Bacteremia:
Bacteremia is also known as a bloodstream infection (BSI). It is sometimes transitory, such as when we brush our teeth or have a dental procedure done, but bacteria in the blood is known as bacteremia. Blood is typically sterile, so a bloodstream infection is caused by a pathogen. Bacteremia is different than sepsis, in that sepsis is the body's inflammatory response to bacteria in the blood.
Bacteria can enter the bloodstream during another infection, such as pneumonia or a wound infection, cellulitis, or meningitis. It can also occur as the result of surgery, resulting from a surgical site infection (SSI). It can also occur as a result of a catheter, such as a midline, PICC line, IV line or port. If a foreign body enters the bloodstream, or a a device is colonized, such as a pacemaker, it can also cause bacteremia. IV drug abusers can get bacteremia.
Bacteremia can have negative implications on health, including an inflammatory immune response, resulting in sepsis or even septic shock, with fever, leukocytosis, and a drop in blood pressure. This has a high mortality rate. Bacteria can seed and spread to other parts of the body as well, which can lead to distant infections like endocarditis or osteomyelitis. The treatment for these infections is IV antibiotics.
The most common cause of bacteremia is Staphylococcus aureus, normally found on the skin. It can enter through a break in the skin, such as an ulcer or wound, a respiratory tract infection, or through an IV line or catheter or a break in the skin during surgery. Several types of streptococcus can also cause bacteremia, including Group A, Group B, Viridans, and S. bovis group. Enterococcus spp is also an important cause of bacteremia. E. coli bacteremia is associated with indwelling urinary catheters. Gram-negative Pseudomonas aeruginosa and Enterobacter spp are the most significant causes of bacteremia in ICU patients.
There are a number of risk factors associated with bacteremia, including:
Contaminated blood cultures can be suspected if only one bottle grows out Staphylococcus epidermidis or Cutibacterium acnes. Two blood cultures drawn from different areas of the body at different times that grow bacteria are sufficient to diagnose bacteremia. If only one set grows something, repeat blood cultures will be taken. Antibiotics should not be started prior to drawing blood cultures. The presence of a fever and chills are signs of infection, as are leukocytosis, focal or local signs and symptoms.
"The Infectious Disease Society of America (IDSA) recommends treating uncomplicated methicillin resistant staph aureus (MRSA) bacteremia with a 14-day course of intravenous vancomycin".
Bacteria can enter the bloodstream during another infection, such as pneumonia or a wound infection, cellulitis, or meningitis. It can also occur as the result of surgery, resulting from a surgical site infection (SSI). It can also occur as a result of a catheter, such as a midline, PICC line, IV line or port. If a foreign body enters the bloodstream, or a a device is colonized, such as a pacemaker, it can also cause bacteremia. IV drug abusers can get bacteremia.
Bacteremia can have negative implications on health, including an inflammatory immune response, resulting in sepsis or even septic shock, with fever, leukocytosis, and a drop in blood pressure. This has a high mortality rate. Bacteria can seed and spread to other parts of the body as well, which can lead to distant infections like endocarditis or osteomyelitis. The treatment for these infections is IV antibiotics.
The most common cause of bacteremia is Staphylococcus aureus, normally found on the skin. It can enter through a break in the skin, such as an ulcer or wound, a respiratory tract infection, or through an IV line or catheter or a break in the skin during surgery. Several types of streptococcus can also cause bacteremia, including Group A, Group B, Viridans, and S. bovis group. Enterococcus spp is also an important cause of bacteremia. E. coli bacteremia is associated with indwelling urinary catheters. Gram-negative Pseudomonas aeruginosa and Enterobacter spp are the most significant causes of bacteremia in ICU patients.
There are a number of risk factors associated with bacteremia, including:
- Hospitalization
- ICU
- Diabetes mellitus
- Cancer
- HIV
- Ongoing chronic hemodialysis
- Having had an organ transplant
- Having had a stem cell transplant
- Being on chemotherapy
- Liver failure
- Spleen removal
- Glucocorticoid therapy
- Having artificial heart valves
Contaminated blood cultures can be suspected if only one bottle grows out Staphylococcus epidermidis or Cutibacterium acnes. Two blood cultures drawn from different areas of the body at different times that grow bacteria are sufficient to diagnose bacteremia. If only one set grows something, repeat blood cultures will be taken. Antibiotics should not be started prior to drawing blood cultures. The presence of a fever and chills are signs of infection, as are leukocytosis, focal or local signs and symptoms.
"The Infectious Disease Society of America (IDSA) recommends treating uncomplicated methicillin resistant staph aureus (MRSA) bacteremia with a 14-day course of intravenous vancomycin".
References:
Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P. (2011-02-01). "Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases. 52 (3): e18–55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
sepsis:
Sepsis is the immune system's inflammatory response to the presence of bacteria in the blood. Sepsis can be life-threatening and has a high mortality rate (30%-50%). The mortality rate for septic shock is up to 80%. The most common signs and symptoms include:
Causes include:
- Fever
- Tachycardia
- Increased breathing rate
- Confusion
- Cough
- Edema
- Hematuria
- Painful urination
- Frequency
- Urgency
- Weakness
- Low rather than high temperature
- Poor organ function
- Poor blood flow/circulation
- Low blood pressure
- High blood lactate
- Low urine output
- Metabolic acidosis
- Septic shock: does not improve with IV fluids; blood pressure remains low
Causes include:
- Bacteria
- Fungi
- Viruses
- Parasites
- Lungs
- Brain
- Urinary tract
- Skin
- Abdominal organs
- Being very young
- Being very old
- Weak immune system
- Cancer
- Diabetes mellitus
- Burns
- Major trauma
- Increased breathing rate
- Change in level of consciousness
- Low blood pressure
- IV fluids
- IV antibiotics
- ICU
- Meds to raise blood pressure if IV fluids aren't working
- Potential mechanical ventilation
- Potential dialysis
- Potential central venous catheter or arterial catheter may be needed for treatment and access to the bloodstream
- Checking of oxygen saturation rates and cardiac output
- Prevention of DVT
- Prevention of stress ulcers
- Prevention of pressure ulcers
- Control of blood sugar