"The higher the volume of blood cultured the higher the yield of blood cultures" has been a well-accepted dictum since J. A. Washington II performed his classic work. This rule has not been questioned in the era of highly automated blood culture machines, nor has it been correlated with clinical variables. Our objective in this study was to complete a prospective analysis of the relationship between blood volume, the yield of blood cultures, and the severity of clinical conditions in adult patients with suspected bloodstream infections (BSI). During a 6-month period, random samples of blood cultures were weighed to determine the volume of injected blood (weight/density). Overall, 298 patients with significant BSI and 303 patients with sepsis and negative blood cultures were studied. The mean volume of blood cultured in patients with BSI (30.03 ؎ 14.96 ml [mean ؎ standard deviation]) was lower than in patients without BSI (32.98 ؎ 15.22 ml [P ‫؍‬ 0.017]), and more episodes of bacteremia were detected with <20 ml (58.9%) than with >40 ml (40.2%) of blood cultured (P ‫؍‬ 0.022). When patients were stratified according to the severity of their underlying condition, patients with BSI had higher APACHE II scores, and higher APACHE II scores were related to lower sample volumes (P < 0.001). A multivariate analysis showed that in the group of patients with APACHE II scores of >18, higher volumes yielded higher rates of bacteremia (odds ratio, 1.04 per ml of blood; 95% confidence interval, 1.001 to 1.08). We conclude that the higher yield of blood cultures inoculated with lower volumes of blood reflects the conditions of the population cultured. Washington's dictum holds true today in the era of automated blood culture machines.According to the classic literature, the volume of blood per culture is the single most important variable in recovering microorganisms from patients with sepsis. The higher the blood volume cultured, the higher the rate of detection of bloodstream infections (BSI) (1, 5-7, 9, 12, 15, 18, 20, 21). However, reports regarding the requirements for blood volume with today's automated and continuous-monitoring blood culture systems are scarce (12,15,22,24). In a previous study, we noted that blood cultures inoculated with lower volumes had a higher yield of detection of BSI at our institution (17).The aim of the present study was to reassess the importance of blood volume in the yield of blood cultures after the introduction of automated systems with continuous agitation and to correlate the findings with clinical variables. MATERIALS AND METHODSOur institution is a general teaching hospital with 1,750 beds serving a mainly urban population of 650,000. We have medical and surgical specialties as well as large psychiatric, obstetric, and pediatric facilities. We have very active bone marrow and solid organ transplantation programs and serve as a referral institution.Study period and patient selection. The study was carried out during a period of 6 months. We randomly selected one of every two episodes o...

Written- or oral-alert reports with clinical advice should complement traditional microbiological reports for patients with BSIs.

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality.

No abstract

This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.

The objective of our study was to evaluate the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV) in preventing hospital admission for communityacquired pneumonia (CAP) in people o65 yrs of age.We conducted a matched case-control study in patients with CAP admitted to five Spanish hospitals. Cases were persons aged o65 yrs admitted to hospital through the emergency department, who presented a clinical and radiological pattern compatible with pneumonia, assessed using established criteria. We matched each case with three control subjects by sex, age (¡5 yrs), date of hospitalisation (¡30 days) and underlying disease. The study period was May 1, 2005 to January 31, 2007. The PPV immunisation status of cases and controls was investigated. Adjusted ORs for vaccination were calculated using logistic regression analysis.A total of 489 cases and 1,467 controls were included in the final analysis. The overall adjusted vaccination effectiveness for all patients was 23.6% (95% CI 0.9-41.0). The adjusted vaccination effectiveness for immunosuppressed patients was 21.0% (95% CI -18.7-47.5).Our results suggest that the PPV may potentially reduce hospitalisations for pneumonia in the elderly and supports vaccination programmes in this age group.KEYWORDS: Case-control study, effectiveness, elderly, pneumococcal polysaccharide vaccine, pneumonia C ommunity-acquired pneumonia (CAP) is an important cause of morbidity and mortality in elderly people and those of any age with underlying diseases [1,2]. In Spain, the overall incidence in adults varies between two and 10 cases per 1,000 persons per yr in all ages and between 14 and 35 per 1,000 persons per yr in persons aged .70 yrs [3,4]. In a Spanish study, the incidence increased dramatically by age in elderly people (9.9/1,000 in people aged 65-74 yrs versus 29.4 in people aged o85 years) [4]. Hospitalisations due to CAP increase with age and may reach 61% for all ages, and 67% in people aged .65 yrs [5,6]. Case-fatality rates may reach 17% in patients aged .75 yrs [5], with higher rates in those with underlying disease [1,3,5]. A substantial proportion of CAP cases requiring hospitalisation are caused by Streptococcus pneumoniae: 30-50% according to most reports [1,[7][8][9][10][11]. Bacteraemic pneumococcal pneumonia, the most severe disease form, accounts for only 10-20% of adult cases of CAP caused by S. pneumoniae, with non-bacteraemic pneumococcal pneumonia being much more frequent [1].The 23-valent pneumococcal polysaccharide vaccine (PPV) has been available in the USA for 25 yrs and is currently licensed in most developed countries. Vaccination is usually recommended for people aged o65 yrs and for high-risk persons aged .2 yrs [1,12,13]. There is a general consensus that observational studies have shown vaccination to be effective in preventing invasive pneumococcal disease [14][15][16]. However, vaccination rates are not high in most countries, partly due to doubts about the vaccine's efficacy and vaccination effectiveness in preventing n...

From July 2003 through October 2004, 42 patients became infected by strains of Leuconostoc mesenteroides subsp. mesenteroides (genotype 1) in different departments of Juan Canalejo Hospital in northwest Spain. During 2006, 6 inpatients, also in different departments of the hospital, became infected (genotypes 2–4). Parenteral nutrition was the likely source.

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