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November 29, 1976

Percussion and Gram-Negative Bacteremia

Author Affiliations

Members, Class of 1977 Georgetown University School of Medicine Washington, DC

JAMA. 1976;236(22):2489-2490. doi:10.1001/jama.1976.03270230013009

To the Editor.—  Urinary tract infections are implicated as the source for about two thirds of all cases of bacteremia caused by enteric bacteria.1 As Shubin and Weil (235:421, 1976) point out, the majority of cases of bacteremic shock is precipitated by some manipulative procedure; they mention insertion of a catheter into the bladder, genitourinary and gastrointestinal surgery, and manipulation of infected wounds. In our experience as medical students, yet another procedure, percussion in the costovertebral angles in patients with pyelonephritis, has been associated with Gram-negative bacteremia and shock.

Report of Cases. Case 1.—  A 60-year-old woman entered the hospital complaining of right flank pain, nausea, vomiting, fever, shaking chills, and malaise. She was essentially well until three days prior to admission, and before this episode had not been under the care of a physician for the last 20 years. Before admission, she had received cephalexin monohydrate, but she