Burns
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
Infection and sepsis are involved in 75–85% of all burn injury deaths (Liu). Defining sepsis in burn patients is problematic due to the always present concurrent hypermetabolic response. Systemic inflammatory response syndrome (SIRS), the typical hallmark of sepsis, is present in most burn patients and therefore not helpful. The 2007 American Burn Association Consensus Conference defined sepsis in burns as three or more changes in temperature, heart rate, respiration rate, platelet abnormalities, hyperglycemia, or inability to continue enteral feedings which should trigger a search for infection (Greenhalgh). Typical causes of bacteremia include Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Enterococci, Acinetobacter, and perhaps the most well know burn-associated pathogen, Pseudomonas aeruginosa. Resistant organisms are becoming more common (Lundy). It should be noted that burn patients are often excluded from major sepsis trials (Greenhalgh), greatly limiting our understanding of sepsis in burn injuries.
Skin and Soft Tissue Infections
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
In addition to debridement, systemic antibiotics are indicated in the presence of systemic signs of infection or underlying osteomyelitis. A variety of empirical antibiotic regimens have been suggested for patients with pressure ulcer-associated cellulitis, osteomyelitis, or bacteremia. Bacteremia in this situation is usually caused by Pseudomonas mirabilis, S. aureus, or Bacteroides fragilis (12). Any antibiotic that is active against the majority of organisms that are causing pressure ulcer infection is appropriate. In the absence of osteomyelitis, a 10-14-day course of antibiotic treatment is commonly administered, but no studies have carefully defined the duration of therapy. If osteomyelitis is present, it requires a more extended (6 weeks or longer) course of therapy. Frequently, bone debridement is also necessary for optimal healing. In older patients or the presence of renal failure, the dose of antibiotics that are excreted in the kidney should be adjusted appropriately.
Bacterial and Atypical Mycobacterial Infections
Clay J. Cockerell, Antoanella Calame in Cutaneous Manifestations of HIV Disease, 2012
First identified in 1983, bacillary angiomatosis (BA) is a vascular infection caused by Bartonella species. It is a rare cutaneous disease that presents most commonly in moderately immunocompromised HIV-positive patients, such as those with CD4 cell counts of less than 200 × 106/l. Some studies suggest that the incidence of BA within the HIV-positive population is approximately 0.1%. The etiological agents have been identified as both Bartonella henselae, the organism responsible for cat scratch disease, and Bartonella quintana, the causative organism of trench fever. The skin as well as many different visceral organs may be involved, but the most common extracutaneous site of involvement is the liver, with peliosis hepatis. Bacteremia and sepsis are also complications.24
Defining microbial invasion of the bloodstream: a structured review
Published in Infectious Diseases, 2020
We have previously argued for the precision in the use of terms to define microbial invasion of the bloodstream and listed preferred definitions [4]. Bacteraemia is most commonly defined as presence of viable bacteria in the bloodstream of a patient. While debate exists about the role of newer molecular based techniques, a positive blood culture in order to demonstrate viability of the infecting organism is widely viewed as mandatory [11]. We believe that implicit within the definition of bacteraemia is that contaminants, by virtue of not actually being present in the bloodstream of a patient, must be excluded [12]. Further, bacteraemia may be transient (intermittent) or persistent (continuous) [13]. Fungaemia is the analogous situation where fungal as opposed to bacterial pathogen is aetiology. The term bloodstream infection may be defined as positive blood culture associated with clinical disease where contamination has been ruled out. This term has advantages in that it is inclusive of all microbial aetiologies and excludes non-clinically significant events. It is effectively equivalent to persistent or continuous bacteraemia/fungaemia. Although subtly different, blood culture positivity, bacteraemia/fungaemia and bloodstream infection are not synonymous.
Differences in the distribution of pathogens and antimicrobial resistance in bloodstream infections in migrants compared with non-migrants in Denmark
Published in Infectious Diseases, 2023
Rikke Thoft Nielsen, Christian Østergaard Andersen, Henrik Carl Schønheyder, Jørgen Holm Petersen, Jenny Dahl Knudsen, Jens Otto Jarløv, Marie Norredam
Bloodstream infection was defined as true bacteraemia detected in blood cultures. All departments use automated blood culture systems (Bactec™ [BD, Franklin Lakes, NJ, USA] or BacT/Alert® [bioMérieux, Marcy l’Etoil, France]). Pathogen identification was obtained by conventional methods and often aided by automated methods like Vitek®2 (bioMérieux) or MALDI-TOF (Bruker, Bremen, Germany) [26]. Susceptibility testing was performed using standard microbiological procedures initially using guidelines from the Swedish Reference Group for Antibiotics and subsequently the European Committee on Antimicrobial Testing. We included susceptibility testing for penicillin, dicloxacillin, ampicillin, piperacillin-tazobactam, cefuroxime, ciprofloxacin, and gentamicin. We divided the pathogens into 10 groups: S. aureus, S. pneumoniae, beta-haemolytic Streptococci, Enterococcus species, other Gram-positive bacteria, E. coli, other Enterobacterales, other Gram-negative bacteria, and fungi.
Escherichia coli and Staphylococcus aureus: leading bacterial pathogens of healthcare associated infections and bacteremia in older-age populations
Published in Expert Review of Vaccines, 2018
Jan T. Poolman, Annaliesa S. Anderson
Bacteremia is often the result of exposure to healthcare-related procedures or interventions, either in a hospital or in an outpatient setting. While bacteremia is mostly community-onset, half of these infections occur in people who are receiving specialized medical services at home or at outpatient clinics; who are residing in long-term care facilities; or who have been discharged recently from hospitals [7]. Community-onset healthcare-associated bacteremia (when infection is associated with outpatient treatment that takes place in communities) has been rising at a faster pace than community-associated (when infection is not associated with healthcare) or hospital-acquired infections (Figure 1). For example, in Denmark, a substantial 14-fold increase in healthcare-associated bacteremia was observed between 1992 and 2006, rising from a low incidence of 3 to 40 per 100,000 persons [4]; in Sweden the incidence of community-onset bloodstream infections (BSIs) rose by 83% between 2000 and 2013 [8], and in Canada by 67% between 2010 and 2015 [9]. The ever-growing pressure on healthcare systems that forces patients to be discharged from hospitals early and receive further care at home or in short-term care facilities is likely to explain in part the specific rise of community onset infections.
Related Knowledge Centers
- Asepsis
- Fungal Infection
- Fungemia
- Meningitis
- Pneumonia
- Blood
- Infection
- Sepsis
- Pathogenic Bacteria
- Blood Culture