Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
-
Bacterial meningitis remains a highly lethal disease in older adults, with mortality rates averaging >20% despite modern antibiotic therapy. In this population, more variable presentations are seen, with fewer patients manifesting fever, neck stiffness, and headache than among younger adults. In addition, many older adults (aged > or =60 years) may have other underlying diseases causing symptoms that may be confused with those of meningitis. ⋯ Therapy is complicated by both the range of possible causative organisms and the increasing antibiotic resistance manifested by some. These difficulties, contrasted with the success of vaccination in the pediatric population, highlight the need for improved preventive strategies for older adults. This review outlines some key clinical points in the management of bacterial meningitis in the older adult.
-
All patients admitted to the medical and surgical intensive care units of a 500-bed nonteaching suburban hospital were followed prospectively for the occurrence of nosocomial primary bloodstream infections for 21 months. The incidence of primary bloodstream infection was 38 (1%) of 3163 patients; among patients with central venous catheters, it was 34 (4%) of 920 patients, or 4.0 infections per 1000 catheter-days. ⋯ Bloodstream infection, however, was not an independent risk factor for death. The incidence, risk factors, and serious outcomes of bloodstream infections in a nonteaching community hospital were similar to those seen in tertiary-care teaching hospitals.
-
The statins, inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, act to regulate the biosynthesis of cholesterol. Statins also deplete nonsterol cholesterol precursors, the isoprenoids, which are necessary for prenylation of critical membrane proteins that regulate cellular communication, including the inflammatory response. ⋯ Among the statin group, diabetes, hypertension, and coronary artery disease were more prevalent (P<.001), and there were more skin and soft tissue infections identified as sources of bacteremia (P=.008). These data suggest a potential clinical role of statins in bacteremic infection; however, the mechanism by which mortality is reduced remains undefined.
-
Nosocomial bacteremia caused by Acinetobacter baumannii (AB) is of increasing concern in critically ill patients, and the risk factors for this infection are not well established. An inception cohort study in a 40-bed medical and surgical intensive care unit (ICU) at a single institution was conducted during a 2-year period to determine the risk factors for AB nosocomial bacteremia. ⋯ We defined an "invasive procedures index" as the number of invasive procedures performed every day during the ICU stay before the onset of AB bacteremia divided by the number of days in the ICU before the onset of AB bacteremia. Risk factors that were independently associated with AB bacteremia were immunosuppression, unscheduled admission to the hospital, respiratory failure at ICU admission, previous antimicrobial therapy, previous sepsis in the ICU, and the invasive procedures index.