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Santiago Long
Santiago Long

Bacteriaemia


The incidence of bacteriaemia and bacteriogenic shock was studied in 2 series of patients undergoing urological procedures. In the first series (A), 52 of 4333 urological patients had symptoms of bacteriogenic shock. Twenty-five of these had a positive blood culture, giving an incidence of shock with proven bacteriaemia of 0.58%. In the second series (B) 628 patients had blood cultures taken after urological procedures with an incidence of bacteriaemia of 12.7%. Bacteriaemia is most common after prostatic surgery (transurethral prostatectomy 2.7%, retropubic, prostatectomy 37%, prostatic biopsy 20%), and is usually due to Esch. coli, Proteus species and Ps. aeruginosa. In hospital practice these organisms are unlikely to be sensitive to common antibiotics and initial therapy with an aminoglycoside is justified, while awaiting the results of blood culture.




bacteriaemia



This case report should make clinicians reflect on how complex the differential diagnosis between microliver abscesses and metastasis could be and the possibility of bacteriaemia by Y. enterocolitica even without iron overload conditions.


The typical symptomatology of liver abscesses reported in the literature is characterized by right upper abdominal pain, fever, jaundice and weight loss. Biliary infections represent the most common cause of bacterial liver abscesses [1], though other possible sources are IBD, bacteriaemia, hepatic traumas and suppurative appendicitis [2]. Enterobacterales, anaerobes [3] and Gram+ cocci are the most common pathogens involved in developing this pathology.


A possible explanation of the initial absence of fever and the negativity of the stool tests could be represented by the ciprofloxacin taken by the patients before hospital admittance; this therapy could have been partially effective, but it did not avoid bacteriaemia and the subsequent formation of microliver abscesses which caused the appearance of fever and the increase of the markers of inflammation.


In this case, we observed how challenging the differential diagnosis between hepatic metastases and microliver abscesses could be; furthermore, bacteriaemia by Y. enterocolitica cannot be excluded in patients with suggestive symptomatology even when there are no risk factors.


Dissemination of Staphylococcus aureus from the site of carriage into the bloodstream and its localisation at a traumatised portion of a bone were studied in four categories of mice, viz., carrier hypersensitive, carrier nonhypersensitive, non-carrier hypersensitive, and non-carrier non-hypersensitive. The provocations used were a pyrogenic stimulus, produced by intraperitoneal injection of 0.1 ml of modified Haffkine plague vaccine, and controlled trauma to the right hind leg, either alone or in combination. It was observed that transient bacteriaemia occurred during periods of induced fever or as a sequel to trauma. It is of interest that 27 per cent. of the hypersensitive carrier mice as opposed to 2 per cent. of the non-hypersensitive carriers showed positive blood culture. Among the non-carrier mice, positive blood culture was obtained from 2.5 per cent. of the hypersensitive animals only. Significantly, localisation of Staph. aureus at the injured bone was detectable in hypersensitive mice only.


Summary: According to the literature the bacteriaemia after sclerotherapy is between 4 and 53%, after ligation is between 0 and 25%. In patients having normal immune system, the bacteriaemia is only transient, and the clinical significance is very low. In case of an immunocompromised patient, serious complications may occur. Listeria infection can be due to esophagus tamponade, sclerotherapy, ligation. Blood cultures collected in fever after therapeutic endoscopic procedures can be useful discovering such rare complications.


Fontos, hogy az ismeretlen eredetű láz etiológiáját ismerjük. A szérum prokalcitoninszint jól korrelál a szepszis súlyosságával és specifikus a bakteriális etiológiára. A bakteriális vagy mycotikus szepszis legfontosabb diagnosztikai eszköze a hemokultúra. A mintavétel időpontjának meghatározásához ismernünk kell a bacteriaemia különböző formáit:


Intravascular devices (IVDs) are a crucial tool in the treatment of pediatric patients with diverse underlying diseases. They provide a reliable access site for frequent transfusions of blood products, prolonged intravenous medications, chemotherapy, apheresis, parenteral nutrition, and blood sampling. However, catheter-related bloodstream infections (BSIs) have emerged as the most important cause of infections in children with intravascular devices (IVDs) [1]. More than 80% of primary bacteriaemia are considered to be catheter associated in the adult population [2].


Second, no concomitant, peripherally drawn blood cultures were obtained as our standard of practice in order to minimize venipunctures in these children with significant venous access difficulties. A distinction between a BSI and contamination might be difficult when skin microbiota is isolated [21]. Gram-positive organisms, especially coagulase-negative staphylococci are judged more to be contaminants than gram-negatives in polymicrobial BSIs in pediatric patients [9]. In our case series, all patients had clinical symptoms of bacteriaemia, and therefore had a high a priori chance of having a true BSI. Furthermore, a low frequency of coagulase-negative staphylococci was found in the polymicrobial BSIs, compared to the monomicrobial BSIs. Furthermore, to be eligible for the ethanol-lock treatment and included in this secondary analysis the catheter-related BSI had to be persistent or recurrent, which suggests that these BSI are not likely to be contaminated. 041b061a72


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