All 134 episodes of bacteremia caused solely by Pseudomonas aeruginosa in a university hospital in the periods 1976-1982 and 1992-1996 were reviewed retrospectively to determine the clinical manifestations, outcome and prognostic factors. The mortality for the 30-day interval after drawing the first positive blood culture was 41%, but dropped from 53% in the first period to 29% in the second period (P=0.006). Mortality was highest in patients treated with an aminoglycoside only, as against those treated with other appropriate antibiotics (55% versus 25%, P=0.001). Over the two decades studied, use of an aminoglycoside only decreased, use of paracetamol (=acetaminophen) increased, and removal of both urinary and blood vessel catheters became more common. The mortality was 18% in patients with catheter removal (46% in the other patients, P=0.017) and 27% in patients who received paracetamol around the time of drawing the first positive blood culture (50% for the other patients, P=0.010). Logistic regression analysis showed that shock, central nervous system involvement, preceding thromboembolism and rapidly fatal underlying disease were associated with a fatal outcome, whereas catheter removal, appropriate antibiotic therapy and paracetamol therapy were associated with survival. The improved prognosis of Pseudomonas aeruginosa bacteremia over the two decades is thus due mainly to three changes in management of the infection: the more frequent use of new anti-pseudomonal beta-lactams and ciprofloxacin instead of aminoglycosides as monotherapy; the more frequent practice of removing catheters; and the increased use of paracetamol around the time of drawing the first positive blood sample.
All cases of bacteremia caused solely by Escherichia coli in 1977-1979, 1987-1989, and 1993-1994 in a Finnish university hospital were reviewed retrospectively to determine the clinical manifestations, the outcome, and the prognostic factors. In 332 episodes, mortality during the month after the first positive blood culture was 17%. This figure diminished during the study period from 23% in the 1970s to 9% in the 1990s (p = 0.028). Mortality was lowest among patients treated with a combination of antibiotics, 7% versus 18% among those treated otherwise (p = 0.034). The use of acetaminophen increased during the study period from 18 to 55%. Mortality among patients who received acetaminophen within a period < 24 h to 48 h of the first positive blood culture was 10% versus 22% among others (p = 0.002). Logistic regression analysis showed six factors predictive of a fatal outcome: pneumonia, no known focus, shock, CNS disorder, thromboembolism, and rapidly fatal underlying disease. Appropriate antibiotic therapy predicted survival. In the analysis, replacement of appropriate antibiotic therapy by acetaminophen revealed that this drug was significantly associated with survival.
Plesiomonas shigelloides was isolated from 20/13,027 stool samples submitted for culture to the Department of Bacteriology and Immunology, University of Helsinki, in 1990. All except 2/20 Plesiomonas-positive patients had diarrhea; 13 patients had acute onset of illness after foreign travel and 5 patients had chronic diarrhea with symptoms lasting > or = 2 months. Travel destinations were outside Europe in most cases. In 12 cases Plesiomonas was isolated in pure culture and in 8 cases together with other enteropathogens. All isolates were susceptible to ciprofloxacin, doxycycline, trimethoprim and sulfamethoxazole, gentamicin, cephalexin, cefuroxime, ceftriaxone and cefixime.
Aeromonas species were isolated from 249/13,027 (1.9%) stool samples submitted to the Dept. of Bacteriology and Immunology, University of Helsinki, during 1 year, to be cultured for bacterial enteropathogens. Aeromonas was the third most common enteropathogen isolated, after campylobacter (3.6%) and salmonella (3.3%). Isolates and clinical information from 234 Aeromonas patients were available for further study. A. caviae (41%), A. hydrophila (27%), and A. veronii biovar sobria (22%) were the most frequent isolates. In 15% of the patients, other enteropathogens were found along with aeromonas. Only 2% of all aeromonas-positive patients were found to be asymptomatic, whereas no aeromonas isolates were detected in the stools of 343 asymptomatic individuals. Almost all (96%) patients with aeromonas in their feces had gastroenteritis. Patients infected with A. veronii biovar sobria had a shorter illness course and had more often travelled abroad. In conclusion, Aeromonas spp. were found to be a potential cause of diarrhea in Finnish patients.
The purpose of our study was to determine retrospectively the risk factors for the acquisition of Enterococcus faecalis vs E. faecium bacteraemia, as well as the clinical outcomes of these patients. 62 patients with Enterococcus faecalis bacteraemia were compared to 31 patients with E. faecium bacteraemia. Haematologic malignancies, neutropenia, high-risk source and previous use of aminoglycosides, carbapenems, cephalosporins and clindamycin were significantly associated with E. faecium bacteraemia. Instead, urinary catheterization was found to be related to Enterococcus faecalis bacteraemia. The mortality rates within 7 d and 30 d were 13% and 27%, respectively, in patients with E. faecalis bacteraemia and 6% and 29%, respectively, in patients with E. faecium bacteraemia. There was no difference in mortality between E. faecalis and E. faecium bacteraemia, nor was there a difference in seriousness of disease at the time of bacteraemia. In the subgroups of patients with monomicrobial or clinically significant E. faecalis vs E. faecium bacteraemia, the mortality rates were similar to the results of all subjects. Our results do not support the theory that E. faecium would be a more virulent organism than E. faecalis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.