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  Free Full Text References 19 Dec 2007

Free Full Text Article[Isolation of periodontal bacteria from blood samples and atheromas in patien...
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[Isolation of periodontal bacteria from blood samples and atheromas in patients with atherosclerosis and periodontitis.]

Rev Med Chil. 2007 Sep;135(9):1118-1124

Authors: Padilla E C, Lobos G O, Jure 0 G, Matus F S, Descouvieres C C, Hasbún A S, Maragaño L P, Núñez F L

Background: Periodontitis is a common oral disease produced by bacterial species that reside in the subgingival plaque. These microorganisms have been associated to atherosclerosis and it is suggested that periodontitis is a cardiovascular risk factor. Aim: To isolate periodontal bacteria from blood and atheroma samples, from patients with atherosclerosis and periodontitis. Material and methods: Twelve patients with periodontitis and a clinical diagnosis of atherosclerosis and 12 patients with periodontitis but without atherosclerosis were studied. Blood samples were obtained immediately before and after scaling and root planing. The samples were incubated in aerobic and anaerobic conditions. One week after scaling, atheromatous plaques were obtained during endarterectomy in the 12 patients with atherosclerosis. These were homogenized and cultured for aerobic and anaerobic bacteria. Microorganisms were identified by means ofPCR. Results: Five patients with and two without atherosclerosis, had bacteremia after scaling and root planing. Bacterial species isolated from blood samples were the same found in periodontic pockets. Four atheromatous plaques of patients with bacteremia yielded positive cultures. The isolated bacteria were the same found in blood samples and periodontal pockets. Conclusions: Bacteremia occurred in seven of 24 patients after scaling and root planing. In four patients, the same species found in periodontic pockets and blood cultures were detected in atherosclerotic plaques obtained one week after the dental procedure.

PMID: 18064365 [PubMed - as supplied by publisher]

Free Full Text Article[Bacteremia in very elderly patients: risk factors, clinical characteristics ...
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[Bacteremia in very elderly patients: risk factors, clinical characteristics and mortality.]

Enferm Infecc Microbiol Clin. 2007 Dec;25(10):612-8

Authors: Payeras A, García-Gasalla M, Garau M, Juan I Roca M, Pareja A, Cifuentes C, Homar F, Gallegos C, Bassa A

INTRODUCTION: There is little information on bacteremia in very elderly patients. This study describes the characteristics of bacteremia in this population. METHODS: This is a prospective study investigating bacteremia episodes in patients over 80 years old in comparison with episodes in patients aged 18-64 and 65-79 years. RESULTS: A total of 146 bacteremia episodes were analyzed in patients over 80 years old. Comorbidity was documented in 66.4% and immunodeficiency in 6.8% of patients. Among the total, 82.2% had no underlying disease or a disease considered non-fatal. Eighty episodes were community-acquired. The main infectious foci included primary (25.3%) and urinary tract (20.5%) infection, and the most frequent isolates were Escherichia coli (28.2%), coagulase-negative Staphylococcus (14.7%) and S. aureus (13.6%). Sepsis or septic shock occurred in 55.5% of the cases, and 31 patients died due to a bacteremia-related cause. Immunodeficiency was less frequent in patients over 80 years old, but they had a higher proportion of community-acquired infections and gram-negative infections. Bacteremia-related mortality was highest in the oldest group of patients and was associated with a fatal or ultimately fatal underlying disease, S. aureus infection, and inappropriate empirical antibiotic treatment. A lower Pitt severity score was related to lower mortality risk. CONCLUSIONS: Very elderly bacteremic patients showed a lower frequency of immunodeficiency, a higher percentage of community-acquired and gram-negative infections. Bacteremia-related mortality was greater in the most elderly group and was associated with fatal or ultimately fatal underlying disease, S. aureus infection and initiation of inappropriate empirical antibiotic treatment.

PMID: 18053471 [PubMed - in process]

Free Full Text ArticleMicrobiological effects of prior vancomycin use in patients with methicillin-...
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Microbiological effects of prior vancomycin use in patients with methicillin-resistant Staphylococcus aureus bacteraemia.

J Antimicrob Chemother. 2008 Jan;61(1):85-90

Authors: Moise PA, Smyth DS, El-Fawal N, Robinson DA, Holden PN, Forrest A, Sakoulas G

Background We sought to determine whether prior vancomycin use (within 30 days) in patients who develop methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with isolates of reduced vancomycin susceptibility and killing in vitro. Methods Thirty-eight MRSA from previously vancomycin-treated patients and 43 MRSA from vancomycin-naive patients were evaluated by vancomycin and daptomycin CLSI broth microdilution and killing assays. PCR was used to determine accessory gene regulator (agr) type and staphylococcal cassette chromosome mec (SCCmec) type, and nucleotide sequencing was used to determine spa type. Results Vancomycin MICs were 0.5, 1.0 and 2.0 mg/L for 19, 55 and 7 isolates, respectively. Daptomycin MICs were 0.25, 0.5, 1.0 and 2.0 mg/L for 4, 50, 26 and 1 isolate, respectively. The agr-type distribution was agr group II (59%), group I (25%) and group III (16%); 90% harboured SCCmec II. The genetic background extrapolated by spa-typing showed that 58% of the isolates were of clonal complex 5. MRSA bloodstream isolates from patients who had received vancomycin within the preceding 30 days had a significantly decreased vancomycin killing at 24 h in vitro (median log(10) decrease, 3.1 versus 2.2 cfu/mL; P = 0.021) and a significantly higher vancomycin MIC than isolates obtained from patients without that history (P = 0.002). Conclusions MRSA bloodstream isolates from patients recently treated with vancomycin may demonstrate reduced susceptibility and increased tolerance to vancomycin in vitro. Given that such microbiological phenotypes have been associated with reduced vancomycin efficacy, consideration may be given to alternative Gram-positive antimicrobial therapy in patients who have recently been treated with vancomycin.

PMID: 18042628 [PubMed - in process]

Free Full Text ArticleBrucella bacteremia in patients with acute leukemia: a case series.
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Brucella bacteremia in patients with acute leukemia: a case series.

J Med Case Reports. 2007 Nov 23;1(1):144

Authors: Al-Anazi KA, Al-Jasser AM

ABSTRACT: BACKGROUND: Brucellosis may cause serious infections in healthy individuals living in countries that are endemic for the infection. However, reports of brucella infections in immunocompromised hosts are relatively rare. Case Presentations: Reported here are two patients with acute leukemia who developed Brucella melitensis bacteremia during their follow up at the Armed Forces Hospital in Riyadh. The first patient developed B. melitensis bacteremia during the transformation of his myelodysplasia into acute myeloid leukemia. The second patient developed B. melitensis bacteremia while his acute lymphoblastic leukemia was under control. Interestingly, he presented with acute cholecystitis during the brucella sepsis. Both brucella infections were associated with a marked reduction in the hematological parameters in addition to other complications. The bacteremic episodes were successfully treated with netilmicin, doxycycline and ciprofloxacin. CONCLUSION: Brucellosis can cause systemic infections, complicated bacteremia and serious morbidity in patients with acute leukemia living in endemic areas. These infections may occur at the presentation of the leukemia or even when the leukemia is in remission. Nevertheless, the early diagnosis of brucellosis and the administration of appropriate antimicrobial therapy for sufficient duration usually improves the outcome in these immunocompromised patients.

PMID: 18036218 [PubMed - as supplied by publisher]

Free Full Text ArticleAeromonas sobria Prostatitis and Septic Shock in a Healthy Man with Chronic A...
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Aeromonas sobria Prostatitis and Septic Shock in a Healthy Man with Chronic Alcoholic Consumption.

Jpn J Infect Dis. 2007 Nov;60(6):400-1

Authors: Huang HC, Yu WL, Huan KH, Cheng KC, Chuang YC

Prostate infection caused by Aeromonas sobria has not been reported in the literature. We presented a 44-year-old healthy man with a habit of alcoholic consumption who was admitted because of primary A. sobria prostatitis with septicemia. The patient was successfully treated with intravenous ofloxacin and was uneventful after a half-year follow-up. Based on our rare case, we suggest to clinical physicians that prostatitis might be considered in healthy male patients with A. sobria bacteremia and a vague primary infection focus.

PMID: 18032845 [PubMed - in process]

Free Full Text ArticleNosocomial Outbreak of Sphingomonas paucimobilis Bacteremia in a Hemato/Oncol...
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Nosocomial Outbreak of Sphingomonas paucimobilis Bacteremia in a Hemato/Oncology Unit.

Jpn J Infect Dis. 2007 Nov;60(6):394-6

Authors: Kilic A, Senses Z, Kurekci AE, Aydogan H, Sener K, Kismet E, Basustaoglu AC

Nosocomial Sphingomonas paucimobilis infections can arise from contaminated water and the contaminated hands of hospital staff. Within a 1-month period, we isolated six S. paucimobilis strains, including four from blood cultures of four patients and two from hospital environment specimens including tap water and a bathtub in a hemato/oncology unit. We described here these strains' molecular epidemiological analyses by pulsed-field gel electrophoresis (PFGE) and antibiotic susceptibilities by E-test. Although clinical and environmental isolates yielded three different antibiotic resistances and PFGE patterns, all four clinical strains had an identical pattern by both methods. Thus, the isolated clinical strain clone could be traced neither to health care workers nor to environmental samples. It was concluded that S. paucimobilis strains can cause outbreaks in hemato/oncology units. We did not demonstrate genetic relatedness between clinical and environmental isolates by PFGE, but did find PFGE a useful identification technique for epidemiological investigation.

PMID: 18032843 [PubMed - in process]

Free Full Text ArticleCluster of Staphylococcus aureus and dengue co-infection in Singapore.
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Cluster of Staphylococcus aureus and dengue co-infection in Singapore.

Ann Acad Med Singapore. 2007 Oct;36(10):847-50

Authors: Chai LY, Lim PL, Lee CC, Hsu LY, Teoh YL, Lye DC, Krishnan P, Leo YS

INTRODUCTION: Singapore saw a resurgence of dengue infections in 2005. Concurrent bacterial co-infections in dengue is rare. CLINICAL PICTURE: We report a cluster of serious methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia or severe soft tissue infection in 5 epidemiologically linked construction workers presenting with dengue and non-resolving fever. Treatment: Surgical intervention was indicated in 4 of the 5 patients despite appropriate antistaphylococcal therapy. OUTCOME: All but 1 patient were eventually discharged. Clonality and Panton-Valentine leucocidin genes were not demonstrated. Epidemiological investigations suggested that occupational contact dermatitis could have predisposed the patients to this opportunistic co-infection. CONCLUSION: Clinicians need to be vigilant to unusual manifestations of dengue which may signal a concomitant aetiology.

PMID: 17987236 [PubMed - in process]

Free Full Text ArticleImpact of reduced vancomycin susceptibility on the therapeutic outcome of MRS...
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Impact of reduced vancomycin susceptibility on the therapeutic outcome of MRSA bloodstream infections.

Ann Clin Microbiol Antimicrob. 2007 Oct 30;6(1):13

Authors: Neoh HM, Hori S, Komatsu M, Oguri T, Takeuchi F, Cui L, Hiramatsu K

ABSTRACT: BACKGROUND: The aim of this study was to determine whether clinical outcome of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia was correlated with vancomycin susceptibility of the corresponding strains. METHODS: A retrospective study on MRSA bacteraemia was performed at a teaching hospital between January 1998 and October 2005 by linking vancomycin susceptibility profiles of patients' isolates with hospitalization data. RESULTS: A total of 20 out of 209 MRSA bacteraemia patients were treated with vancomycin for at least 5 days with adequate trough levels, and fulfilled the study's inclusion and exclusion criteria. Twenty-two S. aureus isolates from these patients' blood cultures were identified as MRSA, including two hetero-VISA from separate patients and two VISA with vancomycin MIC of 4 mg/L from one patient. Between patients who showed 'good' vancomycin response and patients who did not, there was a significant difference (p < 0.01) in their corresponding MRSAs' vancomycin susceptibility expressed by 'area under curve' (AUC) of population analysis. Significant correlations were found between AUC and initial vancomycin therapeutic response parameters of 'days till afebrile' (r = 0.828, p < 0.01) and 'days till CRP <= 30% of maximum' (r = 0.627, p < 0.01) CONCLUSIONS: Our study results caution healthcare personnel that early consideration should be given to cases with a poor vancomycin treatment response that could signify the involvement of MRSA with reduced susceptibility to vancomycin.

PMID: 17967199 [PubMed - as supplied by publisher]

Free Full Text ArticleSpondylodiscitis associated with recurrent Serratia bacteremia due to a trans...
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Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report.

Braz J Infect Dis. 2007 Oct;11(5):525-7

Authors: Marques N, S&#xE1; R, Coelho F, Cunha S, Meliço-Silvestre A

We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection.

PMID: 17962882 [PubMed - in process]

Free Full Text ArticlePediatric mortality due to nosocomial infection: a critical approach.
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Pediatric mortality due to nosocomial infection: a critical approach.

Braz J Infect Dis. 2007 Oct;11(5):515-9

Authors: Lopes JM, Goulart EM, Starling CE

Nosocomial infection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomial infection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomial infection and mortality and pediatrics/neonate/ newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomial infection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE) II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomial infection can be reduced and health care quality improved in pediatric hospitals.

PMID: 17962879 [PubMed - in process]

Free Full Text ArticleInfections after liver transplantation in adults: data from a university hosp...
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Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000).

Arq Gastroenterol. 2007 Apr-Jun;44(2):128-32

Authors: de Souza MV, Barth AL, Alvares-da-Silva MR, Machado AR

BACKGROUND: Infections after liver transplantations are the most important cause of morbi-mortality. In this study, we assessed the main characteristics of these infections in a southern Brazilian university hospital. METHODS: We conducted a retrospective cohort with 55 patients who underwent orthotopic liver transplantation between 1996 and 2000 in the "Hospital de Cl&#xED;nicas de Porto Alegre", Porto Alegre, RS, Brazil, to characterize the infections that occurred in the group. RESULTS: One or more infections (average 2.10) were diagnosed in 47 patients, especially during the first month after transplantation. The most common were bacteremia, intra-abdominal infections and pneumonia, predominantly with bacteria, especially Staphylococcus sp (and particularly S. aureus) and E. coli. The mortality rate attributed to infections was high: 17 cases of all deaths (total 27 deaths). Significant risk factors for infections included reoperation, diabetes, biliary stenosis and higher Child-Pugh scores. CONCLUSION: Infections remain a severe threat in liver transplant patients, and special efforts should be made to prevent and manage them correctly.

PMID: 17962857 [PubMed - in process]

Free Full Text ArticleA New Method to Extract Dental Pulp DNA: Application to Universal Detection o...
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A New Method to Extract Dental Pulp DNA: Application to Universal Detection of Bacteria.

PLoS ONE. 2007;2(10):e1062

Authors: Tran-Hung L, Tran-Thi N, Aboudharam G, Raoult D, Drancourt M

BACKGROUND: Dental pulp is used for PCR-based detection of DNA derived from host and bacteremic microorganims. Current protocols require odontology expertise for proper recovery of the dental pulp. Dental pulp specimen exposed to laboratory environment yields contaminants detected using universal 16S rDNA-based detection of bacteria. METHODOLOGY/PRINCIPAL FINDINGS: We developed a new protocol by encasing decontaminated tooth into sterile resin, extracting DNA into the dental pulp chamber itself and decontaminating PCR reagents by filtration and double restriction enzyme digestion. Application to 16S rDNA-based detection of bacteria in 144 teeth collected in 86 healthy people yielded a unique sequence in only 14 teeth (9.7%) from 12 individuals (14%). Each individual yielded a unique 16S rDNA sequence in 1-2 teeth per individual. Negative controls remained negative. Bacterial identifications were all confirmed by amplification and sequencing of specific rpoB sequence. CONCLUSIONS/SIGNIFICANCE: The new protocol prevented laboratory contamination of the dental pulp. It allowed the detection of bacteria responsible for dental pulp colonization from blood and periodontal tissue. Only 10% such samples contained 16S rDNA. It provides a new tool for the retrospective diagnostic of bacteremia by allowing the universal detection of bacterial DNA in animal and human, contemporary or ancient tooth. It could be further applied to identification of host DNA in forensic medicine and anthropology.

PMID: 17957246 [PubMed - in process]

Free Full Text ArticleClinical significance of potential contaminants in blood cultures among patie...
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Clinical significance of potential contaminants in blood cultures among patients in a medical center.

J Microbiol Immunol Infect. 2007 Oct;40(5):438-44

Authors: Lee CC, Lin WJ, Shih HI, Wu CJ, Chen PL, Lee HC, Lee NY, Chang CM, Wang LR, Ko WC

BACKGROUND AND PURPOSE: Blood culture is important for the diagnosis of sepsis, but it is sometimes difficult to differentiate true bacteremia from pseudobacteremia. This study proposed clinical criteria and evaluated the role of repeat blood cultures in assessing the clinical significance of potential contaminants in blood cultures (PCBCs). METHODS: From February to May in 2004 (prospective study) and 2003 (retrospective study), adult patients with growth of coagulase-negative staphylococci, Bacillus spp., Micrococcus spp., Propionibacterium spp., Gram-positive bacilli, or Clostridium perfringens, collectively referred to as "PCBCs", in at least 1 set of blood cultures in a medical center were included. The demographic and clinical data of patients with PCBCs were collected, and proposed clinical criteria for true bloodstream infections were used to evaluate their clinical outcome. Also, the potential role of repeating blood cultures to differentiate true bacteremia from pseudobacteremia was evaluated. RESULTS: There were 212 cases with 214 PCBCs, of which coagulase-negative staphylococci predominated (182 isolates, 85.0%). The overall contamination rate was 83.9% (178/212). Repeating 2 sets of blood cultures might be useful in the clinical differentiation of true bacteremia and pseudobacteremia, since the contamination rate of patients with potential contaminants in 1 set of blood cultures declined from 95% to 87% (p=0.04) with such a strategy. Those with true bloodstream infections had a significantly higher all-cause mortality rate at 14 days than those with pseudobacteremia (23.8% vs 7.3%, p=0.028), suggesting the validity of the clinical criteria. Of the 178 cases with pseudobacteremia, 73 (41.0%) were unnecessarily treated by systemic antibiotics, of which glycopeptides accounted for 20.0%. For these cases, antimicrobial therapy offered no survival benefit. CONCLUSIONS: In an era of increasing glycopeptide resistance among Gram-positive cocci, clinical strategies for the early diagnosis of pseudobacteremia in cases with PCBCs are urgently required, in order to avoid the unnecessary use of glycopeptides. The proposed criteria and repeat blood culturing seem to be useful in the assessment of the clinical significance of PCBCs, and for reduction of the inappropriate use of glycopeptides.

PMID: 17932605 [PubMed - in process]

Free Full Text ArticleEtiology of blood culture isolates among patients in a multidisciplinary teac...
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Etiology of blood culture isolates among patients in a multidisciplinary teaching hospital in Kuala Lumpur.

J Microbiol Immunol Infect. 2007 Oct;40(5):432-7

Authors: Karunakaran R, Raja NS, Ng KP, Navaratnam P

BACKGROUND AND PURPOSE: Bloodstream infections are an important cause of morbidity and mortality among hospitalized patients and the surveillance of etiological agents in these infections is important for their prevention and treatment. Data on common organisms isolated from blood cultures from Malaysia are limited, and our aim was to identify the common bloodstream isolates in hospitalized patients at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. METHODS: A retrospective analysis was conducted over a 1-year period from January to December 2004 by reviewing laboratory reports of patients from the UMMC. The clinical significance of the isolates was not analyzed. RESULTS: Coagulase-negative staphylococci were the most common organisms isolated, accounting for 33.0% of the total blood culture isolates, followed by Staphylococcus aureus (10.4%) and Escherichia coli (9.7%). The incidence of methicillin-resistant S. aureus, and extended-spectrum beta-lactamase-producing E. coli and Klebsiella spp. bacteremia was low (2.3% and 1.8% of total isolates, respectively). Non-albicans Candida were the most common fungal isolates. CONCLUSIONS: The high number of coagulase-negative staphylococci should motivate clinicians and microbiologists to re-examine blood culture techniques in our institution. We recommend that further studies be carried out to establish the true significance of this organism among blood culture isolates.

PMID: 17932604 [PubMed - in process]

Free Full Text ArticlePulmonary endarteritis and subsequent pulmonary embolism associated with clin...
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Pulmonary endarteritis and subsequent pulmonary embolism associated with clinically silent patent ductus arteriosus.

Intern Med. 2007;46(19):1663-7

Authors: Onji K, Matsuura W

A 49-year-old man without heart murmur was admitted with fever because of bacteremia following a tooth extraction. Antibiotics rapidly alleviated the fever; however, a small nodule in the pulmonary artery was identified on computed tomography (CT). When the patient experienced chest discomfort with fever, CT demonstrated the absence of the nodule and the appearance of an abnormal lung opacity, and echocardiography showed turbulent retrograde flow in the pulmonary artery. We had the rare opportunity to follow a case of pulmonary bacterial endarteritis and subsequent pulmonary embolism with clinically silent patent ductus arteriosus (PDA) that was confirmed by 3-dimensional CT.

PMID: 17917330 [PubMed - indexed for MEDLINE]

Free Full Text Article[An analysis of 182 enterococcal bloodstream infections: epidemiology, microb...
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[An analysis of 182 enterococcal bloodstream infections: epidemiology, microbiology, and outcome]

Enferm Infecc Microbiol Clin. 2007 Oct;25(8):503-7

Authors: Mart&#xED;nez-Odriozola P, Muñoz-Sánchez J, Gutiérrez-Macías A, Arriola-Martínez P, Montero-Aparicio E, Ezpeleta-Baquedano C, Cisterna-Cáncer R, Miguel de la Villa F

INTRODUCTION: Enterococcal bloodstream infections have acquired considerable importance in recent years, mainly because of the increasing number of cases that occur during hospital admission. METHODS: Retrospective study of the clinical records of patients diagnosed with enterococcal bacteremia and hospitalized over a 12-year period (January 1994-April 2006), analyzing epidemiological, clinical and microbiological characteristics, outcome and prognostic factors. RESULTS: A total of 182 episodes of bacteremia were recorded; 68% of them were nosocomial infections, accounting for 5% of the in-hospital bacteremia episodes in this period. The most frequent sources of infection were urinary tract (29%), cardiovascular (25%), intra-abdominal (21%) and primary bacteremia (12%). Associated comorbid conditions were present in 85% of patients, mainly neoplasms (33%). Enterococcus faecalis was responsible for 70% of cases, E. faecium 22%, and other species of enterococci 8%. Twenty percent were polymicrobial bacteremia. Antibiotic resistance was documented in 23% of the strains: 14% ampicillin, 8% gentamicin, 3% ampicillin and gentamicin, and 0.5% vancomycin. Overall mortality was 31%. Polymicrobial bacteremia and comorbidity were associated with a poor prognosis. CONCLUSION: In our hospital, Enterococcus is the fifth most frequent cause of nosocomial bacteremia. E. faecium is characterized by a high incidence (more than 50% of cases) of ampicillin resistance.

PMID: 17915108 [PubMed - in process]

Free Full Text ArticleNosocomial infections after off-pump coronary artery bypass surgery: frequenc...
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Nosocomial infections after off-pump coronary artery bypass surgery: frequency, characteristics, and risk factors.

Interact Cardiovasc Thorac Surg. 2007 Dec;6(6):759-67

Authors: Rosmarakis ES, Prapas SN, Rellos K, Michalopoulos A, Samonis G, Falagas ME

We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004-October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1-3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P<0.05) in patients with infection. Independent risk factors of infection (P<0.05) were history of major nervous system disorder, left ventricular heart failure preoperatively, emergent operation, transfusions of red blood cells during ICU stay, and duration of central venous catheter placement. The identification of risk factors for infection in combination with the appropriate evaluation of the increased CRP and procalcitonin values may help clinicians for the early diagnosis of infection after OPCABG.

PMID: 17905781 [PubMed - in process]

Free Full Text ArticleBlood cultures in paediatric patients: a study of clinical impact.
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Blood cultures in paediatric patients: a study of clinical impact.

Indian J Med Microbiol. 2007 Jul;25(3):220-4

Authors: Murty DS, Gyaneshwari M

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

PMID: 17901638 [PubMed - in process]

Free Full Text Article[Urinary infection by E. coli complicated with multiple abscesses]
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[Urinary infection by E. coli complicated with multiple abscesses]

An Sist Sanit Navar. 2007 May-Aug;30(2):293-6

Authors: Fern&#xE1;ndez V, Anniccherico FJ, Alonso JL, Gutiérrez J, Lasa B

Vertebral osteomyelitis and septic arthritis are pathologies that principally affect people over fifty years old, but their incidence seems to be growing due to the increase of nosocomial bacteraemia associated with intravascular devices and the aging of hospitalised people. The majority of cases are produced by Staphylococcus aureus. We present the case and diagnostic process of a patient with vertebral osteomyelitis caused by another organism, Escherichia coli, with fatal evolution despite adequate treatment.

PMID: 17898824 [PubMed - in process]

Free Full Text ArticleAntibiotics protect against septic shock in mice administered beta-glucan and...
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Antibiotics protect against septic shock in mice administered beta-glucan and indomethacin.

Microbiol Immunol. 2007;51(9):851-9

Authors: Nameda S, Miura NN, Adachi Y, Ohno N

We have developed an animal model of sepsis in mice by repeatedly administering beta-glucan, a biological response modifier, and indomethacin (IND), a nonsteroidal anti-inflammatory drug. The combination of these drugs induced bacteremia by translocation of the enterobacterial flora, resulting in increasing the number of activated leukocytes, and inducing hyper cytokinemia. In the present study, we examined the effect of antibiotics on beta-glucan and IND-induced septic shock. Treatment with antibiotics inhibited microbial translocation, inhibited contraction of the colon, reduced lipopolysaccharides (LPS)-elicited production of TNF-alpha and IL-6, and finally prolonged survival. However, the efficacy of antibiotics treatment was limited in mice administered IND orally. These findings strongly suggested that the antibiotics controlled the gut-associated action of IND and reduced various symptoms accompanying sepsis.

PMID: 17895602 [PubMed - in process]

Free Full Text ArticleCommon TNF-alpha, IL-1 beta, PAI-1, uPA, CD14 and TLR4 polymorphisms are not ...
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Common TNF-alpha, IL-1 beta, PAI-1, uPA, CD14 and TLR4 polymorphisms are not associated with disease severity or outcome from Gram negative sepsis.

BMC Infect Dis. 2007;7:108

Authors: Jessen KM, Lindboe SB, Petersen AL, Eugen-Olsen J, Benfield T

BACKGROUND: Several studies have investigated single nucleotide polymorphisms (SNPs) in candidate genes associated with sepsis and septic shock with conflicting results. Only few studies have combined the analysis of multiple SNPs in the same population. METHODS: Clinical data and DNA from consecutive adult patients with culture proven Gram negative bacteremia admitted to a Danish hospital between 2000 and 2002. Analysis for commonly described SNPs of tumor necrosis-alpha, (TNF-alpha), interleukin-1 beta (IL-1 beta), plasminogen activator-1 (PAI-1), urokinase plasminogen activator (uPA), CD14 and toll-like receptor 4 (TLR4) was done. RESULTS: Of 319 adults, 74% had sepsis, 19% had severe sepsis and 7% were in septic shock. No correlation between severity or outcome of sepsis was observed for the analyzed SNPs of TNF-alpha, IL-1 beta, PAI-1, uPA, CD14 or TLR-4. In multivariate Cox proportional hazard regression analysis, increasing age, polymicrobial infection and haemoglobin levels were associated with in-hospital mortality. CONCLUSION: We did not find any association between TNF-alpha, IL-1 beta, PAI-1, uPA, CD14 and TLR4 polymorphisms and outcome of Gram negative sepsis. Other host factors appear to be more important than the genotypes studied here in determining the severity and outcome of Gram negative sepsis.

PMID: 17877801 [PubMed - indexed for MEDLINE]

Free Full Text ArticleSepsis by Chromobacterium violaceum: first case report from Colombia.
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Sepsis by Chromobacterium violaceum: first case report from Colombia.

Braz J Infect Dis. 2007 Aug;11(4):441-2

Authors: D&#xED;az Pérez JA, García J, Rodriguez Villamizar LA

Chromobacterium violaceum is found in tropical and subtropical regions; it is the only Chromobacterium species pathogenic for humans. Due to its rare presentation, physicians often ignore the importance of this pathogen. We report a fulminant fatal case of bacteremia in a 38-year-old Colombian man. The clinical manifestations were fever, thoracic pain, respiratory failure and death. His condition, from the beginning of clinical diagnosis, went into continuous deterioration, till his death, within a few days after the symptoms began. Two hemocultures isolated C. violaceum. We conclude that doctors should consider this differential diagnosis in patients with systemic inflammatory response syndrome, with continuous deterioration.

PMID: 17874003 [PubMed - in process]

Free Full Text ArticleDynamics of C-reactive protein and white blood cell count in critically ill p...
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Dynamics of C-reactive protein and white blood cell count in critically ill patients with nosocomial Gram positive vs. Gram negative bacteremia: a historical cohort study.

BMC Infect Dis. 2007;7:106

Authors: Vandijck DM, Hoste EA, Blot SI, Depuydt PO, Peleman RA, Decruyenaere JM

BACKGROUND: Nosocomial bacteremia is associated with a poor prognosis. Early adequate therapy has been shown to improve outcome. Consequently, rapid detection of a beginning sepsis is therefore of the utmost importance. This historical cohort study was designed to evaluate if different patterns can be observed in either C-reactive protein (CRP) and white blood cell count (WCC) between Gram positive bacteremia (GPB) vs. Gram negative bacteremia (GNB), and to assess the potential benefit of serial measurements of both biomarkers in terms of early antimicrobial therapy initiation. METHODS: A historical study (2003-2004) was conducted, including all adult intensive care unit patients with a nosocomial bacteremia. CRP and WCC count measurements were recorded daily from two days prior (d(-2)) until one day after onset of bacteremia (d(+1)). Delta (Delta) CRP and Delta WCC levels from the level at d-2 onward were calculated. RESULTS: CRP levels and WCC counts were substantially higher in patients with GNB. Logistic regression analysis demonstrated that GNB and Acute Physiology and Chronic Health Evaluation (APACHE) II score were independently associated with a CRP increase of 5 mg/dL from d-2 to d+1, and both were also independently associated with an increase of WCC levels from d(-2) to d(+1) of 5,000 x 10(3) cells/mm3. CONCLUSION: Increased levels of CRP and WCC are suggestive for GNB, while almost unchanged CRP and WCC levels are observed in patients with GPB. However, despite the different patterns observed, antimicrobial treatment as such cannot be guided based on both biomarkers.

PMID: 17868441 [PubMed - indexed for MEDLINE]

Free Full Text Article[Impact of infectious diseases specialist evaluation on the rational use of a...
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[Impact of infectious diseases specialist evaluation on the rational use of antibiotics in patients with Streptococcus pneumoniae bacteremia]

Rev Chilena Infectol. 2007 Aug;24(4):264-9

Authors: Mella M S, Blarney D R, Palva M O, Y&#xE1;ñez V J, Rledel M G, Aylwin R M, Chabouty G H, Ortega R C

The increasing reporting of Streptococcus pneumoniae resistance to penicillin has lead to the recommendation of third generation cephalospirins for the treatment of serious pneumococcal infections. As a consequence, clinicians usually do not prescribe first line antibiotics despiste the availability of susceptibility studies. Whit the aim to evaluate the impact of the infectious diseases specialist evaluation in the apropriate use oh the susceptibility studies, two series were compared: a historic control one (1998-2002, n = 50) and a prospectuve group that had the advisement of one infectious diseases specialist (2003-2006, n = 60). In both series, pneumonia stood out as the source of the bacteremia, and -alcoholism/hepatic insufficiency as associated factor. In the first series, 48 isolates resulted susceptible to penicillin by agar diffusion, and 1 out of 36 patients with pneumonia had a change in the antibiotic therapy to penicillin. In the prospective series, we found 56 susceptible isolates, and the remaining four were classified as intermediate susceptibility according to the MIC value. Antibiotics were changed in 36 out of 50 patients with bacteremic pneumococcal pneumonia (p < 0.05). The infectious diseases specialist evaluation had a positive impact on the use of the microbiological information for therapeutics purposes.

PMID: 17728912 [PubMed - in process]

Free Full Text ArticleCommunity-acquired versus nosocomial Klebsiella pneumonia bacteremia: clinica...
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Community-acquired versus nosocomial Klebsiella pneumonia bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance.

J Korean Med Sci. 2007 Aug;22(4):770-1

Authors: Vandijck DM, Decruyenaere JM, Depuydt PO, Blot SI

PMID: 17728528 [PubMed - in process]

Free Full Text ArticleAnalysis of methicillin resistance among Staphylococcus aureus blood isolates...
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Analysis of methicillin resistance among Staphylococcus aureus blood isolates in an emergency department.

J Korean Med Sci. 2007 Aug;22(4):682-6

Authors: Heo ST, Peck KR, Ryu SY, Kwon KT, Ko KS, Oh WS, Lee NY, Song JH

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has become of great concern in both hospital and community settings. To evaluate the prevalence and risk factors for methicillin resistance among Staphylococcus aureus, blood isolates in our Emergency Department (ED) were collected. All patients with S. aureus bacteremia (SAB) who presented to the ED from January 2000 to August 2005 were included, and a retrospective study was performed. A total of 231 patients with SAB were enrolled (median age, 59 yr; M:F, 125:106). Among these patients, methicillin-resistant strains accounted for 27.3% (63 patients). Catheter-related infection was the most frequent primary site of SAB (39.0%), followed by skin and soft tissue infection (16.5%). In multivariate analysis, recent surgery (OR, 3.41; 95% CI, 1.48-7.85), recent hospitalization (2.17; 1.06-4.62), and older age (> or =61 yr) (2.39; 1.25-4.57) were independently associated with the acquisition of methicillin-resistant strains. When antimicrobial therapy is considered for the treatment of a patient with suspected SAB, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage for patients with risk factors: older age, recent hospitalization, and recent surgery.

PMID: 17728510 [PubMed - in process]

Free Full Text ArticleDefining childhood severe falciparum malaria for intervention studies.
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Defining childhood severe falciparum malaria for intervention studies.

PLoS Med. 2007 Aug 21;4(8):e251

Authors: Bejon P, Berkley JA, Mwangi T, Ogada E, Mwangi I, Maitland K, Williams T, Scott JA, English M, Lowe BS, Peshu N, Newton CR, Marsh K

BACKGROUND: Clinical trials of interventions designed to prevent severe falciparum malaria in children require a clear endpoint. The internationally accepted definition of severe malaria is sensitive, and appropriate for clinical purposes. However, this definition includes individuals with severe nonmalarial disease and coincident parasitaemia, so may lack specificity in vaccine trials. Although there is no "gold standard" individual test for severe malaria, malaria-attributable fractions (MAFs) can be estimated among groups of children using a logistic model, which we use to test the suitability of various case definitions as trial endpoints. METHODS AND FINDINGS: A total of 4,583 blood samples were taken from well children in cross-sectional surveys and from 1,361 children admitted to a Kenyan District hospital with severe disease. Among children under 2 y old with severe disease and over 2,500 parasites per microliter of blood, the MAFs were above 85% in moderate- and low-transmission areas, but only 61% in a high-transmission area. HIV and malnutrition were not associated with reduced MAFs, but gastroenteritis with severe dehydration (defined by reduced skin turgor), lower respiratory tract infection (clinician's final diagnosis), meningitis (on cerebrospinal fluid [CSF] examination), and bacteraemia were associated with reduced MAFs. The overall MAF was 85% (95% confidence interval [CI] 83.8%-86.1%) without excluding these conditions, 89% (95% CI 88.4%-90.2%) after exclusions, and 95% (95% CI 94.0%-95.5%) when a threshold of 2,500 parasites/mul was also applied. Applying a threshold and exclusion criteria reduced sensitivity to 80% (95% CI 77%-83%). CONCLUSIONS: The specificity of a case definition for severe malaria is improved by applying a parasite density threshold and by excluding children with meningitis, lower respiratory tract infection (clinician's diagnosis), bacteraemia, and gastroenteritis with severe dehydration, but not by excluding children with HIV or malnutrition.

PMID: 17713980 [PubMed - indexed for MEDLINE]

Free Full Text Article[Therapeutic approach to Staphylococcus aureus bacteremia]
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[Therapeutic approach to Staphylococcus aureus bacteremia]

Biomedica. 2007 Jun;27(2):294-307

Authors: Tibavizco D, Rodr&#xED;guez JY, Silva E, Cuervo SI, Cortés JA

Staphylococcus aureus is an important human pathogen, responsible for 11-33% of the bacteremias acquired in the hospital setting and nearly 50% of those acquired in the community at large. The epidemiology of S. aureus bacteremia is discussed, with an special emphasis on the situation in Colombia and the resistance mechanisms against the major drug groups used for the treatment. The clinical keys and laboratory support for the appropriate clinical approaches are presented together with the therapeutic strategies for the treatment of patients with S. aureus bacteremia.

PMID: 17713640 [PubMed - in process]

Free Full Text ArticleClinical features and complications of viridans streptococci bloodstream infe...
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Clinical features and complications of viridans streptococci bloodstream infection in pediatric hemato-oncology patients.

J Microbiol Immunol Infect. 2007 Aug;40(4):349-54

Authors: Huang WT, Chang LY, Hsueh PR, Lu CY, Shao PL, Huang FY, Lee PI, Chen CM, Lee CY, Huang LM

BACKGROUND AND PURPOSE: Viridans streptococci (VS) are part of the normal flora of humans, but are fast emerging as pathogens causing bacteremia in neutropenic patients. The clinical features, outcomes, and antibiotic susceptibilities of VS bloodstream infections in children with hemato-oncological diseases are reported in this study. METHODS: A retrospective chart review of pediatric patients (< or =18 years) diagnosed with VS infections between January 1998 and December 2004 was conducted at the National Taiwan University Hospital. RESULTS: Among the 26 episodes noted in 25 pediatric patients, the incidence rate of VS bacteremia was found to be significantly higher in pediatric patients with acute myeloid leukemia compared with other hemato-oncological conditions. Most of the patients had profound neutropenia related to chemotherapy for a median of 5 days on the day of positive blood culture. Eight of the 25 patients had undergone stem cell transplantations. Streptococcus mitis was the most common bloodstream isolate and only 12 (44%) of the 27 isolated strains of VS were penicillin-susceptible. Empirical antibiotic treatments were not effective in half of the episodes, but did not affect overall mortality. Isolated bacteremia (63%) and pneumonia (22%) were the two leading clinical presentations. Complications were recognized more frequently in patients with pneumonia. Hypotension and mechanical ventilation each developed in 8 patients (31%). The overall mortality rate was 23%. CONCLUSIONS: Penicillin non-susceptible VS infection has emerged as a threat in children with hemato-oncological diseases, especially those with acute myeloid leukemia. S. mitis is the most common spp. of VS causing bacteremia in children and is associated with serious complications. The development of pneumonia resulted in clinical complications and higher mortality. Empirical antibiotic treatments with activity against the infecting strains did not reduce the overall mortality rate in this study.

PMID: 17712470 [PubMed - in process]

Free Full Text ArticleEndocarditis: impact of methicillin-resistant Staphylococcus aureus in hemodi...
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Endocarditis: impact of methicillin-resistant Staphylococcus aureus in hemodialysis patients and community-acquired infection.

J Microbiol Immunol Infect. 2007 Aug;40(4):317-24

Authors: Kuo CB, Lin JC, Peng MY, Wang NC, Chang FY

BACKGROUND AND PURPOSE: Staphylococcus aureus endocarditis showed an increase in the 1990s compared to the 1980s. In order to characterize the clinical and laboratory features of S. aureus endocarditis, we retrospectively reviewed the medical charts of patients diagnosed with endocarditis in the 5-year-period between 2000 and 2005. METHODS: From August 2000 to August 2005, 22 patients with a definite diagnosis of infective endocarditis (IE) caused by S. aureus were reviewed. RESULTS: Of the 22 patients reviewed, 16 cases were caused by methicillin-resistant S. aureus (MRSA) while the causative agent in the other 6 cases was methicillin-susceptible S. aureus (MSSA). Patients with MRSA infections were more likely to show hospital-acquired infections, hemodialysis and ventilator dependence, septic shock, impaired initial renal function, persistent bacteremia, and a higher 3-month mortality rate. MSSA infections in patients were more likely to be community-acquired, and show intravenous drug use and longer days of fever prior to admission. Three patients with MRSA endocarditis, however, presented community-acquired infections. The mortality rate of MRSA endocarditis in hemodialysis patients was 90% (9/10). CONCLUSIONS: MRSA IE is more common than MSSA IE and is associated with a significantly poorer prognosis, especially in patients undergoing hemodialysis. Although most cases of MRSA IE are hospital acquired, we noticed 3 cases of community-acquired MRSA IE. As MRSA IE has been noticed in the community and hemodialysis patients in recent years, and is associated with higher mortalities, strategies for its prevention and management are warranted.

PMID: 17712466 [PubMed - in process]

Free Full Text ArticleMolecular epidemiology of community-acquired methicillin-resistant Staphyloco...
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Molecular epidemiology of community-acquired methicillin-resistant Staphylococcus aureus bacteremia in a teaching hospital.

J Microbiol Immunol Infect. 2007 Aug;40(4):310-6

Authors: Chi CY, Ho MW, Ho CM, Lin PC, Wang JH, Fung CP

BACKGROUND AND PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) is a key nosocomial pathogen globally. Community-acquired MRSA (CA-MRSA) infections have become a growing problem in recent years. The purpose of this 4-year retrospective study was to analyze the molecular epidemiology and susceptibility pattern of isolates from adults (> or =18 years of age) with CA-MRSA bacteremia in northern Taiwan. METHODS: Molecular epidemiology of CA-MRSA isolates was analyzed by pulsed-field gel electrophoresis. Antimicrobial susceptibility was tested by the disk diffusion method and the minimal inhibitory concentration was determined by Etest. RESULTS: Thirty eight patients with CA-MRSA bacteremia were enrolled. Thirty one CA-MRSA isolates were available for further molecular typing and susceptibility testing. A total of 13 distinct genotypes were identified and 48.4% (15/31) of the isolates were found to belong to genotype A. Genotype A CA-MRSA isolates were closely associated with the nosocomial strains. All CA-MRSA isolates were multidrug resistant (19.4% susceptible to clindamycin and 25.8% to trimethoprim-sulfamethoxazole) and consistent susceptibility was only observed to glycopeptides, rifampin, and linezolid. CONCLUSIONS: This study demonstrated that although CA-MRSA genotypes were heterogeneous, the predominant genotype that was circulating in our community was genotype A. Also, the multidrug resistance of CA-MRSA might be connected to the spreading of nosocomial strains in the community.

PMID: 17712465 [PubMed - in process]

Free Full Text ArticlePyogenic sacroiliitis and adult respiratory distress syndrome: a case report.
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Pyogenic sacroiliitis and adult respiratory distress syndrome: a case report.

J Orthop Surg (Hong Kong). 2007 Aug;15(2):226-9

Authors: Asavamongkolkul A, Keerasuntonpong A, Kuagoolwongse C

Staphylococcus aureus sacroiliitis is uncommon and may lead to bacteraemia, sepsis, and death if diagnosis and treatment are delayed. Its association with pulmonary symptoms has not been reported. We report a 36-year-old Thai woman who presented with a 4-day history of right buttock pain, aggravated by walking, which came on after having a traditional foot massage. She later developed adult respiratory distress syndrome. She was treated with open drainage, respiratory support, and antibiotics.

PMID: 17709867 [PubMed - in process]

Free Full Text ArticleListeria monocytogenes following orthotopic liver transplantation: central ne...
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Listeria monocytogenes following orthotopic liver transplantation: central nervous system involvement and review of the literature.

World J Gastroenterol. 2007 Aug 28;13(32):4391-3

Authors: Mizuno S, Zendejas IR, Reed AI, Kim RD, Howard RJ, Hemming AW, Schain DC, Soldevila-Pico C, Firpi RJ, Fujita S

Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals, including solid organ transplant recipients, but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy, and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous ampicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis, and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.

PMID: 17708617 [PubMed - indexed for MEDLINE]

Free Full Text ArticleComparison of infectious complications between incident hemodialysis and peri...
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Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients.

Clin J Am Soc Nephrol. 2006 Nov;1(6):1226-33

Authors: Aslam N, Bernardini J, Fried L, Burr R, Piraino B

The impact of dialysis modality on infection, especially early in the course of dialysis, has not been well studied. This study compared infection between hemodialysis (HD) and peritoneal dialysis (PD) from the start of dialysis and evaluated factors that have an impact on infection risk. In this observational cohort study, all incident dialysis patients (n = 181; HD 119 and PD 62) at a single center from 1999 to 2005 had data collected prospectively beginning day 1 of dialysis. Excluded were those with any previous ESRD therapy. Infection rates were evaluated using multivariate Poisson regression. Overall infection rates were similar (HD 0.77 versus PD 0.86/yr; P = 0.24). Only HD patients had bacteremia (0.16/yr), and only PD patients had peritonitis (0.24/yr). Bacteremia that occurred < or =90 d after start of HD was 0.44/yr, increased compared with overall rate of 0.16/yr (P < 0.004). HD catheters, used in 67% of patients who started HD, were associated with a strikingly increased rate of bacteremia. Peritonitis < or =90 d was 0.22/yr, no different from the overall rate. Modality was not an independent predictor of overall infections (PD versus HD: relative risk 1.30; 95% confidence interval 0.93 to 1.8; P = 0.12) using multivariate analysis. PD and HD patients had similar infection rates overall, but type of infection and risk over time varied. HD patients had an especially high risk for bacteremia in the first 90 d, whereas the risk for peritonitis for the PD cohort was not different over time. These results support the placement of permanent accesses (fistula or PD catheter) before the start of dialysis to avoid use of HD catheters.

PMID: 17699352 [PubMed - indexed for MEDLINE]

Free Full Text ArticleUpregulation of renal inducible nitric oxide synthase during human endotoxemi...
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Upregulation of renal inducible nitric oxide synthase during human endotoxemia and sepsis is associated with proximal tubule injury.

Clin J Am Soc Nephrol. 2006 Jul;1(4):853-62

Authors: Heemskerk S, Pickkers P, Bouw MP, Draisma A, van der Hoeven JG, Peters WH, Smits P, Russel FG, Masereeuw R

The incidence and the mortality of septic acute kidney injury are high, partly because the pathogenesis of sepsis-induced renal dysfunction is not clear. The objective of this study was to investigate the upregulation of renal inducible nitric oxide synthase (iNOS) in human endotoxemia and sepsis and the effect of NO on tubular integrity. Septic patients and endotoxemia that was induced by a bolus injection of 2 ng/kg Escherichia coli LPS in human volunteers were studied. In addition, the effect of co-administration of the selective iNOS inhibitor aminoguanidine was evaluated. The urinary excretion of the cytosolic glutathione-S-transferase-A1 (GSTA1-1) and GSTP1-1, markers for proximal and distal tubule damage, respectively, was determined. In septic patients, an almost 40-fold induction of iNOS mRNA in cells that were isolated from urine was found accompanied by a significant increase in NO metabolites in blood. The mRNA expression of iNOS was induced 34-fold after endotoxin administration. LPS-treated healthy volunteers showed a higher urinary excretion of NO metabolites compared with control subjects. Urinary NO metabolite excretion correlated with urinary GSTA1-1 excretion, indicating proximal tubule damage, whereas no distal tubular damage was observed. Co-administration of aminoguanidine reduced the upregulation of iNOS mRNA, urinary NO metabolite, and GSTA1-1 excretion, indicating that upregulation of iNOS and subsequent NO production may be responsible for renal proximal tubule damage observed.

PMID: 17699297 [PubMed - indexed for MEDLINE]

Free Full Text ArticleRelationship between clinical outcomes and vascular access type among hemodia...
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Relationship between clinical outcomes and vascular access type among hemodialysis patients with Staphylococcus aureus bacteremia.

Clin J Am Soc Nephrol. 2006 May;1(3):518-24

Authors: Inrig JK, Reed SD, Szczech LA, Engemann JJ, Friedman JY, Corey GR, Schulman KA, Reller LB, Fowler VG

The association between hemodialysis vascular access type, costs, and outcome of Staphylococcus aureus bacteremia (SAB) among patients with ESRD remains incompletely characterized. This study was undertaken to compare resource utilization, costs, and clinical outcomes among SAB-infected patients with ESRD by hemodialysis access type. Adjusted comparisons of costs and outcomes were based on multivariable linear regression and multivariable logistic regression models, respectively. A total of 143 hospitalized hemodialysis-dependent patients had SAB at Duke University Medical Center between July 1996 and August 2001. A total of 111 (77.6%) patients were hospitalized as a result of suspected bacteremia; 32 (22.4%) were hospitalized for other reasons. Of the 111 patients, 59.5% (n = 66) had catheters as their primary access type, 36% (n = 40) had arteriovenous (AV) grafts, and 4.5% (n = 5) had AV fistulas. Patients with fistulas were excluded from analyses because of small numbers. Patients with catheters were more likely to be white, had shorter dialysis vintage, and had higher Acute Physiology and Chronic Health Evaluation II scores compared with patients with grafts. Unadjusted 12-wk mortality did not significantly differ between patients with catheters compared with patients with grafts (22.7 versus 10.0%; P = 0.098); neither did 12-wk costs differ by access type ($22,944 +/- 18,278 versus $23,969 +/- 13,731, catheter versus graft; P > 0.05). In adjusted analyses, there was no difference in 12-wk mortality (odds ratio 1.63; 95% confidence interval 0.29 to 9.02; catheter versus graft) or 12-wk costs (means ratio 0.84; 95% confidence interval 0.60 to 1.17; catheter versus graft) among SAB-infected patients with ESRD on the basis of hemodialysis access type. Twelve-week mortality and costs that are associated with an episode of SAB are high in hemodialysis patients, regardless of vascular access type. Efforts should focus on the prevention of SAB in this high-risk group.

PMID: 17699254 [PubMed - indexed for MEDLINE]

Free Full Text ArticleNewer diagnostic tests for bacterial diseases.
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Newer diagnostic tests for bacterial diseases.

Indian J Pediatr. 2007 Jul;74(7):673-7

Authors: Bhatia BD, Basu S

In diagnosing bacterial infections, the rapid identification of bacteremia at an early stage of the disease is critical for a favorable outcome. Furthermore, it is important that exact information be obtained on the stage of the disease rapidly in order to choose and initiate the appropriate therapy. In recent years many new techniques have been added in the diagnostic tools. During the past decade, there has been unprecedented progress in molecular biology as well as in the application of nucleic acid technology to the study of the epidemiology of human infection. Highly sensitive molecular techniques are found to be capable of detecting minute amounts of specific microbial DNA sequences and their complex genetic variations. Moreover, altered levels of biomarkers such as procalcitonin, C-reactive protein, tumor necrosis factor alpha and several interleukins are also found to be promising to define systemic inflammatory response syndrome as indirect evidences of bacterial infections. Lastly, many rapid culture methods are coming up to achieve faster bacterial diagnosis. In this review we will focus on these three newer methods for the early diagnosis of bacterial infections. These approaches will help to expedite the diagnosis of especially early infections and might be a further step towards the improvement of therapeutic methods.

PMID: 17699977 [PubMed - indexed for MEDLINE]

Free Full Text ArticleIdentification of human pathogens isolated from blood using microarray hybrid...
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Identification of human pathogens isolated from blood using microarray hybridisation and signal pattern recognition.

BMC Microbiol. 2007;7:78

Authors: Wiesinger-Mayr H, Vierlinger K, Pichler R, Kriegner A, Hirschl AM, Presterl E, Bodrossy L, Noehammer C

BACKGROUND: Pathogen identification in clinical routine is based on the cultivation of microbes with subsequent morphological and physiological characterisation lasting at least 24 hours. However, early and accurate identification is a crucial requisite for fast and optimally targeted antimicrobial treatment. Molecular biology based techniques allow fast identification, however discrimination of very closely related species remains still difficult. RESULTS: A molecular approach is presented for the rapid identification of pathogens combining PCR amplification with microarray detection. The DNA chip comprises oligonucleotide capture probes for 25 different pathogens including Gram positive cocci, the most frequently encountered genera of Enterobacteriaceae, non-fermenter and clinical relevant Candida species. The observed detection limits varied from 10 cells (e.g. E. coli) to 10(5) cells (S. aureus) per mL artificially spiked blood. Thus the current low sensitivity for some species still represents a barrier for clinical application. Successful discrimination of closely related species was achieved by a signal pattern recognition approach based on the k-nearest-neighbour method. A prototype software providing this statistical evaluation was developed, allowing correct identification in 100 % of the cases at the genus and in 96.7 % at the species level (n = 241). CONCLUSION: The newly developed molecular assay can be carried out within 6 hours in a research laboratory from pathogen isolation to species identification. From our results we conclude that DNA microarrays can be a useful tool for rapid identification of closely related pathogens particularly when the protocols are adapted to the special clinical scenarios.

PMID: 17697354 [PubMed - indexed for MEDLINE]

Free Full Text ArticleRisk factors and prevention of biliary anastomotic complications in adult liv...
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Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation.

World J Gastroenterol. 2007 Aug 21;13(31):4236-41

Authors: Yamamoto S, Sato Y, Oya H, Nakatsuka H, Kobayashi T, Hara Y, Watanabe T, Kurosaki I, Hatakeyama K

AIM: To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction. METHODS: A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS: The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049). CONCLUSION: Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

PMID: 17696254 [PubMed - indexed for MEDLINE]

Free Full Text Article[GEIPC-SEIMC (Study Group for Infections in the Critically Ill Patient of the...
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[GEIPC-SEIMC (Study Group for Infections in the Critically Ill Patient of the Spanish Society for Infectious Diseases and Clinical Microbiology) and GTEI-SEMICYUC ( Working Group on Infectious Diseases of the Spanish Society of Intensive Medicine, Critical Care, and Coronary Units) recommendations for antibiotic treatment of gram-positive cocci infections in the critical patient]

Enferm Infecc Microbiol Clin. 2007 Aug-Sep;25(7):446-66

Authors: Astigarraga PM, Montero JG, Cerrato SG, Colomo OR, Mart&#xED;nez MP, Crespo RZ, García-Paredes PM, Cerdá EC, Lerma FA

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.

PMID: 17692213 [PubMed - indexed for MEDLINE]

Free Full Text ArticleA randomised controlled trial of early insulin therapy in very low birth weig...
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A randomised controlled trial of early insulin therapy in very low birth weight infants, "NIRTURE" (neonatal insulin replacement therapy in Europe).

BMC Pediatr. 2007;7:29

Authors: Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Ahluwalia JS, Vanhole C, Palmer C, Midgley P, Thompson M, Cornette L, Weissenbruch M, Thio M, de Zegher F, Dunger D

BACKGROUND: Studies in adult intensive care have highlighted the importance of insulin and improved glucose control on survival, with 32% reduction in mortality, 22% reduction in intensive care stay and halving of the incidence of bacteraemia. Very low birth weight infants requiring intensive care also have relative insulin deficiency often leading to hyperglycaemia during the first week of life. The physiological influences on insulin secretion and sensitivity, and the potential importance of glucose control at this time are not well established. However there is increasing evidence that the early postnatal period is critical for pancreatic development. At this time a complex set of signals appears to influence pancreatic development and beta cell survival. This has implications both in terms of acute glucose control but also relative insulin deficiency is likely to play a role in poor postnatal growth, which has been associated with later motor and cognitive impairment, and fewer beta cells are linked to risk of type 2 diabetes later in life. METHODS: A multi-centre, randomised controlled trial of early insulin replacement in very low birth weight babies (VLBW, birth weight < 1500 g). 500 infants will be recruited from 10 centres in the UK and Europe. Babies will be randomised to receive a continuous insulin infusion (0.05 units/kg/h) or to receive standard neonatal care from the first day of life and for the next 7 days. If blood glucose (BG) levels fall infants will receive 20% dextrose titrated to maintain normoglycaemia (4-8 mmol/l). If BG is consistently above 10 mmol/l babies will receive standard treatment with additional insulin infusion. The primary end point will be mortality on or before expected date of delivery, secondary end points will be markers of morbidity and include episodes of sepsis, severity of retinopathy, chronic lung disease and growth.

PMID: 17692117 [PubMed - indexed for MEDLINE]

Free Full Text ArticleNosocomial bloodstream infections: organisms, risk factors and resistant phen...
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Nosocomial bloodstream infections: organisms, risk factors and resistant phenotypes in the Brazilian University Hospital.

Braz J Infect Dis. 2007 Jun;11(3):351-4

Authors: Ribas RM, Freitas C, Gontijo Filho PP

Bacteremia is one of the most frequent and challenging hospital-acquired infection and it is associated with high attributable morbidity and mortality and additional use of healthcare resources. The objective of this work was to determine the frequencies of its occurrence, organisms and resistance phenotypes associated to nosocomial acquired bloodstream infections. A total number of 51 nosocomial bacteremia by Gram-negative and 99 by Gram-positive were evaluated and compared during a 15-month period. The risk factors associated with these bacteremias were analyzed and antibiotic use and surgery were associated with bacteremia by Gram-negative and > 2 invasive devices with Gram-positive. The resistance phenotypes ESBL (extended-spectrum beta-lactamases) (23.5%) and AmpC/others (17.6%) correspond to 41.2 % with predominance of E. agglomerans among AmpC (44.4%) and K. pneumoniae among ESBLs (38.5%). Among S. aureus bacteremia, approximately 40% were associated to MRSA (methicillin-resistant Staphylococcus aureus).

PMID: 17684638 [PubMed - in process]

Free Full Text ArticleHeterogeneous resistance to vancomycin and teicoplanin among Staphylococcus s...
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Heterogeneous resistance to vancomycin and teicoplanin among Staphylococcus spp. isolated from bacteremia.

Braz J Infect Dis. 2007 Jun;11(3):345-50

Authors: Nunes AP, Schuenck RP, Bastos CC, Magnanini MM, Long JB, Iorio NL, Santos KR

This study evaluated the BHIA screening method with 4 or 6 mug/mL of vancomycin to detect glycopeptides heteroresistant staphylococci strains isolated from bacteremia. A total of 213 staphylococci strains were isolated from 106 patients between October/2001 and November/2002 in a tertiary hospital in Rio de Janeiro city. Fifty-seven (53.8%) patients presented Staphylococcus aureus, while coagulase-negative staphylococci (CNS) were isolated from 49 (46.2%). Resistance rates for oxacillin of 26.3% and 81.6% were found for the staphylococci isolates, respectively. Thirteen CNS isolated from nine (8.5%) patients grew on agar screening with 4 mug/mL of vancomycin and showed heterogeneous profiles of resistance for vancomycin and teicoplanin by the population analysis profile method. Only 30.8% of them grew at the concentration 6 mug/mL. Bacterial infection and use of antimicrobial therapy were common among these patients. Alert about the emergence of oxacillin-resistant staphylococci presenting heteroresistance to glycopeptides is important in order to achieve judicious use of antimicrobials. Vancomycin agar screening test could help to confirm the presence of these isolates in hospitals.

PMID: 17684637 [PubMed - in process]

Free Full Text ArticleToll-like receptor 2 impairs host defense in gram-negative sepsis caused by B...
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Toll-like receptor 2 impairs host defense in gram-negative sepsis caused by Burkholderia pseudomallei (Melioidosis).

PLoS Med. 2007 Jul 31;4(7):e248

Authors: Wiersinga WJ, Wieland CW, Dessing MC, Chantratita N, Cheng AC, Limmathurotsakul D, Chierakul W, Leendertse M, Florquin S, de Vos AF, White N, Dondorp AM, Day NP, Peacock SJ, van der Poll T

BACKGROUND: Toll-like receptors (TLRs) are essential in host defense against pathogens by virtue of their capacity to detect microbes and initiate the immune response. TLR2 is seen as the most important receptor for gram-positive bacteria, while TLR4 is regarded as the gram-negative TLR. Melioidosis is a severe infection caused by the gram-negative bacterium, Burkholderia pseudomallei, that is endemic in Southeast Asia. We aimed to characterize the expression and function of TLRs in septic melioidosis. METHODS AND FINDINGS: Patient studies: 34 patients with melioidosis demonstrated increased expression of CD14, TLR1, TLR2, and TLR4 on the cell surfaces of monocytes and granulocytes, and increased CD14, TLR1, TLR2, TLR4, LY96 (also known as MD-2), TLR5, and TLR10 mRNA levels in purified monocytes and granulocytes when compared with healthy controls. In vitro experiments: Whole-blood and alveolar macrophages obtained from TLR2 and TLR4 knockout (KO) mice were less responsive to B. pseudomallei in vitro, whereas in the reverse experiment, transfection of HEK293 cells with either TLR2 or TLR4 rendered these cells responsive to this bacterium. In addition, the lipopolysaccharide (LPS) of B. pseudomallei signals through TLR2 and not through TLR4. Mouse studies: Surprisingly, TLR4 KO mice were indistinguishable from wild-type mice with respect to bacterial outgrowth and survival in experimentally induced melioidosis. In contrast, TLR2 KO mice displayed a markedly improved host defenses as reflected by a strong survival advantage together with decreased bacterial loads, reduced lung inflammation, and less distant-organ injury. CONCLUSIONS: Patients with melioidosis displayed an up-regulation of multiple TLRs in peripheral blood monocytes and granulocytes. Although both TLR2 and TLR4 contribute to cellular responsiveness to B. pseudomallei in vitro, TLR2 detects the LPS of B. pseudomallei, and only TLR2 impacts on the immune response of the intact host in vivo. Inhibition of TLR2 may be a novel treatment strategy in melioidosis.

PMID: 17676990 [PubMed - indexed for MEDLINE]

Free Full Text ArticleSuccessful explantation of ventricular assist device for systemic ventricular...
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Successful explantation of ventricular assist device for systemic ventricular assistance in a patient with congenitally corrected transposition of the great arteries.

Interact Cardiovasc Thorac Surg. 2006 Dec;5(6):792-3

Authors: Sugiura T, Kurosawa H, Shin'oka T, Kawai A

We report a case of a 13-year-old boy with congenitally corrected transposition of the great arteries after conventional repair who underwent an implantation of ventricular assist device (VAD) due to right (systemic) ventricular failure after tricuspid valve replacement. The anatomical right ventricle (systemic ventricle) was completely unloaded and the function improved over time under LVAD. He had an explantation of the VAD due to bacteremia 43 days after implantation, and his clinical condition improved significantly.

PMID: 17670716 [PubMed]

Free Full Text ArticleNon-typhoidal salmonella aortitis in a transplant patient.
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Non-typhoidal salmonella aortitis in a transplant patient.

Saudi J Kidney Dis Transpl. 2002 October-December;13(4):501-5

Authors: Tarif N, El Kheder Ael A, Azam MN, Mitwalli AH, Al-Wakeel JS

Non-typhoidal salmonella bacteremia may result in extra gastrointestinal localization of infection. Aortitis due to non-typhoidal salmonella was reported to be the cause of 38-42.5% of all infected abdominal aortitis. Underlying atherosclersis is a frequent site for salmonella aortitis. We describe here a case of possible salmonella aortitis in a renal transplant patient.

PMID: 17660675 [PubMed - in process]

Free Full Text ArticleCellulitis and bacteremia caused by Bergeyella zoohelcum.
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Cellulitis and bacteremia caused by Bergeyella zoohelcum.

J Formos Med Assoc. 2007 Jul;106(7):573-6

Authors: Lin WR, Chen YS, Liu YC

Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone.

PMID: 17660147 [PubMed - indexed for MEDLINE]

Free Full Text ArticleDynamic changes and mechanism of intestinal endotoxemia in partially hepatect...
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Dynamic changes and mechanism of intestinal endotoxemia in partially hepatectomized rats.

World J Gastroenterol. 2007 Jul 14;13(26):3592-7

Authors: Xu CP, Liu J, Liu JC, Han DW, Zhang Y, Zhao YC

AIM: To explore the mechanism of intestinal endo-toxemia (IETM) formation and its changes in partially hepatectomized (PH) rats. METHODS: One-hundred and two adult male Wistar rats were randomly divided into three groups: normal control (NC) group, partially hepatectomized (PH) group and a sham-operated (SO) group. To study the dynamic changes, rats were sacrificed before and at different time points after partial hepatectomy or the sham-operation ( 6 h, 12 h, 24 h, 36 h, 48 h, 72 h, 120 h and 168 h). NC group was used as 0 h time point in observation, namely 0 h group. For each time point indicated, six rats were used in parallel. Endotoxin (ET) and diamine oxidase (DAO) levels were determined in serum using Limulus Lysate test with chromogenic substrate and spectrophotometry. Intestinal mucosa barrier was observed under optical or electron microscope. The number and functional state of Kupffer cells (KCs) in the remnant regenerating liver were measured by immunohistochemical staining. RESULTS: Serum ET levels significantly increased during 6-72 h period after PH compared with NC and SO groups, and there were two peak values at 12 and 48 h while serum DAO level significantly increased at 12 and 24 h. There was positive correlation (r = 0.757, P < 0.05) between the levels of DAO and ET dynamic changes. The optical examination showed neutrophil margination and superficial necrosis of the villi in the intestinal mucosa during 6-24 h period after PH. The penetrated electron microscope examination showed that the gaps between intestinal mucosa cells were increased and the Lanthanum (La) particles were observed among the intestinal mucosa cells during 6-48 h period. The numbers of KCs in the remnant regenerating liver were significantly increased during 24-168 h period after PH. However, the activation of KCs was predominantly observed at 48 h after PH. CONCLUSION: The mechanism of IETM in PH rats might be the injury of intestinal mucosa barrier and the decrease of the absolute number of KCs as well as the depression of functional state of KCs. This observation is of potential value in patients undergoing liver resection.

PMID: 17659709 [PubMed - indexed for MEDLINE]

Free Full Text ArticleMultiple pathogenic factor-induced complications of cirrhosis in rats: a new ...
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Multiple pathogenic factor-induced complications of cirrhosis in rats: a new model of hepatopulmonary syndrome with intestinal endotoxemia.

World J Gastroenterol. 2007 Jul 7;13(25):3500-7

Authors: Zhang HY, Han DW, Zhao ZF, Liu MS, Wu YJ, Chen XM, Ji C

AIM: To develop and characterize a practical model of Hepatopulmonary syndrome (HPS) in rats. METHODS: The experimental animals were randomized into five feeding groups: (1) control (fed standard diet), (2) control plus intraperitoneal injection with lipopolysaccharide (LPS), (3) cirrhosis (fed a diet of maize flour, lard, cholesterol, and alcohol plus subcutaneously injection with carbon tetrachloride (CCl(4)) oil solution), (4) cirrhosis plus LPS, and (5) cirrhosis plus glycine and LPS. The blood, liver and lung tissues of rats were sampled for analysis and characterization. Technetium 99m-labeled macroaggregated albumin (Tc99m-MAA) was used to test the dilatation of pulmonary microvasculature. RESULTS: Typical cirrhosis and subsequent hepato-pulmonary syndrome was observed in the cirrhosis groups after an 8 wk feeding period. In rats with cirrhosis, there were a decreased PaO(2) and PaCO(2) in arterial blood, markedly decreased arterial O(2) content, a significantly increased alveolar to arterial oxygen gradient, an increased number of bacterial translocated within mesenteric lymph node, a significant higher level of LPS and tumor necrosis factor-alpha (TNF-alpha) in plasma, and a significant greater ratio of Tc99m-MAA brain-over-lung radioactivity. After LPS administration in rats with cirrhosis, various pathological parameters got worse and pulmonary edema formed. The predisposition of glycine antagonized the effects of LPS and significantly alleviated various pathological alterations. CONCLUSION: The results suggest that: (1) a characteristic rat model of HPS can be non-invasively induced by multiple pathogenic factors including high fat diet, alcohol, cholesterol and CCl(4); (2) this model can be used for study of hepatopulmonary syndrome and is clinically relevant; and (3) intestinal endotoxemia (IETM) and its accompanying cytokines, such as TNF-alpha, exert a crucial role in the pathogenesis of HPS in this model.

PMID: 17659698 [PubMed - indexed for MEDLINE]

Free Full Text ArticleActinomycotic bacteraemia after dental procedures.
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Actinomycotic bacteraemia after dental procedures.

Indian J Med Microbiol. 2002 Apr-Jun;20(2):72-5

Authors: Bhatawadekar S, Bhardwaj R

PURPOSE: To assess role of oral flora in causing bacteraemia following dental manipulations. METHODS: Fifty patients undergoing dental manipulations were assessed to study the incidence and nature of bacteraemia following dental procedures with special emphasis on Actinomyces. RESULTS: Incidence of bacteraemia was seen to be 80% of which Actinomycotic bacteraemia was found to be 30 %. Common species of Actinomyces isolated were A.viscosus (58.33 %), A.odontolyticus (8.33 %) and A. naeslundi (8.33 %). Aerobic bacteraemia was seen in 48% patients. Common aerobes isolated from bacteraemia following dental procedures were alpha haemolytic streptococci (25.93 %) and diphtheroides (20.38 %). Anaerobic bacteraemia was seen in 6% patients. Common Anaerobes isolated were Peptostreptococcus spp (33.32 %), Prevotella spp. (16.66%) and Bacteroides spp (16.66%). Mixed aerobic and anaerobic bacteraemia was present in 26 % of the patients. CONCLUSIONS: Actinomycotic bacteraemia was more commonly seen in patients with periodontal infections. Thus, prophylactic measures need to be instituted in such patients to prevent cervicofacial, thoracic or abdominal Actinomycosis developing later on.

PMID: 17657035 [PubMed - in process]

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