ABSTRACT
Bacteremia due to a newly described species of Corynebacterium was identified in 12 patients during a two-year period. Infection occurred after a long period of hospitalization, extended granulocytopenia, and treatment with several antibiotics. Breaks in the mucocutaneous surfaces were the origin of infection in eight patients. All patients had evidence of colonization reported by cultures before infection. The invading organism caused death in three patients. Vancomycin hydrochloride was the antibiotic of choice. Corynebacterium is increasingly recognized as a primary cause of morbidity and mortality of patients with tumors.
Subject(s)
Antineoplastic Agents/adverse effects , Corynebacterium Infections/complications , Disease Susceptibility , Neoplasms/complications , Sepsis/etiology , Adult , Aged , Antineoplastic Agents/therapeutic use , Corynebacterium Infections/drug therapy , Female , Humans , Immunity/drug effects , Male , Middle Aged , Neoplasms/drug therapy , Vancomycin/therapeutic useABSTRACT
Twenty-nine patients with bacteremia due to Corynebacterium vaginale, an inhabitant of the female genital tract, are described. Four were newborn babies. Nineteen were healthy young women delivered at full term by an operative procedure, cesarean section, or episiotomy. Within 48 hours fever and bacteremia developed. While receiving antibiotics the fever returned to normal, usually within 48 hours. The remaining cases were associated with septic abortion, tubal pregnancy, an intrauterine device, hydatidiform mole, and cellulitis. None of the adults showed evidence of brain abscess, meningitis, or endocarditis. Corynebacterium vaginale is an opportunistic minor pathogen that apparently gains access to the blood stream via an exposed vascular bed rather than as the result of immunosupression.
Subject(s)
Gardnerella vaginalis/isolation & purification , Haemophilus Infections/microbiology , Haemophilus/isolation & purification , Sepsis/microbiology , Adolescent , Adult , Drug Resistance, Microbial , Female , Genital Diseases, Female/complications , Humans , Infant, Newborn , Infant, Newborn, Diseases/microbiology , Pregnancy , Pregnancy Complications , Pregnancy Complications, Infectious , Sepsis/drug therapyABSTRACT
In order to optimize the clinical management of fever in acute myelocytic leukemia (AML), our experience with febrile patients during two therapy periods was reviewed. A structured approach to the management of fever was then devised and evaluated during a third period. Among a total of 104 patients with AML, 77 were febrile at presentation. Only agranulocytic patients (15%) had severe infection, while 43% had localized sites which responded to specific antibiotic therapy. The remainder (42%) had fever functionally attributed to leukemia. In contrast, life-threatening infection occurred in most patients (90%) after antileukemic treatment was begun. During the trial therapy period, the empiric use of carbenicillin-gentamicin for fever greater than or equal to 101 degree F during aplasia reduced the incidence of sepsis from 90 to 30% and of bacteremia from 50 to 23%. The fall in the incidence of blood and localized site cultures positive for Pseudomonas aeruginosa from 65 to 15% corresponded to a reduction in the number of distinct organisms per site from 1.6 to 1.0. These data suggest that hematogenously born invasion of infected sites by endogenous organisms has been prevented. Aplastic patients with fever responded to therapy by defervescing (54%) or improving clinically (34%). Stopping antibiotics once started while evaluating persistent fever was detrimental. Although the early empiric use of amphotericin B reduced the incidence of fungemia, its proper use in fever management is yet to be determined.
