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Community-acquired bacteremia at a teaching versus a nonteaching hospital: Impact of acute severity of illness on 30-day mortality

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第1期29卷 13-19页

作者： Mylotte, JM Kahler, L McCann, C Erie Cty Med Ctr & Labs Dept Med Div Infect Dis Buffalo NY 14215 USA SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA

Background: Few studies have focused recently on the epidemiology of community-acquired bacteremia (CAB) and there have been few comparisons of CAB in teaching versus nonteaching hospitals. Objectives: To compare the clinical characteristics, acute severity of illness, and 30-day mortality of patients with CAB admitted to a teaching and a nonteaching hospital and to define predictors of 30-day mortality among patients with CAB that would be identifiable at the time of admission to the hospital. Methods: This was a retrospective study of CAB at a reaching hospital (n = 174 episodes) compared to a community nonteaching hospital (n = 74 episodes) during 1995. Data collected included demographic characteristics, underlying diseases, sources of CAB, and antimicrobial therapy. Acute severity of illness on admission was measured by using the acute physiology score component of the Acute Physiology and Chronic Health Evaluation III system (APS APACHE III). Main Outcome Measure: Status, dead or alive, 30 days after admission for CAB. Results: At the nonteaching hospital, patients were older but, on average, significantly less acutely ill (as measured by the admission APS APACHE III score) than were those at the teaching hospital. In contrast, patients with HN infection, posttransplantation, or on hemodialysis were identified only at the teaching hospital. Overall, organisms causing CAB at both hospitals were similar except that Staphylococcus aureus CAB occurred significantly more often at the teaching hospital and Escherichia coli CAB occurred more often at the nonteaching hospital. There was no significant difference in 30-day mortality in patients with CAB between the teaching hospital (19.3%) and the nonteaching hospital (16.7%;P =.63). APS APACHE III score on admission identified episodes of CAB with a low- and a high-risk for 30-day mortality at both hospitals. Independent predictors of 30-day mortality were APACHE III score on admission (P < .001) and pneumonia as a s

关键词：急性病生理学和长期健康评价急性病年龄因素菌血症/药物疗法菌血症/微生物学菌血症/死亡率交叉感染/药物疗法交叉感染/微生物学交叉感染/死亡率大肠杆菌感染/死亡率医院死亡率纽约/流行病学肺炎细菌性/死亡率预后回顾性研究疾病严重程度指数葡萄球菌感染/死亡率存活率分析存活率时间因素治疗结果成年人老年人老年人 80以上人类中年人

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Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies

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CLINICAL INFECTIOUS DISEASES 2000年第3期31卷 705-711页

作者： Micozzi, A Venditti, M Monaco, M Friedrich, A Taglietti, F Santilli, S Martino, P Univ Roma La Sapienza Sez Ematol Dipartimento Biotecnol Cellulari & Ematol I-00161 Rome Italy Univ Roma La Sapienza Dipartimento Med Clin Rome Italy Ist Super Sanita I-00161 Rome Italy

Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P = .025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%];P = .0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs, only 24% of those due to P. aeruginosa;P = .002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score greater than or equal to4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta -lactams, and ciprofloxacin, Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.

关键词：菌血症/并发症菌血症/微生物学菌血症/死亡率革兰氏阴性菌感染/并发症革兰氏阴性菌感染/微生物学革兰氏阴性菌感染/死亡率血液肿瘤/并发症医院大学/统计学和数值数据假单胞菌感染/并发症假单胞菌感染/微生物学假单胞菌感染/死亡率假单胞菌铜绿/分离和提纯回顾性研究嗜麦芽窄食单胞菌/分离和提纯存活率青少年成年人老年人儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Bacteremia among kidney transplant recipients:: a case-control study of risk factors and short-term outcomes

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SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2000年第1期32卷 69-73页

作者： Miemois-Foley, J Paunio, M Lyytikäinen, O Salmela, K Univ Helsinki Cent Hosp Dept Surg 4 Helsinki Finland Univ Helsinki Dept Publ Hlth Helsinki Finland Natl Publ Hlth Inst Dept Infect Dis Epidemiol Helsinki Finland

Kidney transplant recipients are highly susceptible to life-threatening infections, including bacteremia. To determine the risk factors for bacteremia within the first month after renal transplantation we performed a non-concurrent transplant population-based case-control study involving all 1,000 consecutively operated adult patients at Helsinki University Central Hospital in 1987-93. All patients with at least 1 positive blood culture within 31 d of transplantation were defined as cases. Control patients were drawn systematically from the transplant population with no positive blood cultures within the first 31 d post-transplant. The study included 35 cases and 123 controls. The overall rate of bacteremia in the population was 3.50%. The case patients were more likely to have been on haemodialysis prior to transplantation (71% vs. 43%, p < 0.05) and to have experienced acute rejection (46%, s. 20%, p < 0.05) than the controls. Local infections (46% vs. 12%, p < 0.05) were also more common among case patients. In the crude analysis an additive interaction of acute rejection and haemodialysis was found, with a 10% rate of bacteremia occurring if both conditions were present. The mortality rate within 2 months of follow-up was higher among case patients than among controls (14% us. 1%, p < 0.05) and they also returned more often to dialysis (23% vs, 4%, p < 0.05). Bacteremia during the immediate postoperative period might still have severe outcomes measured as allograft and patient survival at 2 months post-transplant. Further evaluation will confirm whether a lower rate of bacteremia among kidney transplantation patients can be achieved if peritoneal dialysis is preferred to haemodialysis whenever possible.

关键词：菌血症/病因学菌血症/死亡率病例对照研究芬兰随访研究移植物排斥/病因学医院大学肾移植/副作用纵向研究手术后并发症/病因学手术后并发症/死亡率肾透析/副作用危险因素存活率时间因素青少年成年人老年人女(雌)性人类男(雄)性中年人

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Bacteremia caused by staphylococci with inducible vancomycin heteroresistance

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CLINICAL INFECTIOUS DISEASES 1999年第4期29卷 760-767页

作者： Wong, SSY Ho, PL Woo, PCY Yuen, KY Univ Hong Kong Queen Mary Hosp Dept Microbiol Div Infect Dis Univ Pathol BldgPokfulam Rd Hong Kong Peoples R China

The clinical significance of bacteremia due to vancomycin-heteroresistant staphylococci and a rapid laboratory screening method were examined;203 strains of staphylococci isolated from patients with clinically significant bacteremia were screened by the disk-agar method with use of vancomycin-salt agar to demonstrate satellitism around an aztreonam disk as well as by conventional population screening. Eighteen isolates (three Staphylococcus aureus and 15 coagulase-negative staphylococci) were shown to be heteroresistant to vancomycin, A case-control clinical study showed that the interval between admission and bacteremia, admission to the intensive care unit, prior use of vancomycin and/or beta-lactams, and isolation of methicillin-resistant staphylococci were significantly more common among patients with bacteremia due to staphylococci with hetero-resistance to vancomycin;these patients had an overall mortality of 44.4%. The use of vancomycin and admission to the intensive care unit were independently significant risk factors on multivariate analysis. Vancomycin heteroresistance is inducible by salt and beta-lactams. Indiscriminate sequential use of beta-lactams and glycopeptides may facilitate the emergence of glycopeptide resistance.

关键词：菌血症/药物疗法菌血症/病因学菌血症/死亡率甲氧西林抗药性危险因素葡萄球菌属/药物作用万古霉素抗药性青少年成年人老年人儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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The bacteriology of neonatal septicaemia in Ile-Ife, Nigeria

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JOURNAL OF TROPICAL PEDIATRICS 1999年第3期45卷 146-151页

作者： Ako-Nai, AK Adejuyigbe, EA Ajayi, FM Onipede, AO Obafemi Awolowo Univ Dept Microbiol Ile Ife Osun Nigeria Obafemi Awolowo Univ Coll Hlth Sci Dept Paediat & Child Hlth Ilfe Ife Osun Nigeria Obafemi Awolowo Univ Coll Hlth Sci Dept Med Microbiol & Parasitol Ile Ife Osun Nigeria

The incidence of septicaemia among neonates categorized as being at high risk was 55 per cent in Ile-Ife, Nigeria, Gram-positive organisms, specifically Staphylococcus aureus, were predominant (33.8 per cent) among bacteria cultured from proven eases of septicaemia, Other coagulase-negative staphylococci also contributed 21 per cent;with Staphylococcus epidermidis occurring in 5 per cent of the isolates. Listeria monocytogenes was cultured from 8.4 per cent of septic neonates, Pseudomonas aeruginosa was cultured from 3 per cent, Klebsiella pneumoniae from 14 per cent, and Escherichia coli from 7 per cent. Other Gram-negative bacilli cultured were Enterobacter aerogenes (5 per cent), Citrobacter freundii, Salmonella sp., and Proteus sp. (2 per cent each), The bacterial isolates were relatively resistant to antibiotics traditionally employed to treat cases of septicaemia, The study shows a high prevalence of neonatal bacterial sepsis at the centre and the emerging role of Listeria monocytogenes in the aetiology of neonatal sepsis. It highlights the preponderance of multiple antibiotic resistant organisms among these neonates early in life which is of epidemiological importance in the control of the infections agents.

关键词：菌血症/微生物学菌血症/死亡率交叉感染/微生物学交叉感染/死亡率抗药性微生物医院大学发病率感染控制微生物敏感性试验尼日利亚患病率女(雌)性人类婴儿新生男(雄)性

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