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Elaborating on the use of the terms sepsis, septicemia, bacteremia and septicopyemia, the author stresses the importance of precise concepts and correct terminology to describe clinico-pathological entities with different pathogenesis. The significance of this attitude for medical teaching is discussed.
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Bacteremias and septicemias are diagnostic and therapeutic challenges. Disseminated bacterial infections may be associated with a number of different conditions and can present with any of a wide variety of clinical signs. Additionally, they are often complicated by the adverse effects of an overzealous immune response in the patient. The most immediately severe and life threatening of these complications is septic shock, a frequent sequela to bacteremia characterized by endotoxin-producing gram-negative microorganisms. Infection with any of a large number of gram-positive or gram-negative aerobes or anaerobes is possible, as is mixed infection. Definitive diagnosis of bacteremia is by repeatable isolation of the pathogen(s) from culture of the patient's blood. Successful therapeutic outcome is dependent on early diagnosis and prompt treatment with a prolonged course of high doses of bactericidal antibiotics, facilitated by in vitro sensitivity testing.
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PURPOSE: To describe the epidemiology of hospitalization of elderly Americans for septicemia or bacteremia. METHODS: Medicare claims data for discharges from 1991 through 1998 were used to study 75,920 hospitalizations with the principal diagnosis of septicemia or bacteremia in patients aged 65 years or older. RESULTS: "Unspecified septicemia" was the commonest principal diagnosis, followed by septicemia due to Escherichia coli or staphylococci. From 1991 through 1997, annual discharges for "unspecified septicemia" increased 108%, and those for pneumococcal septicemia increased 310%. Decreases in reported septicemia were seen after increases in the proportion of beneficiaries in Medicare health maintenance organizations. Discharge rates for septicemia principal diagnoses increased steeply with age. Age-specific discharge rates were usually highest for black men and lowest for white women. Exceptions included septicemia due to E. coli, with white men at low risk, and pneumococcal septicemia, without significant differences between races or sexes. The case-fatality rate in hospital ranged from 4.2% with "bacteremia" and 6.9% with E. coli septicemia to 22.2% with "septicemia due to gram-negative organism, unspecified," and 26.8% with "unspecified septicemia." Staphylococcal septicemia, septicemia due to pseudomonas, and septicemia due to anaerobes were the costliest common principal diagnoses in terms of the mean duration of hospital stay. CONCLUSIONS: Unexplained sharp increases were reported in hospitalization for septicemia or bacteremia in elderly Americans. Marked variation by race and sex were evident in discharge rates with these principal diagnoses. Prognosis and average cost of treatment also differed substantially among common rubrics. Further investigation of individual diagnoses should concentrate on explaining secular trends, exploring the basis for variation by race and sex, and elucidating risk factors for poor clinical outcomes.
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OBJECTIVE: The present study aims to define the pattern of bacteremia with clinical sepsis in diabetic patients at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), in relation to the type of infection, microbial pattern, source, complication, outcome, and the risk factors associated with high mortality. METHODS: Retrospective study of adult diabetic patients with bacteremia and septicemia admitted to KAUH during a 2 years period between January 2000 through to December 2002 was carried out. RESULTS: A total of 4850 blood culture were submitted to the Microbiology Laboratory of KAUH over a 2 years period. Two hundred and ninety (6%) cases had positive blood cultures, 70 were diabetic patients with an incidence rate of 24% with p-value of 0.043 which is statically significant. Urinary tract infection was the most common source of bacteremia in our study group with Escherichia coli as the most frequent organism in 62%. Mortality rate was 44%. Old age was an important risk factors for high mortality with p-value 0.011, which is statically significant. Other risk factors included comorbidity associated with diabetes, septic shock, mechanical ventilation and disseminated intravascular coagulation. CONCLUSION: Increase age was one of the important risk factors for high mortality rate in our study group. Good empiric antibiotics coverage should be instituted early in high risk groups.
No previous isolation of the agent on the media is needed in using a new microbiological express-method of automatic control over antibacterial therapy of bacteremia and septicemia. The method is efficient in determination of sensitivity to the drug of the whole heterogeneous population of bacteria. It does not predict efficacy of antibacterial therapy but states the presence or absence of the effect in vivo. The method is integral, evaluates antibacterial plasma titer suggesting adequate correction. The duration of the test is maximum 12 h that is 3-4 times less than other methods.
Among 31 patients with positive blood cultures for gram-negative bacilli seen in a department of internal medicine, 13 had at least 3 positive blood cultures from samples taken over more than 12 hours and were diagnosed as having septicemia (group I) ; 18 patients had less than three positive blood cultures over the same period or had several positive blood cultures over a shorter period and were diagnosed as having bacteremia (group II). There were no significant differences between these two groups concerning age, sex, fever, other clinical features, or biological findings. E. coli was recovered in 70 % of cases and was almost always related to urinary infection. 8 patients died (3 in group I, 5 in group II), 6 of whom had cirrhosis. The sensitivity of the pathogens to the main antibiotics is described. The most often used antibiotic combination was ampicillin-gentamycin. It is suggested that in departments receiving patients from outside the hospital rather than from intensive care units the ampicillin-gentamycin combination can be advocated as the first treatment. As there were no significant differences between patients with septicemia or bacteremia, in severe infections a single positive blood culture should be taken into account and discrimination between septicemia and bacteremia is useless.
The literature on the assessment and the preferred treatment strategies for children without a focus of infection is reviewed. Opinions are offered regarding the diagnostic evaluation and therapeutic interventions for febrile infants and children who are at risk for occult bacteremia or sepsis. Clinicians are encouraged to consider the proposed strategies but not to supplant their prevailing practice.
BACKGROUND: Nosocomial bloodstream infections in pediatrics are an important cause of morbidity and mortality. To identify pathogens causing nosocomial bloodstream infections, evaluate associated risk factors and take preventive measures, we conducted a prospective study from January 1995 to December 1995 at Saint-Vincent-de-Paul Hospital (Paris). PATIENTS AND RESULTS: All patients hospitalized more than 48 hours were included in the study. During this period, we recorded 21 bloodstream infections in 20 children. The incidence rate of nosocomial bloodstream infection was 1/1,000 admissions. Sixteen children were hospitalized in surgery, three in medical intensive care unit; the median day onset of infection was approximately 20 days. Recorded risk factors were: surgery, invasive procedures, central catheterization, bladder catheters, parenteral nutrition, device, endotracheal tube, antibiotic therapy before infection. The number of risk factors ranged from zero to six per patient. The most common isolated pathogens were in ten cases Gram positive cocci: five methicillin-sensible Staphylococcus aureus, four methicillin-resistant coagulase-negative staphylococci and one Streptococcus milleri. Other bacteria were seven enterobacteria, three Pseudomonas sp and three Candida sp. In 11 cases, the same bacteria as in bloodstream infection could be found: in three urine samples, in two tracheal samples, in two gastro-intestinal samples, two puncture sites, one device, and one umbilical catheter. CONCLUSION: In our study, 6.2% of positive blood culture were due to a nosocomial infection. We confirm the importance of Gram positive cocci, and particularly of methicillin-resistant coagulase negative staphylococci.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.