Bacteremia In Women Research Articles

Comparative genomic analysis of Streptococcus dysgalactiae subspecies dysgalactiae, an occasional cause of zoonotic infection

Streptococcus dysgalactiae comprise two subspecies. Typically, S.dysgalactiae subspecies equisimilis (SDSE) are large colony β-haemolytic Group C and Group G streptococci that cause pharyngitis, skin and soft tissue infections in humans. On the other hand, S.dysgalactiae subspecies dysgalactiae (SDSD) are classically described as α-haemolytic Group C streptococci that are animal pathogens. We compared the genome sequences of five S.dysgalactiae isolated from four cases of bacteraemia in women with breast cancer, and one from fish meat. One human isolate was SDSE, all other isolates were SDSD. Zoonotic SDSD infection may be under-recognised because of lack of patient and clinician awareness, and failure to distinguish SDSD from SDSE in the routine lab. The possibility of zoonotic SDSD should be suspected in patients with bacteraemia and ascending cellulitis of the upper limb with a history of handling raw fish and meat.

A simple model to predict bacteremia in women with acute pyelonephritis

To construct a simple model to predict bacteremia in women with uncomplicated acute pyelonephritis (APN) for the judicious use of blood cultures. A prospective database including 735 women with uncomplicated APN at an academic urban emergency department was analyzed retrospectively. Independent risk factors were determined using multivariate logistic regression in two-thirds of patients. Cutoff values representing 10% and 30% of risk were selected for the stratification. This model was internally and externally validated using a remaining one-thirds of patients and 169 independent patients, respectively. Independent risk factors were as follows: age ≥65 years (odds ratio [OR]=5.18, 4 points), vomiting (OR=2.40, 2 points), heart rate >110 beats/min (OR=2.35, 2 points), segmented neutrophils >90% (OR=3.17, 3 points), and urine WBC ≥50/HPF (OR=4.27, 4 points). Patients were stratified as low (points <4), intermediate (points, 4-6), or high risk (7≤ points). The areas under receiver operating characteristics curves were 0.707 and 0.792 in internal and external validation cohorts, respectively. The model stratified internal and external validation cohort into low (8.5% and 5.7%), intermediate (16.5% and 14.8%), and high risk of bacteremia (42.0% and 56.4%). This model provides a useful tool to predict the risk of bacteremia, which can be helpful to decide whether to perform blood cultures and whether to admit the patient for the intravenous antibiotics in women with uncomplicated APN.

Burden of Community‐OnsetEscherichia coliBacteremia in Seniors

Although Escherichia coli is a well-recognized cause of urinary tract infection in seniors, little is known about the burden of invasive E. coli infection in this population. We conducted a population-based cohort study of 46,238 noninstitutionalized Group Health Cooperative members>or=65 years of age to ascertain incidences of community-onset E. coli bacteremia and, for comparison, pneumococcal bacteremia, and we then performed a case-control study to identify risk factors for community-onset E. coli bacteremia. The overall rate of community-onset E. coli bacteremia in the study cohort was 150 cases/100,000 person-years, which was approximately 3 times higher than the rate of pneumococcal bacteremia. In the case-control study, urinary catheterization and urinary incontinence were the only factors associated with an increased risk of E. coli bacteremia in men (62 cases), whereas cancer, renal failure, congestive heart failure, coronary artery disease, and urinary incontinence were associated with an increased risk of E. coli bacteremia in women (119 cases). E. coli appears to be the leading cause of community-onset bacteremia in seniors, and, on the basis of these rates, we estimate that 53,476 cases occur in noninstitutionalized seniors each year in the United States. Community-onset E. coli bacteremia in seniors is, therefore, an infection of public health importance.