Nosocomial Pneumococcal Bacteremia

Álvarez, Salvador; Guarderas, Juan; Shell, Charles G.; Holtsclaw-Berk, S; Berk, Steven L.

doi:10.1001/archinte.1986.00360200059010

Cited by 41 publications

(28 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another factor of possible influence is that elderly patients may currently tend to seek medical attention more promptly than in previous years [18]. Second, we did not find a significantly higher mor tality among patients with nosocomial bacteremia than among those with community-acquired bacter emia; this result is in contrast to those of recent studies of veterans [19]. Third, an intriguing obser vation not previously made is that pneumococcal bacteremia occurred significantly more frequently in women than in men.…”

Section: Discussioncontrasting

confidence: 78%

Pneumococcal Bacteremia in Adults over a to-Year Period at University Hospital, Leiden

Bruyn

Meer

Hermans

et al. 1988

Clinical Infectious Diseases

View full text Add to dashboard Cite

The medical records on all cases of pneumococcal bacteremia in adults at the University Hospital, Leiden, over a 10-year period (1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986) were retrospectively reviewed. In this series of 147 episodes (an annual incidence of 0.8 episodes/10,000 adults), overall mortal ity was 25.9%. Factors significantly related to a higher mortality rate were shock, respira tory insufficiency, preexisting renal failure, and rapidly fatal underlying disease. Several laboratory abnormalities -such as a low percentage of band forms, an elevated level of serum lactate dehydrogenase, and hyperbilirubinemia -were significantly related to a poor outcome. Multilobar pneumonia and meningitis were both associated w'ith high mortal ity, although not to a statistically significant degree. Discriminant analysis showed the presence of shock as the most powerful predictive factor of death. Surprisingly, prior splenectomy did not correlate with higher mortality. Treatment with p-lactam antibiotics favorably influenced the outcome of illness in patients with ultimately fatal and nonfatal underlying disease, while the use of these agents in patients w'ith rapidly fatal underlying disease did not correlate significantly with a good prognosis.

show abstract

Section: Discussioncontrasting

confidence: 78%

Pneumococcal Bacteremia in Adults over a to-Year Period at University Hospital, Leiden

Bruyn

Meer

Hermans

et al. 1988

Clinical Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…These cases represented 4.4% of the total number of cases of nosocomial bacteremia and 27.4% of all cases of pneumococcal bacteremia. Similarly, Ruben et al [1] found that 22% of the cases of pneumococcal bacteremia were hospital acquired, and this figure was 41% and 59% in 2 other studies [14,15]. These figures are clearly higher than those found in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have delineated epidemiological, clinical, and prognostic characteristics of community-acquired pneumococcal bacteremia [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. However, nosocomial pneumococcal disease has received little attention.…”

mentioning

confidence: 99%

Hospital‐Acquired Pneumococcal Bacteremia

et al. 2002

View full text Add to dashboard Cite

To assess the most relevant features of hospital-acquired pneumococcal bacteremia, all cases of pneumococcal bacteremia at a single teaching hospital that occurred during 1988-2000 were prospectively studied. During this period, 374 cases of pneumococcal bacteremia were documented; 39 (10%) of these episodes were hospital acquired. Twenty-nine (74%) cases occurred during the period of December through May. Eleven (28%) of 39 patients had received antimicrobial agents in the month before the onset of bacteremia. All patients had underlying diseases that predisposed them to pneumococcal infection. The most common origin of infection was the respiratory tract, followed by the intra-abdominal region. Fifteen strains were fully susceptible to penicillin, and 20 were intermediately resistant. Only 25 strains were susceptible to erythromycin; all strains that were resistant to erythromycin were penicillin nonsusceptible. Eighteen (46%) of 39 patients died; the mortality rate related to infection was 39%.

show abstract

“…Adults ( 50 years of age) have re p o rted fatality rates of 2.4% compared with 15% in patients 50 years of age (103). Some series have re p o rted high fatality rates (up to 50%) with nosocomial pneumococcal b a c t e remia (93,95), whereas others have re p o rted rates of 7-9% (16,94). In series re p o rting both high and low fatality rates, patients with diabetes have had a high incidence (20-29%) of nosocomial acquire d infections (16,95).…”

Section: Clinical Reports Of Infectionmentioning

confidence: 99%

“…A re t ro s p e c t i v e s u rvey of select re f e rral clinics for people with diabetes did not support an incre a s e d risk (90). The number of patients with diabetes in other case series of pneumococcal infection has been as little as 1-3% in patient g roups 50 years of age and 12-19% in older groups (16,(91)(92)(93)(94)(95). Several re v i e w s and series of pneumococcal bacteremia fail to mention individual patients with diabetes (96-100).…”

mentioning

confidence: 99%

Use of influenza and pneumococcal vaccines in people with diabetes.

2000

View full text Add to dashboard Cite

R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s 96DIABETES CARE, VOLUME 23, NUMBER 1, JANUARY 2000 Technical Review that results from bacterial and viral infections such as influenza and pneumococcus.Poor antibody response has been shown to be a marker of immunologic susceptibility to infection and its sequelae (17). Immunity (as measured by in vitro opsonic activity of serum from vaccinated patients), howe v e r, has not always been correlated with level of antibody measured by radioimmunoassay (18,19). Antibody responses to the pneumococcal vaccine in people with diabetes have been examined and have been shown to be no diff e rent than in people without diabetes (20)(21)(22). Observations of i m p a i red antibody response to the influenza vaccine, in particular when there is poor metabolic control, has led some to question the value of the influenza vaccination in people with diabetes (23)(24)(25)(26).Cell-mediated abnormalities (and related humoral responses), such as d e c reased CD4/CD8 lymphocyte ratios, changes in natural killer cell function, reduced lymphocyte blastogenesis, acquire d defects in interleukin-2 production, and a reduced phagocytic function of monocytes, have all been re p o rted in people with diabetes (27-30) and could account for an i n c reased risk of infection (both bacterial and viral) and poor antibody response to vaccination. It has also been proposed that cell-mediated immunity may be a more re l iable predictor of adequate immune re s p o n s e as it relates to viral infections such as influenza infection (25).Leukocyte function is important in the p r i m a ry immune response to bacterial infections (both primary and secondary infections complicating viral infections). Poorly c o n t rolled diabetes has been associated with a l t e red granulocyte function (31-33). It appears from these studies that the complex cellular processes of bacteria engulfment and killing could be influenced by glycemic cont rol independent of active infection. Bacterial colonization, if significant, could contribute to patients' risks for complicating nosocomial infection from primary infections. Patients with diabetes have been shown to have a higher incidence of positive s u rveillance cultures (and carrier rates) for coagulase-positive S t a p h y l o c o c c u s and Gro u p B streptococci (34), whereas others have re p o rted a colonization rate for people with diabetes that is no higher than that expected for other individuals (35). Carrier status appears to be associated with glycemic cont rol (34,36). While it is tempting to speculate how colonization may have contributed to Leonard Thompson' s complicating s t a p h ylococcal pneumonia (1), it is difficult to assess colonization' s specific impact on the morbidity and mortality of disease for people with diabetes. Epidemiological evidenceT h e re are limited studies re p o rting the incidence, morbidity, and mortality of viral and bacterial infections specifically in patients with diabetes. Tables 1 and 2 summ...

show abstract

Nosocomial Pneumococcal Bacteremia

Cited by 41 publications

References 15 publications

Pneumococcal Bacteremia in Adults over a to-Year Period at University Hospital, Leiden

Pneumococcal Bacteremia in Adults over a to-Year Period at University Hospital, Leiden

Hospital‐Acquired Pneumococcal Bacteremia

Use of influenza and pneumococcal vaccines in people with diabetes.

Contact Info

Product

Resources

About