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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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Inappropriate medical management of spinal epidural abscess

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ANNALS OF THE RHEUMATIC DISEASES 2001年第3期60卷 218-222页

作者： Harrington, P Millner, PA Veale, D St James Univ Hosp Spinal Surg Unit Leeds W Yorkshire England Leeds Gen Infirm Dept Rheumatol Leeds W Yorkshire England

A 67 year old man with longstanding rheumatoid disease was referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar spine. Ten months previously, he had started antibiotic treatment at another hospital for an epidural abscess arising at the level of the L2-3 disc space. Despite completing seven months of medical treatment with appropriate antibiotics, he had a recrudescence of acute back pain shortly after restarting methotrexate treatment. Urgent anterior spinal decompression with excision of the necrotic vertebral bodies of L1-3 was performed. The indications for the surgical management of spinal epidural abscess are reviewed.

关键词：关节炎类风湿/并发症菌血症/药物疗法菌血症/病因学清创术/方法减压术外科/方法硬膜外脓肿/并发症硬膜外脓肿/诊断硬膜外脓肿/治疗磁共振成像甲氧西林抗药性轻截瘫/病因学轻截瘫/外科学修复外科手术再手术葡萄球菌感染/并发症葡萄球菌感染/药物疗法体层摄影术 X线计算机治疗结果老年人人类男(雄)性

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Emergence of multidrug-resistant Gram-negative organisms in a neonatal unit and the therapeutic implications

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JOURNAL OF TROPICAL PEDIATRICS 2000年第2期46卷 86-91页

作者： Musoke, RN Revathi, G Univ Nairobi Dept Paediat Nairobi Kenya Univ Nairobi Dept Microbiol Nairobi Kenya Kenyatta Natl Hosp Nairobi Kenya

Multidrug-resistant organisms are increasing worldwide. Over the years we have noted increasing resistance of organisms isolated in our neonatal unit. There is a need therefore to scrutinise the problem so as to be able to plan for the future. Over a 5-month period, 716 infants were admitted of which 192 were screened for sepsis. Overall, 121 (16.7 per cent) had positive blood cultures. The predominant organisms were Gram negative (73.6 per cent of isolates) with Klebsiella species topping the list at 31 per cent. Case fatality for infants infected with Gram negative organisms was 41 per cent. Resistance to gentamicin was 20 per cent chloramphenicol 23.6 per cent, and amoxicillin/ ampicillin 66.3 per cent. Of worry is the resistance to ceftazidime 19.1 per cent, and cefuroxime 21.3 per cent, with the figures rising to 27 per cent when more specialized tests are done (disc approximation and potentiation tests). If these drugs cannot be used in 20-27 per cent of cases then the situation is serious. The contributory factors to increased resistance include: non-investigation of infants put on antibiotics (50 per cent of cases);prolonged (73 per rent) and sometimes unjustified (41.7 per cent) use of antibiotics;and non-utilization of investigations when these are done (52 per cent) together with the delay in getting results back in the ward (6 days).

关键词：抗菌药/投药和剂量菌血症/诊断菌血症/药物疗法菌血症/流行病学发展中国家抗药性多药革兰氏阴性菌/药物作用革兰氏阴性菌/分离和提纯革兰氏阴性菌感染/诊断革兰氏阴性菌感染/药物疗法革兰氏阴性菌感染/流行病学发病率重症监护病房新生儿肯尼亚/流行病学回顾性研究危险因素存活率女(雌)性人类婴儿新生男(雄)性

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Inadequate antimicrobial treatment: An important determinant of outcome for hospitalized patients

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CLINICAL INFECTIOUS DISEASES 2000年第Sup4期31卷 S131-S138页

作者： Kollef, MH Washington Univ Sch Med Div Pulm & Crit Care Dept Internal Med St Louis MO 63110 USA Barnes Jewish Hosp Med Crit Care Serv St Louis MO 63110 USA Barnes Jewish Hosp Resp Care Serv St Louis MO 63110 USA

Inadequate antimicrobial treatment, generally defined as microbiological documentation of an infection that is not being effectively treated, is an important factor in the emergence of infections due to antibiotic-resistant bacteria. Factors that contribute to inadequate antimicrobial treatment of hospitalized patients include prior antibiotic exposure, use of broad-spectrum antibiotics, prolonged length of stay, prolonged mechanical ventilation, and presence of invasive devices. Strategies to minimize inadequate treatment include consulting an infectious disease specialist, using antibiotic practice guidelines, and identifying quicker methods of microbiological identification. In addition, clinicians should determine the prevailing pathogens that account for the community-acquired and nosocomial infections identified in their hospitals, Clinicians can improve antimicrobial treatment by using empirical combination antibiotic therapy based on individual patient characteristics and the predominant bacterial flora and their antibiotic susceptibility profiles. This broad-spectrum therapy can then be narrowed when initial culture results are received. Further study evaluating the use of antibiotic practice guidelines and strategies to reduce inadequate treatment is necessary to determine their impact on patient outcomes.

关键词：抗菌药/治疗应用菌血症/药物疗法交叉感染/药物疗法抗药性微生物药物疗法联合/治疗应用肺炎细菌性/药物疗法危险因素治疗结果人类

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Regional variation in ampicillin and trimethoprim resistance in Escherichia coli in England from 1990 to 1997, in relation to antibacterial prescribing

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2000年第3期46卷 411-422页

作者： Livermore, DM Stephens, P Weinberg, J Johnson, AP Gifford, T Northcott, D James, D George, RC Speller, DCE Cent Publ Hlth Lab Antibiot Resistance Monitoring & Reference Lab London NW9 5HT England IMS Hlth UK Pinner HA5 5HQ Middx England Publ Hlth Lab Serv Headquarters London NW9 5HT England

Over 200 hospitals in England report resistance data for bacteraemia and meningitis isolates to the Public Health Laboratory Service. We reviewed ampicillin and trimethoprim resistance rates from 1990 to 1997 for Escherichia coli, which is the species reported most frequently from these bacteraemias. Ampicillin resistance was relatively stable over time, but varied between Health Regions. The proportion of ampicillin-resistant E. coli in the East Anglia region remained less than or equal to 42% in all years except one and that in the South Western region always remained <50%. At the other extreme, the proportions of ampicillin-resistant isolates in the Northern and Trent regions never fell below 59%. The prevalence of resistance to trimethoprim rose over time in most regions;again, however, the prevalence of resistant isolates was lowest in the East Anglia and South Western regions, whereas the highest resistance rates were reported from Mersey, NW Thames, NE Thames and North Western regions. These observations were related to data for community prescribing, which accounts for most ampicillin and trimethoprim use. Prescribing data for ampicillin and trimethoprim from 1987 to 1997 were obtained from the IMS-HEALTH Medical Data Index, and data for all antibacterial drugs between 1995 and 1997 from the Prescription Pricing Authority. Correlations between resistance rates and prescribing of specific antibiotics were weak, although there was some trend for regions with high total prescribing to have higher rates of ampicillin resistance. The South Western region was conspicuous both for low rates of resistance and low prescribing. Several factors may determine the lack of wider and more obvious relationships between resistance and prescribing. In particular, regions may be inappropriately large areas to test the relationship, isolates from bacteraemias may not be representative of those experiencing selection pressure in the community and the resistance data may have bee

关键词：氨苄西林/药理学氨苄西林/治疗应用氨苄西林抗药性抗感染药泌尿系/药理学抗感染药泌尿系/治疗应用菌血症/药物疗法菌血症/流行病学菌血症/微生物学药物处方药物利用英格兰/流行病学大肠杆菌/药物作用大肠杆菌感染/药物疗法大肠杆菌感染/流行病学大肠杆菌感染/微生物学青霉素类/药理学青霉素类/治疗应用患病率甲氧苄啶/药理学甲氧苄啶/治疗应用甲氧苄啶抗药性人类

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Optic disk edema associated with peripapillary serous retinal detachment:: An early sign of systemic Bartonella henselae infection

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第3期130卷 327-334页

作者： Wade, NK Levi, L Jones, MR Bhisitkul, R Fine, L Cunningham, ET Univ Calif San Francisco Francis I Proctor Fdn Pearl & Samuel J Kimura Ocular Imunol Lab Med Ctr San Francisco CA 94143 USA Univ Calif San Francisco Med Ctr Dept Ophthalmol San Francisco CA 94143 USA Univ Calif San Diego Dept Ophthalmol La Jolla CA 92093 USA Univ Calif San Diego Dept Neurosci La Jolla CA 92093 USA

PURPOSE: To describe optic disk edema associated with peripapillary serous retinal detachment as an early sign of systemic Bartonella henselae infection. METHODS: Multicentered, retrospective case series. RESULTS: Five women and two men presented with optic disk edema producing peripapillary serous retinal detachment, Each patient had a markedly elevated serum anti-B, henselae antibody titer. Patient age ranged from 11 to 44 years, with a mean and median of 26.6 and 28 years, respectively. The time from the onset of systemic symptoms to the onset of visual symptoms varied from 3 days to 1 month. The peripapillary serous retinal detachment resolved within 1 to 3 weeks in each case, producing a macular star in four of seven patients, Initial vision was 20/200 or worse in five of seven patients and improved in four of these five patients to 20/30 or better, CONCLUSIONS: Systemic B, henselae infection should be considered in patients who develop optic disk edema associated with a peripapillary serous retinal detachment, even in the absence of classic neuroretinitis with a macular star. (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：抗菌药/治疗应用抗体细菌/分析菌血症/诊断菌血症/药物疗法菌血症/微生物学巴尔通体汉赛/免疫学巴尔通体汉赛/分离和提纯猫抓病/诊断猫抓病/药物疗法猫抓病/微生物学多西环素/治疗应用眼感染细菌性/诊断眼感染细菌性/药物疗法眼感染细菌性/微生物学荧光素血管造影术眼底免疫球蛋白G/分析免疫球蛋白M/分析视乳头水肿/诊断视乳头水肿/药物疗法视乳头水肿/微生物学视网膜脱离/诊断视网膜脱离/药物疗法视网膜脱离/微生物学回顾性研究视敏度青少年成年人儿童女(雌)性人类男(雄)性

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Bacteremic cellulitis caused by Non-01, Non-0139 Vibrio cholerae:: report of a case in a patient with hemochromatosis

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DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE 2000年第1期37卷 77-80页

作者： Fernández, JM Serrano, M De Arriba, JJ Sánchez, MV Escribano, E Ferreras, P Albacete Gen Hosp Dept Microbiol Albacete 02006 Spain Albacete Gen Hosp Dept Internal Med Albacete 02006 Spain

We report a case of bacteremia associated with hemorrhagic bullous skin lesions on the leg caused by non-01, non-0139 Vibrio cholerae in a 66-year-old man with hemochromatosis developed in an inland region. The organism was isolated from blood and bullae fluid. The patient was treated successfully with cefotaxime and doxycycline. This report emphasizes the potential of this organism to produce bacteremic cellulitis in people with underlying illness in the absence of usual epidemiological risk factors. (C) 2000 Elsevier Science Tnc. All rights reserved.

关键词：抗菌药/治疗应用菌血症/并发症菌血症/药物疗法菌血症/病理学头孢噻肟/治疗应用蜂窝织炎/并发症蜂窝织炎/药物疗法蜂窝织炎/病理学头孢菌素类/治疗应用多西环素/治疗应用血色素沉着症/并发症血色素沉着症/药物疗法血色素沉着症/病理学治疗结果霍乱弧菌/分离和提纯霍乱弧菌/生理学老年人人类男(雄)性

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Leukocytoclastic vasculitis complicating Klebsiella pneumoniae bacteremia

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DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE 2000年第4期37卷 275-277页

作者： Lum, PNL Woo, PCY Wong, SSY Yuen, KY Univ Hong Kong Queen Mary Hosp Dept Microbiol Hong Kong Hong Kong Peoples R China

A 79-year old woman, with a history of hypertension, presented with clinical features of congestive heart failure, fever, a purpuric rash, and left lower quadrant abdominal tenderness. Contrast computed tomography scan of the abdomen showed features of acute diverticulitis, and blood culture was subsequently positive for Klebsiella pneumoniae. Histological examination of a biopsy of the rash confirmed a diagnosis of leukocytoclastic vasculitis (LCV). The bacteremia responded to intravenous amoxycillin/clavulanic acid and gentamicin and the rash subsided. This case represents the first case of LCV complicating K. pneumoniae bacteremia in the English literature. The English literature on bacteria-associated LCV is reviewed. Taking aside organisms such as Rickettsia that cause endothelial invasion, the associated bacterial species tends to be subacute or chronic pathogens e.g. Mycoplasma pneumoniae, Mycobacterium tuberculosis, and Yersinia enterocolitica;or the disease process is of a subacute or chronic nature e.g. endocarditis, bronchiectesis, and cystic fibrosis, leading to prolonged exposure to pathogens that apparently cause acute pyogenic infections, such as K. pneumoniae. (C) 2000 Elsevier Science Inc. All rights reserved.

关键词：阿莫西林/投药和剂量阿莫西林/治疗应用抗菌药/投药和剂量抗菌药/治疗应用菌血症/并发症菌血症/药物疗法菌血症/微生物学棒酸/投药和剂量棒酸/治疗应用庆大霉素类/投药和剂量庆大霉素类/治疗应用注射静脉内克雷伯菌感染/并发症克雷伯菌感染/诊断克雷伯菌感染/药物疗法克雷伯菌肺炎/药物作用克雷伯菌肺炎/分离和提纯微生物敏感性试验血管炎超敏感性/药物疗法血管炎超敏感性/微生物学老年人女(雌)性人类

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Bacillus cereus fatal bacteremia and apparent association with nosocomial transmission in an intensive care unit

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SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2000年第1期32卷 98-100页

作者： Carretto, E Barbarini, D Poletti, F Marzani, FC Emmi, V Marone, P IRCCS Policlin San Matteo Lab Batteriol & Micol Lab Sperimentali Ric Area Infettivol IT-27100 Pavia Italy IRCCS Policlin San Matteo Serv Rianimaz 1 Pavia Italy

Bacillus cereus has sometimes been implicated in food poisoning and in opportunistic infections of seriously ill patients. This report describes an unusual case of persistent bacteremia and multiple organ failure associated with B. cereus in a patient admitted to our institution for lung cancer. The patient was undergoing treatment with an antimicrobial agent (imipenem) that was shown to be effective against the micro-organism in vitro. No portal of entry for the strain was detected. After treatment with vancomycin. also shown to be effective in vitro. no clinical improvement was noted and the patient died. Molecular studies showed that the same strain caused an episode of pseudobacteremia in another patient admitted to the same ICU room.

关键词：腺癌/并发症抗菌药/药理学抗菌药/治疗应用蜡状芽孢杆菌/药物作用蜡状芽孢杆菌/遗传学蜡状芽孢杆菌/分离和提纯菌血症/药物疗法菌血症/微生物学菌血症/传播交叉感染/微生物学交叉感染/传播 DNA指纹法 DNA 细菌/遗传学致命性结局亚胺培南/药理学亚胺培南/治疗应用重症监护病房肺肿瘤/并发症微生物敏感性试验噻烯霉素类/药理学噻烯霉素类/治疗应用万古霉素/药理学万古霉素/治疗应用女(雌)性人类中年人

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A medical clerk with chills, fever, and neck mass

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HOSPITAL PRACTICE 2000年第8期35卷 22-24页

作者： Arias, JR Sanders, S Adelman, HM Univ S Florida Coll Med Dept Med Tampa FL 33612 USA

A 36-year-old woman presented with a three-day history of sore throat, cough productive of blood-tinged mucus, shaking chills, and temperatures as high as 40.5 degrees C. After taking acetaminophen, she was well enough to go to work the next day but continued to have a sore throat and cough. Feeling increasingly weak and tired, she saw her family physician,who prescribed a five-day course of azithromycin in addition to the acetaminophen. The following day, she vomited four or five times. The vomitus was yellow, with no visible blood. Her neck glands were swollen, and swallowing was so painful that she could only tolerate clear liquids. She had no history of HIV risk factors, tuberculosis, rash, arthralgias, abdominal pain, diarrhea, or urinary symptoms. Her last menses occurred one week prior to admission.

关键词：抗菌药/治疗应用菌血症/并发症菌血症/诊断菌血症/药物疗法菌血症/微生物学克林霉素/治疗应用诊断鉴别梭杆菌感染/并发症梭杆菌感染/诊断梭杆菌感染/药物疗法梭杆菌感染/微生物学梭杆菌坏死颈静脉磁共振成像微生物敏感性试验咽炎/并发症咽炎/诊断咽炎/药物疗法咽炎/微生物学血栓性静脉炎/诊断血栓性静脉炎/微生物学成年人女(雌)性人类

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