Late-onset Bacteremia Research Articles

Individualized management of bacteraemia in patients with a permanent endocardial pacemaker

Fifty-five episodes of bacteraemia arising in patients with a permanent endocardial pacemaker (PEP), from May 1987 to March 2006, were reviewed to determine whether clinical and microbiological data might assist in individual clinical management. Episodes of PEP-related bacteraemia were divided into early-onset bacteraemia, occurring within 6 months after device implantation or manipulation, and late-onset bacteraemia, occurring thereafter. Episodes with a source different from the PEP were classified as out-of-system bacteraemia. The PEP was the source of infection in 27 (49%) patients. Among patients with early-onset PEP-related bacteraemia (n = 16), Staphylococcus aureus was isolated in 87.5% (14/16) of cases; 81% of them (13/16) had local signs of infection at the PEP pocket and 25% (4/16) died. Conversely, patients with late-onset PEP-related bacteraemia (n = 11) had a protracted clinical course; local signs of infection were infrequently observed (18%); a coagulase-negative staphylococcus was isolated in 91% of cases, and no death-related infection was registered. In patients with out-of-system bacteraemia (n = 28), the device became colonized and required explantation in 56% (5/9) of patients with S. aureus infection; the remaining 19 patients with out-of system bacteraemia caused by a microorganism other than S. aureus were successfully managed with medical treatment. Early-onset and late-onset PEP-related bacteraemia differ regarding the microorganism involved, the clinical presentation, and the prognosis. When the pacing system is involved, a complete explantation of the device is necessary to cure the infection. However, most episodes of bacteraemia arising outside the PEP, mainly those not caused by S. aureus, can be conservatively managed.

Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

To examine the temporal relationship between early enteral nutrition (EN) and coagulase-negative staphylococcal (CoNS)-related late-onset bacteremia (LOB) in very low birth weight (VLBW) neonates. Multivariate analyses performed on a large retrospective cohort of neonates admitted to a tertiary care neonatal unit. Due to the predominance and particular timing of CoNS, LOB occurred mostly during a critical period peaking at 9 days of age. This period also corresponded to a gestational maturation-dependent breakpoint in time to achieve full EN, associated with significant reduction in incidence of bacteremia (adjusted OR 0.15; 95%CI [0.10-0.20]; P<0.05). In subgroup analyses, more 'mature' (i.e. >or=28 and <32 weeks) preterm neonates reached full EN before this critical period and consequently, earlier EN in this group was associated with a shorter duration of PN and reduced incidence of CoNS bacteremia. In contrast, most 'immature' preterm neonates (i.e. <28 weeks) generally received PN beyond this critical period and therefore, did not appear to benefit from earlier initiation of EN. Even though EN was usually initiated earlier when formula milk was used as a complement to breast-milk, this practice was not associated with a reduction in the incidence of CoNS in any preterm gestational groups tested. A reduction in incidence of bacteremia was observed only in more mature VLBW neonates who achieved full EN before the second-week of life critical period for CoNS, These results provide important endpoints for future trials evaluating changes in nutritional interventions potentially effective in reducing neonatal LOB.

Significance of coagulase-negative staphylococci isolated from a single blood culture from neonates in intensive care

Coagulase-negative staphylococci (CoNS) are the most common pathogens of late-onset bacteraemia in neonatal intensive care units (NICUs). Discriminating true infection from contamination is difficult. To evaluate the significance of a single blood culture yielding CoNS from only one blood culture obtained from NICU infants between July 1999 and November 2000, paired blood cultures were obtained simultaneously from two peripheral sites from infants hospitalised in two NICUs with clinically suspected late-onset sepsis, and a single blood culture was obtained peripherally from infants hospitalised in a third NICU. Demographic data, predisposing factors, clinical manifestations, laboratory data, management and outcome of infants with either paired or single blood cultures yielding CoNS were analysed and compared. Both blood cultures yielded CoNS during 26 episodes in 24 infants. A single blood culture which grew CoNS from one blood culture was identified during 24 episodes in 23 infants. Except for prior use of an umbilical venous catheter, there was no significant difference between the infants with CoNS isolated from a paired or a single blood culture in terms of demographic characteristics, predisposing factors, clinical manifestations, laboratory findings, management and outcome. There was no difference in the clinical features of CoNS infection between single and paired CoNS-positive blood cultures.

CoNS Bacteremia in Neonates: Not Necessarily Benign

Coagulase-negative staphylococci (CoNS) are the most common agents of late-onset neonatal bacteremia. Disease is usually mild, and mortality is

Late-onset bacteremia in uncomplicated pediatric liver-transplant recipients after a febrile episode

The aim of this study was to analyze the incidence and risk factors of bacteremia after a febrile episode in uncomplicated pediatric recipients more than 2 months after liver transplantation, which has not previously been studied. This cross-sectional study was conducted over a 4-year period. Patients with known risk factors for sepsis at the time of admission were excluded from the study. Seventy-one patients were hospitalized on 128 occasions, with bacteremia occurring in the case of 11 admissions (8.6%). No laboratory tests were predictive of bacteremia. The bacteremic group most frequently presented with ill appearance ( P<0.001), lethargy ( P<0.01), decreased physical activity, and a history of early-onset bacteremia after transplantation and segmental graft ( P<0.05). This study identified a significant incidence of bacteremia in uncomplicated patients many months after liver transplantation.

Early and late onset bacteremia have different risk factors in trauma patients.

The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma. A prospective study conducted on 141 consecutive trauma patients. A general intensive care unit (ICU) of a university hospital. All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severity of coma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (chi 2 = 4.1, P = 0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1). Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.

Early and late onset bacteremia have different risk factors in trauma patients

Early and late onset bacteremia have different risk factors in trauma patients

Depositional environments and revised stratigraphy along the Black River-Trenton boundary in New York and Ontario

<h3>Background</h3> One in six infant deaths worldwide are caused by invasive bacterial infections, of which a substantial but unquantified proportion are caused by Gram-negative bacteria. <h3>Methods</h3> We conducted a systematic review of studies published from 31 May 2010 to 1 June 2020 indexed in MEDLINE, Embase and Global Health databases. We performed meta-analyses of the incidence of Gram-negative bacteraemia and of individual Gram-negative species as proportions of all infant bacteraemia, stratified by onset (early vs late) and country income (low/middle vs high). <h3>Results</h3> 152 studies from 54 countries were included, 60 in high-income countries (HIC) and 92 in low-income/middle-income countries (LMIC). Gram-negatives represented a higher proportion (53%, 95% CI 49% to 57%) of all infant bacteraemia in LMIC compared with HIC (28%, 95% CI 25% to 32%). Incidence of infant Gram-negative bacteraemia was 2.01 (95% CI 1.15 to 3.51) per 1000 live births; it was five times higher in LMIC (4.35, 95% CI 2.94 to 6.43) compared with HIC (0.73, 95% CI 0.39 to 7.5). In HIC, <i>Escherichia coli</i> was the leading Gram-negative pathogen, representing 19.2% (95% CI 15.6% to 23.4%) of early and 7.3% (95% CI 5.3% to 10.1%) of all late-onset bacteraemia; <i>Klebsiella</i> spp were the next most common cause (5.3%) of late-onset bacteraemia. In LMIC, <i>Klebsiella</i> spp caused 16.4% (95% CI 11.5% to 22.7%) of early and 15.0% (95% CI 10.1% to 21.8%) of late-onset bacteraemia, followed by <i>E. coli</i> (early-onset 7.50%, 95% CI 4.98% to 11.1%; late-onset 6.53%, 95% CI 4.50% to 9.39%) and <i>Pseudomonas</i> spp (early-onset 3.93%, 95% CI 2.04% to 7.44%; late-onset 2.81%, 95% CI 1.99% to 3.95%). <h3>Conclusion</h3> <i>E. coli</i>, <i>Klebsiella</i> and <i>Pseudomonas</i> spp cause 20%–28% of early-onset infant bacteraemia and 14% cases of infant meningitis worldwide. Implementation of preventive measures could reduce the high incidence of Gram-negative bacteraemia in LMIC. <h3>PROSPERO registration number</h3> CRD42020191618.