Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS

BACKGROUND: Previous antibiotic exposure may inhibit the growth of microorganisms in blood culture bottles. The authors investigated the frequency of previous antibiotic usage and analyzed the relationships among antibiotic usage, microbiological culture results and mortality of sepsis patients. METHODS: From April to May 2011, all blood cultures requested from inpatients were analyzed according to the admitted ward and antibiotic prescription records. The BacT/Alert 3D system (bioMerieux Inc.) was used with a standard bottle (SA, SN) for blood culture. RESULTS: Of 900 inpatients, 48% had been receiving antimicrobial agents when blood cultures were ordered. This group had a significantly higher mortality rate (36.2%) compared to the patients who had not received antibiotics (11.1%). Gram-negative rod bacteremia (37.1%) and candidemia (100%) resulted in a significantly higher mortality rate compared to Gram-positive cocci bacteremia (16.4%). In the analysis of 21 cases resulting in death, 15 (71.4%) patients died before or on the date when blood culture results were reported. CONCLUSION: Patients who receive antibiotics prior to blood collection may be at a higher risk for mortality. In the present study, Gram-negative rod bacteremia and candidemia cases showed a rapid progression of sepsis as indicated by Gram staining and thus should be regarded seriously.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteremia ; Candidemia ; Gram-Positive Cocci ; Humans ; Inpatients ; Prescriptions ; Sepsis ; Sydnones

Endotoxemia ; diagnosis ; Endotoxins ; analysis ; Humans ; Sepsis ; diagnosis

Severe sepsis and septic shock is a life-threatening disease. It is combined with multi-organ failure. In the past decade, early goal directed therapy has been proposed as an effective treatment strategy for better outcome. Recent epidemiologic studies showed that the outcome of sepsis has been improved with the introduction of early goal directed therapy. However, it is unclear which elements of early goal directed therapy contributed to the better outcome. Recent prospective and randomized trials suggested that some elements of early goal directed therapy did not have any effect on the outcome benefit. In this paper, recent articles about early goal directed therapy will be reviewed and the effectiveness of individual elements of early goal directed therapy will be discussed.
Sepsis* ; Shock, Septic

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.
Aged ; Anemia, Aplastic* ; Bacteremia ; Cellulitis ; Ecthyma ; Erythema ; Humans ; Immunocompromised Host ; Klebsiella* ; Pneumonia* ; Sepsis ; Shock, Septic ; Skin ; Track and Field

BACKGROUND: Catheter-related sepsis (CRS) has become an important cause of nosocomial infections and the major complication with the intravenous central venous catheter (CVC) use. In this paper, we present the culture results of two years from Chonnam National University Hospital on the etiologic agents of CRS. METHODS: We reviewed the culture results for the most recent two years (July 1999 to June 2001) including semiquantitative CVC tip cultures (n=622) and differential quantitative blood cultures (n=149), as well as hospital records to determine clinical correlates of CRS. CRS was defined as a positive blood culture and catheter culture with the same organism in conjunction with a CVC tip >or=15 CFU or a central-to-peripheral blood culture colony count ratio of >or=5 :1. RESULTS: Forty-two (6.8%) of 622 CVC tip cultures and 13 (8.7%) of 149 differential quantitative blood cultures were associated with CRS. A total of 48 (32.0%) of 150 patients with bacteremia or candidemia were confirmed as having CRS, using semiquantitative tip cultures (30.9%, 42 of 136) and/or differential quantitative blood cultures (27.1%, 13 of 48). Twenty-one (48.8%) of 43 candidacies patients were associated with CRS and were more frequent than bacteremia due to Gram-positive cocci (27.3%, 18 of 66), and Gram-negative bacilli (23.1%, 9 of 39)(P<0.05). In 48 cases with proven CRS, Candida parapsilosis (29.2%) and Staphylococcus aureus (25.0%) were the most common etiologic agents, followed by coagulase negative Staphylococcus (10.4%), and Acinetobacter baumannii (8.3%). CONCLUSIONS: In culture proven cases of CRS, C. parapsilosis and S. aureus were the predominant causative organisms, and candidemia was more frequently associated with CRS than was bacteremia.
Acinetobacter baumannii ; Bacteremia ; Candida ; Candidemia ; Catheters ; Central Venous Catheters* ; Coagulase ; Cross Infection ; Gram-Positive Cocci ; Hospital Records ; Humans ; Jeollanam-do ; Prevalence* ; Sepsis* ; Staphylococcus ; Staphylococcus aureus

Enterococcus hirae is a member of the Enterococcus genus and is known to cause infections in animals, but it is uncommonly encountered in clinical isolates from humans. We isolated E. hirae from blood of a patient with acute pyelonephritis and sepsis. This is the first case report of bacteremia caused by E. hirae in Korea.
Animals ; Bacteremia ; Enterococcus* ; Humans ; Korea ; Pyelonephritis* ; Sepsis*

Enterococcus hirae is a member of the Enterococcus genus and is known to cause infections in animals, but it is uncommonly encountered in clinical isolates from humans. We isolated E. hirae from blood of a patient with acute pyelonephritis and sepsis. This is the first case report of bacteremia caused by E. hirae in Korea.
Animals ; Bacteremia ; Enterococcus* ; Humans ; Korea ; Pyelonephritis* ; Sepsis*

The Philippine General Hospital (PGH) has the most number of high-risk infant admissions locally. Neonatal bacteremia and sepsis are the perennial problems encountered. Previous researches may not be reflective of the current situation in the Neonatal Intensive Care Unit (NICU) of PGH, thus an updated study on neonatal bacteremia becomes important. Objectives: This study was performed to describe the clinical profile of neonates born with positive blood cultures together with the new criteria for sepsis as defined by the 2001 International Pediatric Consensus Conference at PGH from July to December 2006. Methods: A prospective chart review of all neonates born with positive blood cultures at UP-PGH from July 1 to December 31, 2006 was performed. Demographic, clinical, and laboratory data were then analyzed. Results: Out of 3,870 live births, 103 (2.6%) patients with positive blood cultures fulfilled the criteria of sepsis. Mothers were around 20 to 25 years of age comprising 35 (34%), less than half had prenatal check-ups and more than 2/3 had not maternal immunizations. Fifty-eight (56%) of the neonates were males, 68 were premature (66%), 76 were appropriate for gestational age (74%), and 37 were of low birth weight (36%). Most patients (62 or 60%) developed sepsis within the first 3 days of admission, while 65 (63%) patients had pneumonia. The most common organisms isolated were Pseudomonas putida (50 or 49%), Burkholderia mallei (15 or 15%) and Burkholderia cepacia (8 or 8%). The organisms were sensitive Ceftazidime, Cefepime and Piperacillin-Tazobactam. Of 103 subjects, 58 or 56% fulfilled the criteria for systemic inflammatory response syndrome (SIRS) for sepsis. Multivariate analysis showed that those with SIRS were 4.89 times more likely to die than those without SIRS. Conclusion: Sepsis usually develops among neonates in less than 72 hours after their delivery at PGH. The neonates who were prone to develop sepsis were those who are male, premature, appropriate for gestational age, and of low birth weight. The organisms that predominate in PGH are usually gram-negative pathogens. The number of hospital-acquired infection is significant. SIRS could be an important prognostic factor in affecting outcome and may aid significantly in the proper diagnosis of sepsis in newborns.
Human ; Male ; Female ; Infant Newborn ; BACTEREMIA ; SEPSIS

No abstract available
Sepsis*