Bacteremia DANIEL

and the

H. SCHIMMEL,”2

LAURENCE

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AND

antimicrobiotic

medication

during

the

barium enema examination performed radiographic

least

are

2,500,000

done

in the

United

Of the 42 patients, 38 had normal findings on the barium enema examination. The remaining four patients had diverticulosis. There was no evidence of diverticulitis. None of the patients demonstrated bacteremia due to an enteric organism prior to the enema. Of the 126 separate cultures, only one pour plate grew out a colony of enterococcus. This was from the 1 0 mm blood sample of

preceding at

one

is one of the procedures; at States

each

COHEN,4

Results

patient

Several

The conventional most frequently

STEPHEN

I. GOLDBERG’

To investigate the possible association of bacteremia with barium enema examinations, blood samples were obtamed from 42 patients before and at 5, 10, and 20 mm after administration of the enema. Patients with fever or symptoms suggestive of inflammatory bowel disease were not included in the study; neither were patients who had

received

Enema

G. HANELIN,”3

HENRY

3 months. Pour-plate blood cultures showed no bacteremia due to enteric organism in the 42 patients-a result variance with previously published reports.

Barium

and,

pour

we

plates

believe,

grew

species or Staphylococcus both considered common

year

An

unusual

submucosal

complication

of the

veins

emboli [3]. A report

of septicemia

is barium

colon,

leakage

which

following

results

a barium

into

in

175

patients

who

underwent

enema examination. Using methods arrive at quite different conclusions.

Subjects

and

similar

contaminants

[5]

of each

patient

immediately

the

and

we

after

23,

1976;

accepted

after

revision

November

even

higher

than

unable

to

detect

any

since

it was

not

Present

address

Present address: Department of

Am

J Roentgenol

128:207-208.

of Radiology, Harbor General Medicine, University of California February

1977

with

the

incidence

associated

bacteremia

of with How-

due

analogous

to

the

42

patients in our bacteremia

patients (10%) developed examination. In the 115 gastrointestinal diseases, (12%)

developed

LeFrock

et al.

of enterococcal ular disease induced

the

barium

or valvular

enema

an

earlier

study. after

cultures

our

results

sampling

In that 60

of

tract

and

study, whom

disease,

Six of those barium enema

patients with a variety of lower including ulcerative colitis, 14

bacteremia.

[51 raised endocarditis

by barium

to

of enterococcus obrepresented contamiin

the

question

prostheses

enema.

poses

of

in patients We

increased

risk

cardiac

valv-

with

as a result are

not

a risk to these

yet

of bacteremia convinced

that

patients.

1976.

in part by U.S. Public Health Service grant GM 01272 from the National Institutes of Health. University of california School of Medicine. San Francisco, California 94143 Address reprint Department of Radiology. Wright Patterson Air Force Base Medical Center. Dayton. Ohio 45433

Department Laboratory

the

that

present

This work was supported Department of Radiology. 2

found

organism. The single colony in one late culture probably

nation,

spot

2,

be

in association

They

of that patient. We cannot explain the difference between and those of LeFrock et al. 15. 61, in which culture techniques were almost identical. 175 hospitalized patients were examined. had no history of lower gastrointestinal

(5 mm). overhead filming (10 mm), and evacuation (20 mm). The venipuncture site was prepared with povidone-iodine (Betadine’, Purdue Frederick, Yonkers. N.Y.). A 19-gauge butterfly infusion needle was introduced into the vein and 2.5 ml of venous blood drawn into a heparin-rinsed sterile syringe; then 0.5 ml was flushed back into the infusion set. The syringe was removed and replaced with a new heparin-rinsed syringe for the next sampling. The barium enema was begun and blood cultures were subsequently obtained at the times indicated. Pour plates containing 1 ml of each blood sample were prepared with melted trypticase soy agar and Shaedler’s agar and processed as described by LeFrock et al. [6].

August

bacteremia

examination.

to

were

enteric served

filming

Received

surface,

sigmoidoscopy ( 1 1 .4% compared to 9.5%) I 5. 6 I. ever, in another recent study involving colonoscopy. a procedure which involves more manipulation of the colon and rectum than sigmoidoscopy, no bacteremia was found [12].

barium

We

enema

transient

enema

bacteremia

Methods

before

reported

barium

The series included 42 patients undergoing barium enema examinations. None had received antimicrobial agents during the preceding 3 months and none had fever or symptoms suggestive of inflammatory bowel disease. The techniques of blood sampling, amount of blood removed. and culturing methods were similar to those outlined by LeFrock et. al [5, 6]. Blood was obtained from an antecubital or forearm vein

of bacillus the

that transient bacteremia occurs in in association with dental trauma 8]. urological manipulation 191, percutaneous liver biopsy [10], and sigmoidoscopy [6, 11 1. Recently, LeFrock et al.

exam-

to theirs,

on [7].

It is well known humans, particularly

the

ination in a patient with leukemia [4] prompted us to investigate the association of bacteremia with this procedure. LeFrock et aI. [51 recently reported an 1 1 .4% incidence of,bacteremia

colonies

Discussion

in barium

enema

a contaminant.

or two

epidermidis

[1 1. Complications from this procedure are rare and consist mainly of either perforation or rupture of the colon [2].

represents

out one

Hospital. School

of

1000 West Medicine.

207

Carson Street, San Francisco,

Torrance, California

California 94143

requests

90509.

to

H

I. Goldberg.

SCHIMMEL

208

REFERENCES 1 - Thomas

SF:

All

speed

and

no

control

(editorial).

89:889-890. 1963 2. Seaman WB, Wells J: Complication of the Gastroenterology 48:728-737. 1965

Am

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Roentgenol

3. Cove JKJ, Snyder RN: barium enema. Radiology 4.

Richman

cemia:

LS. Short Occurrence

226:62-63, 5. LeFrock

barium

enema.

Fatal barium 112:9-10,

intravasation during 1974 WF. Cooper WM: Barium enema septiin a patient with leukemia. JAMA

1973 J,

Ellis CA,

Klainer

AS,

Weinstein

L:

Transient

bacteremia associated with barium enema. Arch Intern Med 135:835-837, 1975 6. LeFrock JL, Ellis CA, Turchik JB, Weinstein L: Transient bacteremia associated with sigmoidoscopy. N Engl J Med 289:467-469, 1973

J

ET AL.

7. MacGregor RR, Beaty HN: Evaluation of positive blood cultures. Arch Intern Med 130:84-87, 1972 8. Murray M, Moosnick F: Incidence of bacteriemia [sic] in patients with dental disease. J Lab Clln Med 26:801-802, 1941 9. Slade N: Bacteraemia and septicaemia after urological operations. Proc R Soc Med 51:331-334, 1958 10. LeFrock JL, Turchik JB, Weinstein L: Transient bacteremia associated with percutaneous liver biopsy. J Infect Dis 131 :S104-S107, 1975 11. Lal D, Levitan ‘R: Bacteremia following proctoscopic biopsy of a rectal polyp. Arch Intern Med 130:127-128, 1972 1 2. Norfleet RG, Mulholland DD, Mitchell PD, Philo J. Walters EW: Does bacteremia follow colonoscopy? Gastroenterology 70:20-21, 1976