RRML - Bloodstream infections in the Cardiovascular Surgery Clinic Iaşi, Romania

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Nr. 19(1)/2011

Bloodstream infections in the Cardiovascular Surgery Clinic Iaşi, Romania

Eduard Dabija, Maria Dan, Daniela Bosnea, Rucsandra Danciulescu Miulescu, Vasilica Cristescu, Carmen Panzaru, Grigore Tinica

Abstract:

Objectives: to analyze the aetiology, the origin, epidemiologic features and outcome of bloodstream infections in patients that underwent cardiovascular surgery. Methods: A retrospective study of bloodstream infections was conducted between 27th April 2001 – 26 June 2010 in the Cardiovascular Surgery Clinic of Iasi, Romania. Results: We detected 114 consecutive bloodstream infections in a number of 4304 hospitalizations. Bacteraemia was secondary to an infectious body site in 53.50% of the episodes. Cell-wall deficient forms (52.63%) were the most prevalent microorganisms (78 strains, out of which 53 reverted to the classical state and 25 were L – stable), followed by Gram-positive cocci, Gram-negative bacilli, Gram-positive bacilli, fungi, HACEK group and anaerobes. Conclusions: We found a high proportion of cell wall deficient forms, rarely reported before. This may be due to blood culture collection under antimicrobial therapy (p=0.016), especially β-lactams, and/or the use of more adequate blood culture methods (acridine orange stain for microscopy of the blood culture and reversion media). The therapy of the infections with cell wall deficient forms raises particular problems. For systemic infections associations of chloramphenicol + spiramycin, erythromycin + cephalotin, chloramphenicol + tetracyclin could be adequate treatment, but currently we are collecting more data in order to establish therapeutic protocols.

Keywords: nosocomial bloodstream infections, L-forms, cell wall deficient forms, acridine-orange stain, blood culture, cardiovascular surgery, bacteremia, infective endocarditis.

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Dabija E, Dan M, Bosnea D, Danciulescu Miulescu R, Cristescu V, Panzaru C, et al. Bloodstream infections in the Cardiovascular Surgery Clinic Iaşi, Romania. Rev Romana Med Lab. 2011;19(1):27-35