revealed a low incidence of bacteremia . Our findings suggest that prostatic aspiration should be used more widely as the initial diagnostic procedure for suspected prostatic cancer. Postgrad Med, 1983 May, 73(5), 295 - 300 Fever without localizing signs in children . Detection and management of occult bacteremia; Lorin MI; Occult bacteremia should be of major concern in the child with fever without localizing signs . A number of clinical features and laboratory findings correlate with the risk of bacteremia in such children, and their recognition permits the identification of a group of children at high risk . Treatment of such children with antibiotics on an ambulatory basis appears to significantly lessen the incidence of persistent bacteremia, subsequent meningitis, and other serious localized bacterial infections. Arch Intern Med, 1983 May, 143(5), 885 - 9 Previous hospital care and pneumococcal bacteremia . Importance for pneumococcal immunization; Fedson DS et al.; At the University of Chicago Hospitals and Clinics (UCHC), 60% of 126 patients who survived, and 70% of 40 patients who died with pneumococcal bacteremia had been discharged at least once within the previous five years . The experience of 39 patients with bacteremia at the Mary Imogene Bassett Hospital, Cooperstown, NY, was similar . There were 144 UCHC patients with high-risk conditions . In 69%, these conditions were evident on an earlier hospital admission . In contrast, only two of 22 UCHC patients without high-risk conditions had been previously discharged . In addition to age and underlying medical condition, previous hospital care can help to define high-risk individuals for pneumococcal immunization . The results also suggest that hospitals should assume a major role in the prevention of serious pneumococcal infections. Zh Mikrobiol Epidemiol Immunobiol, 1983 May, (5), 54 - 6 {Improved method of studying the blood for sterility}; Talapa AI; The technique used for the inoculation and subculturing of blood samples in testing them for sterility is described . This technique eliminates the possibility of contaminating the culture medium and the blood sample under test with extraneous bacterial flora . Blood samples were inoculated without opening the containers with the culture medium . Inoculation was made with the syringe and the needle used for taking the blood sample through the punctured rubber stopper closing the container . Subculturing on solid culture media was also carried out without opening the containers: the rubber stopper was punctured and the contents of the container withdrawn with a pipette needle . The use of this new technique made it possible to detect bacteremia in 12.8% of cases, only in persons with purulent and septic diseases, whereas by using the existing technique bacteremia was detected both in sick and healthy persons, in 38.6% and 26.6% of cases, respectively. Klin Padiatr, 1983 May-Jun, 195(3), 222 - 4 {Experience with the Hickman catheter in bone marrow transplantation and intensive cytostatic chemotherapy}; Bender-Gotze C et al.; Long-Term indwelling right atrial (Hickman) catheters were placed in 37 patients undergoing bone marrow transplantation or intensive chemotherapy for acute leukemia and other malignancies . Blood sampling, application of blood products or intravenous drugs and parenteral nutrition were impressively facilitated . Parents were easily trained for catheter care at home . The median duration of function has been 85 (2-312) days . 7 catheters had to be changed because of dislocation - especially in smaller children - or fluid leakage . In 6 severely neutropenic patients bacteremia was observed which resolved without catheter removal . The cause of death in 9 children with functioning catheter was due to the underlying disease (graft rejection, relapse) . The use of Hickman-catheters improved venous access and supportive care in children with acute leukemia or other malignancies at an acceptable complication rate. Am J Med, 1983 May, 74(5), 741 - 6 Management of hematologic and infectious complications of intensive induction therapy for small cell carcinoma of the lung; Markman M et al.; In an effort to improve response rate and survival in small cell carcinoma of the lung, considerable attention has been focused on induction therapy with intensive chemotherapeutic regimens . The morbidity and mortality of such therapeutic programs have been of considerable concern . The hematologic and infectious complications of highly intensive induction chemotherapy in 72 patients with small cell lung cancer treated at the Johns Hopkins Oncology Center were reviewed, and guidelines for the management of aplasia in this patient population are suggested . Bone marrow aplasia was severe, with 90 percent of 140 cycles of therapy associated with the development of fever . However, during only 20 percent of febrile episodes could a specific site of infection or pathogen be identified . Prophylactic platelet transfusions were administered during 42 percent of courses because of severe thrombocytopenia (platelet count below 20,000/mm3) . Only a single significant bleeding episode developed during therapy . The occurrence of bacteremia (9.3 percent of cycles) was strongly associated with the development of severe thrombocytopenia . There were no deaths during aplasia . It is concluded that intensive combination chemotherapy can be safely administered to this elderly patient population with acceptable morbidity provided there is strict adherence to the unique principles of antibiotic usage and platelet support during bone marrow aplasia. Cancer, 1983 Apr 15, 51(8), 1546 - 50 Severe pneumococcal infection in patients with neoplastic disease; Chou MY et al.; A study of pneumococcal bacteremia in 56 patients with neoplastic disease from January 1, 1972 to June 30, 1980 is presented and compared to an earlier study between 1955 and 1971 . Patients at highest risk were those with Hodgkin's disease who had been splenectomized, multiple myeloma and chronic lymphocytic leukemia showing an attack rate of 15.6/1000, 12.5/1000, and 10.8/1000, respectively . The attack rate was more than three times higher among patients with Hodgkin's disease in the present series compared to the previous series . In 32% of cases there was no identifiable source for the infection . Four splenectomized patients with Hodgkin's disease developed pneumococcal meningitis and two died . The overall mortality rate was 32% versus a rate of 18% for those treated with appropriate antibiotics for more than 24 hours . There was a significant improvement in overall survival when compared with our previous series . As before, almost one fourth (24%) of our isolates were not among those included in the pneumococcal vaccine presently available . Antibiotic prophylaxis should be considered in high risk patients. Am Fam Physician, 1983 Apr, 27(4), 129 - 34 The infant with unexplained fever; Poole SR; Managing the infant who has fever without an obvious source can be difficult . The clinician should know how the infant's age, temperature, degree of toxicity and white blood cell count relate to the risk of occult bacterial disease, particularly bacteremia . In many instances, presumed bacteremia can be managed initially with outpatient blood culture and antibiotics . Close follow-up and early reexamination are necessary if blood cultures are positive. Surgery, 1983 Apr, 93(4), 533 - 7 Comparison of Greenfield filter and vena caval ligation for experimental septic thromboembolism; Peyton JW et al.; Septic thromboembolism resulting from the placement of infected autologous thrombi was studied in three groups of ten dogs each following vena caval ligation (VCL) or Greenfield filter (GF) placement with or without antibiotic treatment . All the dogs that did not receive antibiotic therapy died, and the shortest survival time was after acute VCL . Dogs with GF and with delayed embolism after VCL survived significantly longer than did the control animals . Antibiotic therapy consisting of ampicillin and clindamycin resulted in survival except for one control dog with lung abscess . Cultures of the GF and contained thrombus were negative after 2 weeks . However, after VCL, two died of sepsis and two survivors had caval abscess . In a group of six dogs with VCL and delayed embolism, there were four deaths from sepsis and one survivor found to have a caval abscess . To test secondary infection of a trapped thrombus, in 12 dogs with GF and a sterile thrombus we created an extremity abscess with a fecally contaminated sponge, which resulted in death from sepsis in six animals within 3 days . Surgical drainage and antibiotic treatment of the remaining six resulted in survival in five dogs . Cultures of filters and emboli showed heavy contamination in the untreated animals and in one treated dog that died within 24 hours . The remainder had sterile filters and emboli . The presence of sepsis does not preclude use of the Greenfield filter, which is well tolerated in the face of septic embolism and allows sterilization with antibiotic treatment . Prophylactic antibiotic therapy seems advisable for any patient with a filter during a procedure that may produce bacteremia. Emerg Med Clin North Am, 1983 Apr, 1(1), 101 - 11 Initial evaluation for and management of bacteremia and bacterial meningitis in infants; Fulginiti VA; The diagnosis of bacteremia or meningitis in young infants may be straightforward or difficult . Clinical assessment is important in segregating a high risk group from the large number of febrile children with less serious infections . Specific diagnostic procedures such as culture of the blood and examination of the cerebrospinal fluid may need to be employed, despite a lack of definitive clinical or nonspecific laboratory test results . The physician who first encounters such children must develop guidelines for the use of these diagnostic tests. Pediatr Infect Dis, 1983 Mar-Apr, 2(2), 131 - 5 The evaluation and treatment of the febrile infant; Caspe WB et al.; Over a period of 5 1/2 years 305 infants less than 60 days of age with temperatures greater than or equal to 100.4 degrees F (38.0 degrees C) were evaluated for sepsis . Of these 20.6% of the infants had significant diseases although only 3.6% had bacteremia . Neither the age of the child (above or below 30 days of age) nor the height of the fever helped to identify infants with bacteremia . A white blood cell count of greater than 15,000/mm3 was useful in identifying bacteremic infants over 30 days of age only . The differential white blood cell count was not helpful in distinguishing between bacteremic and nonbacteremic infants . The appearance of the infant was the most significant predictor (P less than 0.001) of bacteremia in this age group . Infants between 30 and 60 days of age who both appeared ill and had white blood cell counts greater than or equal to 15,000/mm3 had a 27.3% chance of having bacteremia. Am J Surg, 1983 Mar, 145(3), 364 - 8 Gastric mucosal blood flow and Escherichia coli bacteremia; Genter B et al.; The specific changes in gastric blood flow during sepsis are controversial . Previous investigations of intragastric blood flow using endotoxin models revealed decreased total gastric blood flow and decreased gastric mucosal blood flow . Endotoxin models are now thought to be inadequate due to the accompanying depression of the systemic circulation . More recently, increased gastric blood flow has been demonstrated in a septic hindlimb model . To further elucidate the changes in intragastric blood flow in sepsis, the gastric mucosal and nonmucosal blood flow were measured in the antrum and corpus of pig stomachs before and after the onset of sepsis . Increased gastric mucosal blood flow was demonstrated in both the antrum and corpus 15 minutes after the onset of E . coli bacteremia . By 75 minutes postonset, the changes were not significant, which implied partial recovery . Clinically, gastric mucosal ulcers may accompany the multiple organ system failure of sepsis . These data suggest that mucosal ischemia is not an etiologic factor as previously postulated from experiments with endotoxin. Ann Intern Med, 1983 Mar, 98(3), 290 - 3 The acquired immunodeficiency syndrome and Mycobacterium avium-intracellulare bacteremia in a patient with hemophilia; Elliott JL et al.; A 27-year-old previously healthy man with hemophilia presented with Pneumocystis carinii pneumonia . The patient had several episodes of oral candidiasis followed by disseminated infection with Mycobacterium avium-intracellulare . He was not homosexual nor did he take illicit drugs, but he had been self-administering two to four monthly infusions of factor VIII concentrate for 7 years . In-vitro lymphocyte studies showed findings consistent with the acquired immunodeficiency syndrome that had previously been reported only in homosexual men, drug addicts, and Haitian refugees . The cause of this syndrome is unknown, but the possibility that it is associated with a transmissible agent acquired through the use of blood products such as factor VIII concentrate must be considered. JAMA, 1983 Jan 14, 249(2), 214 - 8 Pneumococcal pneumonia in hospitalized patients . Clinical and radiological presentations; Ort S et al.; The clinical and radiological features of pneumococcal pneumonia were studied in 94 hospitalized patients . Fifty-seven (61%) had a bronchopneumonic pattern on roentgenogram, and 37 (39%), a lobar pattern . Eighty-two (87%) of the patients in both roentgenographic classifications had one or more underlying disease states . There was no difference in the frequency of heart disease, diabetes, chronic pulmonary disease, or malignancy between the two categories . Sputum Gram's stains were also similar in both patterns . Twenty (54%) of the 37 patients with the lobar pattern were bacteremic compared with only five (9%) of the 57 patients with the bronchopneumonic pattern; all five patients with bronchopneumonia and bacteremia had an associated malignancy . Although a lobar pattern is usually emphasized in the diagnosis of pneumococcal pneumonia, this study showed that the majority of patients hospitalized with pneumococcal pneumonia had a roentgenographic bronchopneumonic pattern rather than the classic lobar pattern . Thus, patients with the bronchopneumonic pneumococcal pneumonia pattern may be underdiagnosed . The implications are important both for treatment and for epidemiologic data used in the selection of pneumococcal types for prophylactic vaccines. J Pediatr Gastroenterol Nutr, 1983, 2(1), 171 - 4 Hepatic abscess as a complication of Crohn's disease; Weinberg RJ et al.; A 17-year-old male with Crohn's disease presented with persistent fever and right upper quadrant tenderness . Ultrasonography and abdominal computerized axial tomography (CAT scan) showed two large loculated abscess cavities in the right lobe of the liver . Surgical drainage and antibiotic therapy led to resolution of both cavities over a 5-month period . Unlike six previously reported patients, our patient had no evidence of pylephlebitis or mesenteric abscess formation at surgery . We speculate that his abscesses arose through seeding of mesenteric vessels and portal bacteremia. J Am Geriatr Soc, 1983 Jan, 31(1), 19 - 27 Pneumococcal bacteremia in adults: age-dependent differences in presentation and in outcome; Finkelstein MS et al.; In order to evaluate the effect of age on the presentation of and response to acute bacterial infection, the hospital charts of 187 adult patients with community-acquired pneumococcal bacteremia admitted to Bellevue Hospital over a nine-and-a-half year period were reviewed . Compared with younger patients, older patients (aged 65 or older) more frequently had (1) a lower fever in response to the infection, (2) an unclear history of illness, (3) a delay in diagnosis and/or therapy, and (4) a higher risk of dying . On admission, their leukocyte counts and heart rates were similar to those in a group of younger patients, which was composed largely of alcoholic patients and those addicted to intravenous drugs . Response to therapy was also similar in surviving older patients . Lower temperature and an unclear history were features most commonly associated with both delayed diagnosis and higher mortality . When patients with a history of alcohol abuse and those dying shortly after admission (i.e., presenting in a moribund state) were eliminated from the analysis, many of these age-related differences in presentation and outcome became even more evident. Dis Colon Rectum, 1983 Jan, 26(1), 22 - 4 Bacteremia associated with lower gastrointestinal endoscopy: fact or fiction? II . Proctosigmoidoscopy; Kumar S et al.; In an effort to elucidate whether bacteremia occurs during endoscopic examination of the lower gastrointestinal tract, two prospective studies were undertaken involving patients undergoing colonoscopy and proctosigmoidoscopy . The former group has been presented earlier, and the second study, which includes the proctosigmoidoscopy group, is the basis for this study . Fifty-seven patients undergoing proctosigmoidoscopy were studied . Excluded from the study were patients with fever, diarrhea, inflammatory bowel disease, valvular heart disease, vascular prosthesis, chemotherapy, and immunosuppression . Aerobic and anaerobic blood cultures were taken before, during, and after proctosigmoidoscopy . Additional cultures were taken after a biopsy or polypectomy . Skin cultures were taken from the venipuncture site prior to venipuncture . No bacteremia was demonstrated . Three blood cultures were positive, but all were considered contaminants on the basis of the nature of organisms . No correlates could be drawn as to the depth of insertion, length of time, or position of patient during the procedure . It is concluded that no significant bacteremia occurs during proctosigmoidoscopy . Further studies are warranted in the excluded high-risk group. Zentralbl Chir, 1983, 108(20), 1312 - 7 {Transitory bacteremia following rectoscopy?}; Knoch HG et al.; Our rectoscopies were made in patients for various indications . Venous blood samples before rectoscopy as well as 1, 5, 10, 20 and 30 minutes after its beginning and blood cultures were taken . No transient bacteriaemia could be identified . Only in patients suffering from carditis an internist should be consulted before performing the rectoscopy. Circ Shock, 1983, 11(3), 217 - 22 Effect of bacteremia and fluid resuscitation on cardiac output; Carroll GC et al.; The cardiac output acutely inducible by a 1-ml/kg/min saline infusion was observed in 12 septic and 7 nonseptic cynomolgus monkeys . In septic monkeys intravenous live E . coli were titrated to rapidly produce equivalent hypotension which was maintained for 1 hr before saline . Bacteria dose range was 1.3 X 10(11) bacteria/kg-400 X 10(11) bacteria/kg . There was no significant correlation between the dose of bacteria and the cardiac output nadir; however, the subsequent maximum cardiac output during saline resuscitation was significantly negatively correlated with the bacterial dose . In conclusion, widely varying amounts of intravenous bacteria can produce the same degree of hypotension and not correlate with cardiac output . In contrast, cardiac output measured early during subsequent saline resuscitation better predicts the severity of bacteremia. Adv Shock Res, 1983, 9, 101 - 14 The pathophysiology of septic shock: responses to different doses of live Escherichia coli injection in rats; Tanaka J et al.; Responses to different doses of Escherichia coli (E coli; 0-18) injection were studied from the pathological standpoint . Various amounts of live E coli were intravenously injected through the tail vein (group A: 2.7-3.3 X 10(9); B: 1.7-2.0 X 10(9); C: 1.2-1.5 X 10(9); D: 0.3-0.5 X 10(9) organisms/100 g of body weight) . All rats from group A died within 6 h; 14 out of 15 rats from group D survived . Hypothermia was commonly seen in the lethal groups (groups A, B, and C) prior to death, and hyperthermia was observed only in groups C and D . Leukopenia was seen in all groups and remained in the lethal groups, whereas in group D, leukocytosis following leukopenia was observed at 12 and 24 h . Light microscopic studies were performed in the lethal groups, showing the following differences among the three lethal groups; a dose-related depletion of white pulp of the spleen, cortical hemorrhage of the adrenal glands (only in groups A and B), foci of bacterial colonies in the heart and small intestine with aggregated leucocytes (only in group C); focal liver necrosis was found in group C, but not in group A . Tubular necrosis and cast formation were also predominant in the kidneys of group C animals . The above findings indicate that the milder, lethal group shows more severe morphological changes in all organs except the spleen and adrenal glands, and suggest that sudden death from bacteremia may involve a depleted host defense. JAMA, 1982 Dec 3, 248(21), 2868 - 73 A prospective study of prolonged central venous access in leukemia; Abrahm JL et al.; A three-year prospective study was conducted to evaluate right atrial silicone elastomer catheters for long-term venous access in adults with acute leukemia . Objectives included establishing the safety of catheter insertion in thrombocytopenic patients and the feasibility of maintaining the catheter during septicemia . Seventy-one catheters were placed in 57 consecutive patients entering intensive leukemia therapy . Excessive bleeding occurred at three catheter insertion sites . Eight catheter-related infections occurred . In 34 of 36 noncatheter-related and two catheter-related bacteremias, catheters were left in place with intensive monitoring . In 20, bacteremia cleared . Fourteen patients died; in eight autopsies, no evidence of catheter-related mortality was found . Catheters were in use 6,799 days, including 3,932 home use and 2,570 granulocytopenic days . The data indicate that thrombocytopenia does not preclude catheter insertion and that catheters can be safely maintained in septicemic granulocytopenic patients. Radiology, 1982 Dec, 145(3), 639 - 40 Work in progress: hypotension and high-volume biliary excretion following external percutaneous transhepatic biliary drainage; Taber DS et al.; A review of 120 consecutive percutaneous transhepatic biliary drainage (PTBD) procedures performed for high-grade obstructive jaundice identified seven patients whose bile output exceeded normal volumes . Three patients required intense fluid therapy for intravascular volume depletion . No patient exhibited fever or bacteremia . Hypovolemia due to high-volume biliary drainage was considered responsible for severe hypotension . Hypovolemia secondary to large-volume biliary secretion may complicate PTBD . The pathophysiology of high-volume biliary drainage unrelated to initial decompression is uncertain. J Pediatr, 1982 Nov, 101(5), 686 - 9 Febrile infants: predictors of bacteremia; Crain EF et al.; One hundred and seventy-five infants less than 8 weeks of age, presenting to the pediatric emergency room of the Bronx Municipal Hospital Center with rectal temperature greater than or equal to 38 degrees C (100.4 degrees F), were studied . House officers recorded their impressions of the infants on a number of variables prior to performing a lumbar puncture and obtaining laboratory data . All infants were admitted for parenteral antibiotic therapy pending culture results . Culture-positive bacterial infections occurred in 6.3% (n = 11); the incidence of bacteremia was 3.4% (n = 6) . Of special concern were the 134 infants who had no visible source for their fever during the first examination . A major goal was to determine whether there were any early predictors of bacteremia in this group . The individual variables of white blood cell count greater than or equal to 15,000/mm3, band count greater than or equal to 500/mm3, temperature, impression of irritability, tone, cry, and activity level were not related to the presence of bacteremia . An erythrocyte sedimentation rate greater than or equal to 30 and the examiner's impression of sepsis were significantly associated with bacteremia but did not correctly identify all cases . However, the combination of impression of sepsis, white blood count greater than or equal to 15,000/mm3, and erythrocyte sedimentation rate greater than or equal to 30 identified all infants with bacteremia and excluded 82% of the infants who were eventually shown not to have bacteremia. J Am Geriatr Soc, 1982 Nov, 30(11), 690 - 3 Symptomatic pyelonephritis in elderly men; Gleckman R et al.; A prospective study was carried out of the clinical, laboratory, radiologic and therapeutic features of acute, symptomatic, bacterial pyelonephritis as experienced by 12 consecutive elderly, noncatheterized men who required hospitalization . In spite of the advanced ages of the men and the inordinate frequency of bacteremia and septic shock, no patient died . "Appropriate" antibiotic therapy, supportive treatment, and, as importantly, a lack of associated "imminently" or "ultimately" fatal illnesses contributed to the 100 per cent survival rate . Guidelines are provided for the diagnostic evaluation and antibiotic therapy of community-acquired pyelonephritis in elderly men. Hosp Pract (Off Ed), 1982 Nov, 17(11), 124A - C, 124K-L, 124N-P Rifampin prophylaxis against H . flu type b spread - is it valid? Daum RS, Glode MP. H . influenzae can cause not only meningitis in children but epiglottitis, cellulitis, pneumonia, pericarditis, and bacteremia . It is possible to radically reduce, if not abolish, the spread of this pathogen . But effective prophylaxis requires answers to questions of practicability relative to the availability, cost, and logistics of administering rifampin to contacts, as has been recommended. Ann Surg, 1982 Oct, 196(4), 436 - 41 Nonspecific enhancement of resistance to bacterial infection: evidence of an effect supplemental to antibiotics; Polk HC Jr et al.; Experiments have been undertaken to further characterize the actions of the synthetic immunoadjuvant compound, muramyl dipeptide (MDP), in an animal model simulating surgical infection . When used prophylactically in combination with antibiotics, MDP proved to be significantly additive in terms of local and systemic effects, and survival, to both chloramphenicol (p less than 0.01) and cephaloridine (p less than 0.05) . The combined use of MDP and cephaloridine therapy, initiated four or six hours following infectious challenge and including a surgical foreign body in starved and refed animals, showed statistically significant decreases in bacteremia during early time periods, as well an increased early survival (p less than 0.02), compared with the use of cephaloridine alone . Benefits observed in the therapeutic mode were of lesser magnitude than those observed following prophylactic use, but the model used was a much more significant physiologic challenge . Evidence indicating additive effects to those of antibiotics is essential prior to the use of MDP in clinical trials. Surgery, 1982 Sep, 92(3), 480 - 5 Splenic abscess--presentation, diagnosis, and treatment; Sarr MG et al.; Splenic abscess is an unusual entity . In the last 30 years at the Johns Hopkins Hospital, only 11 patients have been treated for clinically overt splenic abscess . Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function . Prior to 1970, diagnosis was one of exclusion, and delay in treatment was frequent . Recently, diagnosis has been facilitated by splenic scintiscans, ultrasonography, and computerized axial tomography . These techniques now afford earlier, objective evidence of splenic involvement . Although splenectomy controls local splenic suppuration, the ultimate prognosis rests on the underlying process predisposing the patient to development of splenic infection. J Clin Microbiol, 1982 Sep, 16(3), 590 - 2 Influence of a blood culture inoculation technique on detection of bacteremia by the BACTEC system; Carlson LG et al.; A 2-year study compared the influence of blood culture inoculation technique on the detection of bacteremia by an automated radiometric system (BACTEC; Johnston Laboratories, Inc.) . A total of 4,690 specimens (20 ml each) were collected . Of each sample, 10 ml was inoculated into a pair of Bactec bottles at the bedside (BACTEC system) . The remaining 10 ml was placed in an evacuated blood collection tube (VACUTAINER; Becton Dickinson VACUTAINER Systems) and transported to the laboratory for subsequent inoculation into an identical set of vials (VACUTAINER-BACTEC system) . A total of 309 cultures grew organisms considered to be clinically significant . The recovery rate, time to positivity, and spectrum of isolates were similar for the two methods . There were substantially more sporeforming "contaminants" isolated in the VACUTAINER-BACTEC system. Ann Emerg Med, 1982 Aug, 11(8), 417 - 24 Hypothermia: the Bellevue Experience; White JD; All adult patients (102 cases) presenting to Bellevue Hospital Medical Center over a calendar year (1978) with core temperatures less than 35 C were studied . Statistically significant correlations between hypothermia and mortality were identified according to mental status, hypoxia, hypotension, hyperamylasemia, duration and severity of hypothermia, and history of exposure and alcohol ingestion . Mortality could not be predicted on the basis of season, age (if greater than 40 years old), sex, presence of infection, or presenting temperature (if greater than 26 C) . Thyroid and adrenal function were not significantly altered . Of only nine diabetic patients, four died in ketoacidosis or hyperosmolar states . There were no cases of meningitis, and the incidence of "occult" bacteremia was less than 1% . Prolonged hypothermia was uniformly associated with profound underlying medical disease . In patients presenting with temperatures less than 26 C, 50% of deaths resulted from temperature-induced ventricular arrhythmias . Alcoholics hypothermic from exposure had excellent prognoses; however, temperatures less than 26 C were associated with a marked and statistically significant incidence of death. J Pediatr, 1982 Aug, 101(2), 176 - 9 Pneumococcal and other infections in children with sickle-cell hemoglobin C (SC) disease; Topley JM et al.; The pattern of infection was compared in 139 children with sickle cell-hemoglobin C (SC) disease and in 250 control children with a normal hemoglobin (AA) genotype ascertained at birth and followed prospectively for periods of zero to six years . Both infection incidence rates and survival curve analysis indicated highly significant increases in serious infection among children with SC disease . Respiratory infection and gastroenteritis were the most common infections, but only respiratory infections were significantly more frequent in SC disease . Pneumococcal bacteremia was confined to the SC group . No hematologic differences were apparent between SC patients with and without a history of serious infection, but infection was significantly more common in patients manifesting early splenomegaly. Infect Immun, 1982 Aug, 37(2), 830 - 2 Comparison of virulence and colonizing capacity of Escherichia coli K1 and non-K1 strains in neonatal rats; Scannapieco FA et al.; Neonatal rats fed three strains of Escherichia coli K1 at birth had bacteremia rates of 29 to 81%; negligible bacteremia was seen with K92 and an unencapsulated strain . Despite this marked difference in virulence, K1, K92, and the unencapsulated strain all promptly, reliably, and stably colonized the entire alimentary tract, from pharynx to colon. Cancer, 1982 Jul 1, 50(1), 187 - 90 Rates of hospital-acquired bloodstream infections in patients with specific malignancy; Mayo JW et al.; Prospective surveillance of hospitalized patients with leukemia or solid tumors was performed in order to define the rate of nosocomial bloodstream infection according to specific diagnosis . During the 38-month study, there were 842 nosocomial blood stream infections in 704 patients, 22% of whom had leukemia or solid tumors . In the patients with malignancy, the diagnoses associated with the highest rate of bloodstream infections were chronic myeloid leukemia (18.4/100 patients), acute lymphocyte leukemia (17.7/100), promyelocytic and undifferentiated leukemia (16.1/100) and acute monocytic/myelomonocyte (13.8/100) . In 76% of patients with chronic lymphocytic, chronic myeloid, or undifferentiated leukemia, the peripheral blood polymorphonuclear leukocyte count at the time of bacteremia was less than 100 cells/mm-3 . In contrast to patients with leukemia, those with solid tumors, as a group, were at no greater risk of bloodstream infection than those without malignancy . In preparation for prophylactic trials of antibiotics or immunotherapy this study has more clearly defined the risk of bloodstream infection in cancer patients. J Trauma, 1982 Jul, 22(7), 527 - 32 Effect of nonviable tissue and abscesses on complement depletion and the development of bacteremia; Heideman M et al.; Complement concentrations and blood cultures were compared in 58 patients within 24 hours of injury and weekly thereafter . Extensive amounts of nonviable tissue (n = 40) were associated with a mean depletion of C4, C3, and C5 by 56%, and minor injuries (n = 18) by 22% of normal concentration within 14 hours after injury . The C4, C3, and C5 concentrations returned to normal or above within a week after minor injuries, but not following major injuries . However, C4, c3, and C5 levels remained depressed after major injuries unless necrotic tissue was removed or abscesses were drained . If complement concentration was below 50% of normal for more than a week all patients developed bacteremia . Following debridement or drainage complement returned to normal in 11 patients and blood cultures became negative in seven . Possible consequences by activation and altered availability of complement for chemotaxis, opsonization, and lysis of bacteria have been analyzed and related to the development of bacteremia. Infect Control, 1982 Jul-Aug, 3(4), 303 - 8 Hospital-based pneumococcal immunization: the epidemiologic rationale and its implementation; Fedson DS; Many patients hospitalized for or dying of pneumococcal bacteremia have been discharged from a hospital within the previous five years . In addition to age and underlying medical condition, previous hospital care, particularly for high risk conditions, is a useful marker for identifying individuals who are destined to develop serious pneumococcal infections . Relatively few patients, especially those with high risk conditions, would need to receive pneumococcal vaccine at the time of hospital discharge to prevent, within the next five years, each subsequent readmission or death from pneumococcal pneumonia . Although pneumococcal vaccine has not been widely used in the hospital setting, there are sound epidemiologic reasons to expect that organized programs for vaccine delivery in hospitals would be an effective approach to preventing many serious pneumococcal infections. Infect Immun, 1982 Jun, 36(3), 870 - 5 Iron-suppressible production of hydroxamate by Escherichia coli isolates; Stuart SJ et al.; A total of 476 strains of Escherichia coli isolated from humans, pigs, cattle, poultry, potable water, or effluent were examined for iron-suppressible ability to produce hydroxamate . Isolates able to produce such material (Hyd+ isolates) are presumed to be able to carry out hydroxamate-dependent transport of iron . The percentages of Hyd+ isolates found among E . coli isolated from the feces of breast-fed babies (71%), adults (46%), milk-fed calves (32%), or poultry (28%) were significantly greater (P less than 0.01) than the percentages isolated from potable water and effluent (6%) or from the feces of suckling piglets (6%), weaned pigs (6%), or weaned cattle (4%) . The percentages of Hyd+ isolates found among E . coli associated with diarrhea in humans (51%), weaned pigs (7%) or calves (25%) were not significantly different (P greater than 0.1) from those found among strains isolated from corresponding nondiarrheic hosts . Many of the E . coli isolated from cases of E . coli bacteremia in humans and poultry were Hyd+ (64% and 83%, respectively) . We conclude that ability to carry out hydroxamate-mediated transport of iron is widely distributed among natural isolates of E . coli but that the distribution of Hyd+ E . coli is not random . E . coli isolated from sources where levels of available iron might be expected to be low tend to be Hyd+ . It seems that a link may exist between prevalence of Hyd+ E . coli and active host-defense based on restricted availability of iron. Ann Thorac Surg, 1982 Apr, 33(4), 382 - 4 Fever and infection after cardiac operation; Pien F et al.; The occurrence of fever (daily maximal temperature greater than or equal to 38 degrees C) was analyzed in 123 patients after open-heart operation . A statistical difference was found in the incidence of fever after the third postoperative day between patients without infection and patients with bacteremia, wound infection, or pneumonia . Fever after the third day should prompt a diligent search for deep-seated infection. J Infect Dis, 1982 Apr, 145(4), 525 - 31 Enhanced susceptibility of mice infected with murine cytomegalovirus to intranasal challenge with Escherichia coli: pathogenesis and altered inflammatory response; Bale JF Jr et al.; Three-week-old mice inoculated intraperitoneally with murine cytomegalovirus (MCMV) and then challenged intranasally with Escherichia coli strain K1 demonstrated enhanced mortality (70%-90%) as compared with control animals infected with either pathogen alone (0-20%, P less than 0.05) . Mortality was greatest when animals were challenged with E . coli on days 1 or 3 after MCMV inoculation . On day 3 of infection with MCMV, clearance of E . coli from blood and tissues was impaired, and there was a decreased inflammatory response to an E . coli-inoculated sponge implanted subcutaneously (geometric mean of 830 leukocytes in sponge fluid/mm3 in MCMV-infected animals vs . 8,510 leukocytes/mm3 in controls, P less than 0.01) . On days 1 and 3 of MCMV infection, decreased leukocyte counts in sponge fluid correlated with increased levels of bacteremia (P less than 0.05) . These results indicate that MCMV enhances susceptibility to an intranasal challenge with E . coli . A decrease in the inflammatory response may be one mechanism by which MCMV increases susceptibility to bacterial infections. J Infect Dis, 1982 Mar, 145(3), 351 - 7 The adherence of polymorphonuclear leukocytes in patients with sepsis; Venezio FR et al.; Adherence of polymorphonuclear leukocytes (PMNLs) to nylon in patients with bacteremia was studied using a whole-blood assay . Adherence of PMNLs was studied in blood obtained from patients who were not in shock; the results did not differ from the control values (70.9% +/- 4.9% vs 72.1% +/- 2.8%, respectively; P greater than 0.3) . Adherence of PMNLs in the whole blood of patients was studied 24-36 hr after antibiotic therapy was begun for documented bacteremia, and elevated values were demonstrated (79.2% +/- 8.6%; P less than 0.01) . patients with bacteremic shock had a greatly augmented level of PMNL adherence (91.1% +/- 8.5%; P less than 0.001), and enhanced adherence was demonstrated when the normal PMNLs were suspended in plasma from hypotensive patients . The administration of methylprednisolone significantly reduced the adherence of PMNLs in the whole blood of four patients with bacteremia . Assay of PMNL adherence to nylon is a simple test with the potential of identifying bacteremic patients who are at risk of developing shock. J Periodontol, 1982 Mar, 53(3), 172 - 9 Effect of a local germicide on the occurrence of bacteremia during subgingival scaling; Witzenberger T et al.; The purpose of this investigation was to determine the effectiveness of irrigating periodontal pockets with povidone-iodine in reducing the incidence of bacteremia found during subgingival scaling . Twenty male patients requiring subgingival scaling had the following factors recorded on two contralateral groups of three posterior teeth: age, race, mean pocket depth, mobility, and scores of gingival, plaque, calculus, bleeding indices . In control areas, 5 ml blood samples were taken before, during and after scaling through an in dwelling Minicath . In experimental areas, the patients first rinsed with a povidone-iodine mouthwash for 1 minute, and the teeth then received a 3-minute sulcus irrigation with 10% povidone-iodine . Blood samples were taken as with the controls, and also 2 minutes after the irrigation . Blood samples were anaerobically cultured, and isolates were classified by Gram staining and cellular morphology . No significant difference in factors between control and experimental areas was noted . All preoperative blood cultures, including those taken 2 minutes after irrigation, were negative . In the 11 patients (55%0 who showed positive cultures during the scaling, cultures were positive in both control and experimental areas . None of the preoperatively recorded factors in either control or experimental ares were significantly correlated with the occurrence of bacteremia . Local degerming by mouthrinsing and sulcus irrigation with povidone-iodine prior to subgingival scaling seems neither to increase nor decrease the incidence of bacteremia. Arch Intern Med, 1982 Feb, 142(2), 263 - 8 Blood culture positivity: suppression by outpatient antibiotic therapy in patients with bacterial endocarditis; Pazin GJ et al.; Recognition of the increasing prevalence of outpatient antibiotic use prompted this review of 32 patients with verified infectious endocarditis . The results of 161 quantitative blood cultures obtained before definitive therapy were correlated with clinical information to determine whether outpatient antibiotic administration influenced blood culture positivity . In 17 patients receiving outpatient antibiotics, 56 (64%) of 88 blood cultures obtained before definitive treatment were positive, whereas all cultures obtained from 15 patients without recent antibiotic exposure were positive . Notably, seven patients showed a phase of total suppression, and two patients showed a phase of partial suppression of blood culture positivity after discontinuation of outpatient antibiotic treatment . Consequently, patients with recent antibiotic exposure and suspected endocarditis should have blood cultures obtained initially and periodically throughout the phase of potential suppression of bacteremia to optimize the chance of obtaining a positive result. J Am Vet Med Assoc, 1982 Feb 1, 180(3), 313 - 6 Myelomonocytic myeloproliferative diseases in a horse; Brumbaugh GW et al.; Myelomonocytic myeloproliferative disease in a horse was diagnosed on the basis of hematologic, enzymatic, and histopathologic findings . It was characterized clinically by depression, weight loss splenomegaly, lymphadenopathy, coagulopathy, and bacteremia . Hematologic findings included severe refractory anemia, thrombocytopenia, monocytosis, and pleomorphic leukocytes, with a left shift of the myeloid series . The serum lysozyme concentration was 14.5 microgram/ml (normal, less than 5 microgram/ml) . The bone marrow contained many immature cells of the myeloid series and had a myeloid-to-erythroid ratio of 30.5 to 1 . The horse died after brief hospitalization . Necropsy revealed generalized lymphadenopathy and hemorrhages throughout the body . Histopathologically, primitive cells were seen in several tissues . Cells that proliferated in the bone marrow were primarily myeloblastic, with some additional erythropoietic cells . Myeloblastic cells with evidence of normal erythropoiesis were seen in numerous lymph nodes and in the spleen, whereas primarily normal erythropoietic cells proliferated in the adrenal glands . Myeloid blast-type cells predominated in the lungs, myocardium, liver, and kidneys. J Periodontol, 1982 Feb, 53(2), 96 - 100 Effect of nonsterile versus sterile water irrigation with ultrasonic scaling on postoperative bacteremias; Reinhardt RA et al.; The contribution of nonsterile water irrigation during ultrasonic scaling to postoperative blood stream contamination was evaluated . Thirty human volunteers were subjected to a random split-mouth technique comparing sterile and municipal tap water irrigation with ultrasonic root preparation on contralateral mandibular quadrants . Scaling was performed by a single operator using a premeasured quantity of irrigant . Postoperative blood samples were obtained immediately and cultured aerobically and anaerobically in tryptic soy broth and on BHI agar plates for enumeration of colony forming units . Positive blood cultures were inoculated onto selective media for presumptive identification . The difference in the bacteremia incidence after scaling with sterile water (50%) versus scaling with tap water (53.3%) was not significant . The degree of the bacteremias (less than 1 colony forming unit/ml) was similar between groups . Therefore tap water irrigation used in ultrasonic scaling did not appear to be a significant causative agent in postoperative bacteremias. South Med J, 1982 Feb, 75(2), 147 - 50 Blood cultures in bacteremia; Lewis JF et al.; Blood cultures in a 700-bed hospital were examined for clinical relevance . During a six-month period 5,154 blood samples were drawn from 1,091 patients . Of the 124 patients with positive blood cultures, 7% had polymicrobic isolates . A review of hospital records for a three-year period revealed 162 charts with adequate documentation for evaluation of bacteremia . An additional 11 charts were found with inappropriately negative blood cultures . Fifteen percent of these patients were found to have polymicrobic isolates . The importance of establishing guidelines and criteria concerning acceptable blood culture practices is detailed. J Am Dent Assoc, 1982 Feb, 104(2), 171 - 7 Dental care for patients with renal failure and renal transplants; Sowell SB; Patients with renal failure have characteristic systemic and oral conditions that require special precautions during dental treatment . Drugs must be administered with caution and patients undergoing hemodialysis must receive special consideration . Both hemodialysis and transplant patients must be protected against infection . This is achieved by early, aggressive, and thorough dental treatment . Use of antibiotics during dental treatment is essential in transplant patients and is often necessary in hemodialysis patients to protect them against bacteremia . Bacterial endocarditis is a concern in patients with renal failure and with heart disease and, in these patients, antibiotic prophylaxis is essential . Hepatitis is often present in patients with renal failure, and precautions should be taken against its spread . Before dental treatment of patients with renal failure is begun, the dentist should consult the patient's physician regarding specific precautions . A treatment plan should be constructed which best restores the patient's dentition and protects from potentially severe infection of dental origin. Ann Med Interne (Paris), 1982, 133(2), 97 - 102 {Bacterial endocarditis : lack of diagnostic value of immunological investigations (author's transl)}; Kernbaum S et al.; To evaluate the diagnostic help afforded by immune determinations in feverish valvular patients, we prospectively determined: total hemolytic complement, cryoglobulin, rheumatoid factor, circulating immune complexes and direct skin immunofluorescence . Twenty patients entered the study, twelve with bacterial endocarditis, six without any bacteremia and two septicemic patients without endocarditis . We detected at least one immune abnormality in 10/12 endocarditis patients: - in 7/11 (64 p . cent) circulating immune complexes; - in 3/12 rheumatoid factor; - in 3/12 positive fluorescence in dermal vessels (IgM-C3); - and in one patient an IgG lupus-like band in the membrane basal zone . We also found circulating immune complexes in 3/4 patients without bacteremia and in 1/2 septicemic patients . We conclude that, in our small prospective study, immune abnormalities are frequent in bacterial endocarditis patients but their diagnostic values is rather limited : their absence do not rule out endocarditis and they can be present in many other febrile disorders. Scand J Infect Dis, 1982, 14(1), 75 - 8 Legionnaires' disease and fever of unknown origin; Gump DW; In a patient with fever of unknown origin and granulomas of the liver extensive serological testing revealed a significant rise in antibodies only to Legionella pneumophila despite the fact that he never was shown to have pneumonia . Absorption studies yielded additional evidence that this immunological response was specific for L . pneumophila . Bacteremia and extrapulmonary involvement, including the liver, has been shown with L . pneumophila, but never without pneumonia . Furthermore, granulomas of the liver have not been described in connection with legionellosis . This patient is regarded as a case of fever of unknown origin related to L . pneumophila infection. Circ Shock, 1982, 9(1), 27 - 35 Mucosal lesions in the feline small intestine in septic shock; Falk A et al.; The incidence and possible pathogenic mechanisms in the development of small intestinal mucosal lesions in experimental septic shock were investigated in cats . Mucosal lesions were found in 50% of the animals following a standardized bacteremia, and 15% had pronounced mucosal damage . The development of these lesions was not correlated with intestinal vasoconstriction or to portal hypertension but with decreased systemic arterial blood pressure during the last hour of the experiments . The correlation between mucosal damage and arterial hypotension in septic shock supports the view that these lesions are caused by hypoxia secondary to an increased efficiency in the countercurrent exchange mechanisms of oxygen in the villi. Acta Chir Scand Suppl, 1982, 508, 295 - 302 A shared effect of abscesses and nonviable tissue influencing the development of sepsis and acute respiratory distress syndrome; Heideman M; The influence of extensive accumulation of pus (n=20) or nonviable tissue (n=50) on complement has been studied . Plasma concentrations of C1 esterase inhibitor, C4, C3 and C5 were determined by electroimmunodiffusion technique . A good correlation between the extent of complement depletion and the amount of nonviable tissue or pus present was found . A prolonged state with reduced plasma concentrations of complement was in high frequency followed by the development of bacteremia . Patients with ongoing extensive complement activation were prone to develop ARDS . The relation between a depleted complement system and the development of bacteremia has been analysed and so has a relation between impaired oxygenation of arterial blood and products formed when complement is activated. J Surg Oncol, 1982 Jan, 19(1), 5 - 8 Aspergillus Peritonitis complicating perforated appendicitis in adult acute leukemia; Weingrad DN et al.; A 38-year-old male with terminal transferase positive acute lymphoblastic leukemia experienced fever, polymicrobial bacteremia, gastrointestinal bleeding, abdominal pain during induction therapy, and remission . Cecal perforation, Aspergillus peritonitis, and subsequent disseminated aspergillosis were successfully managed with colon resection, drainage, and antibiotic and antifungal therapy . Serologic tests for antibody to Aspergillus were repeatedly negative. Oral Surg Oral Med Oral Pathol, 1982 Jan, 53(1), 32 - 6 The oral flor as a source of septicemia in patients with acute leukemia; Greenberg MS et al.; This study was performed to determine the role of the oral cavity in causing septicemia in patients with acute leukemia . Thirty-three patients with acute nonlymphocytic leukemia were investigated prospectively via clinical, hematologic, and microbiologic techniques . The mouth was the most likely source of septicemia in seven of twelve cases . Necessary dental treatment prior to chemotherapy was accompanied by a significant reduction in the rate of septicemia . The authors conclude that oral sources of bacteremia should be eliminated prior to chemotherapy in patients with acute leukemia. J Pediatr Gastroenterol Nutr, 1982, 1(4), 551 - 3 Bacteremia in children following upper gastrointestinal endoscopy or colonoscopy; Byrne WJ et al.; Fifty children undergoing upper gastrointestinal endoscopy and 25 undergoing colonoscopy were studied prospectively with aerobic and anaerobic blood cultures for the development of bacteremia . Twenty-six of the endoscopies and all the colonoscopies were done under general anesthesia . Cultures were obtained before, at 5 min, and at 30 min after the procedure . Only a single positive blood culture was obtained in an upper endoscopy patient . All cultures from the colonoscopy patients were negative . Biopsy or polypectomy were not important variables in the development of bacteremia . It is concluded that the risk of bacteremia in children following upper endoscopy or colonoscopy is minimal and should not be considered a contraindication to their performance. Scand J Urol Nephrol, 1982, 16(3), 265 - 7 Continued experimental study on the pathogenesis of sporadic bacteriuria in the rat . II; Hjort EF; The previously described experimental model implying ligature of the left ureter in the rat has been used in continued experiments . The present experiments intended to saturate the reticuloendothelial system with dead E . coli, and thereby produce a possible increase in the seeding of bacteria into the experimental locus minoris resistentiae . The results indicate that usage of organic material as E . coli may also stimulate the RES system . Most probably, the incidence of experimental infections in the left ureter is influenced upon by 2 main variables: the size of the experimental bacteremia and the current state of host defence mechanisms. Adv Shock Res, 1982, 7, 25 - 42 The pathophysiology of septic shock: changes in hemodynamics in rats following live E coli injection . An application of the thermodilution method for measurement of cardiac output; Sato T et al.; Fifteen anesthetized rats, 273 +/- 9 gm (SEM), were monitored hemodynamically for six hours following an IV injection of a sublethal (4--5) X 10(8) organisms/100 gm body wt, n = 5) or lethal 12--15 X 10(8) organisms/100 gm body wt, n = 5) dose of live Escherichia coli or saline (control, n = 5) . A transpulmonary thermodilution method was used for measurement of cardiac output . Changes in the arterial blood temperature and pressure were recorded on a polygraph . In a simulated hydraulic model system, the measured flow rate was well correlated ( r = 0.993, P less than 0.001) with various actual flow readings (30--130 ml/minute) . A sublethal dose resulted in a transient hyperdynamic state in the early stage; the cardiac index was increased from the initial ra