Bacteremia

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Bacteremia
ICD-10 A49.9 (NOS)
ICD-9 790.7
MeSH D016470

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Bacteremia (Bacteræmia in British English, also known as blood poisoning or toxemia) is the presence of bacteria in the blood. Bacteremia is different to sepsis in that it refers to the presence, not the replication, of pathogens.

Diagnosis

Bacteremia is most commonly diagnosed by blood culture, in which a sample of blood is allowed to incubate with a medium that promotes bacterial growth. Since blood is normally sterile, this process does not normally lead to the isolation of bacteria. If, however, bacteria are present in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected. Any bacteria that incidentally find their way to the culture medium will also multiply. For this reason, blood cultures must be drawn with great attention to sterile process. Occasionally, blood cultures will reveal the presence of bacteria that represent contamination from the skin through which the culture was obtained. Blood cultures must be repeated at intervals to determine if persistent — rather than transient — bacteremia is present.

Excluding endocarditis

A clinical prediction rule aids in identifying patients with bacteremia from staphylococcus aureus who might develop bacterial endocarditis.[1]

Causes

Consequences

Bacteremia is the principal means by which local infections are spread to distant organs (referred to as hematogenous spread). Bacteremia is typically transient rather than continuous, due to a vigorous immune system response when bacteria are detected in the blood. Hematogenous dissemination of bacteria is part of the pathophysiology of meningitis, endocarditis, aortitis, Pott's disease and many other forms of osteomyelitis.

A related condition, septicemia, refers to the presence of bacteria or their toxins in the bloodstream.

Bacteremia, as noted above, frequently elicits a vigorous immune system response. The constellation of findings related to this response (such as fever, chills, or hypotension) is referred to as sepsis. In the setting of more severe disturbances of temperature, respiration, heart rate or white blood cell count, the response is characterized as sepsis syndrome, septic shock, and may result in multiple organ dysfunction syndrome.

Follow-up

In some settings, blood cultures should be repeated to verify cure[2][3][4]:

  • Original infection was gram positive cocci[2][3] including enterococci[5]
  • Central venous catheter[2] or endovascular source[3] presence
  • Hemodialysis[2]
  • Persistent fever[2]

Follow-up blood cultures may be positive with the same pathogen in 7%[3] to 10%[4] to 14%[2] of patients.

If repeat blood cultures are obtained in the initial 72 hours of antibiotics, a higher rate of 46% are positive[6].

Repeating blood cultures among patients with intravenous catheters may require special methods[7].

See also

External links

References

  1. Kaasch AJ, Fowler VG, Rieg S, Peyerl-Hoffmann G, Birkholz H, Hellmich M; et al. (2011). "Use of a Simple Criteria Set for Guiding Echocardiography in Nosocomial Staphylococcus aureus Bacteremia.". Clin Infect Dis. 53 (1): 1–9. PMID 21653295. doi:10.1093/cid/cir320. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Canzoneri CN, Akhavan BJ, Tosur Z, Andrade PEA, Aisenberg GM (2017). "Follow-up Blood Cultures in Gram-Negative Bacteremia: Are They Needed?". Clin Infect Dis. 65 (11): 1776–1779. PMID 29020307. doi:10.1093/cid/cix648. 
  3. 3.0 3.1 3.2 3.3 Wiggers JB, Xiong W, Daneman N (2016). "Sending repeat cultures: is there a role in the management of bacteremic episodes? (SCRIBE study).". BMC Infect Dis. 16: 286. PMC 4906775Freely accessible. PMID 27296858. doi:10.1186/s12879-016-1622-z. 
  4. 4.0 4.1 Tabriz MS, Riederer K, Baran J, Khatib R (2004). "Repeating blood cultures during hospital stay: practice pattern at a teaching hospital and a proposal for guidelines.". Clin Microbiol Infect. 10 (7): 624–7. PMID 15214874. doi:10.1111/j.1469-0691.2004.00893.x. 
  5. Sayood S, Sutton J, Baures T, Spivak E. The Utility of Repeat Blood Cultures for Bacteremic Urinary Tract Infections and Associated Durations of Therapy. Open Forum Infect Dis. 2017 Oct 1;4(suppl_1):S344–5. doi:10.1093/ofid/ofx163.824
  6. Grace CJ, Lieberman J, Pierce K, Littenberg B (2001). "Usefulness of blood culture for hospitalized patients who are receiving antibiotic therapy.". Clin Infect Dis. 32 (11): 1651–5. PMID 11340541. doi:10.1086/320527. 
  7. Safdar N, Fine JP, Maki DG (2005). "Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection.". Ann Intern Med. 142 (6): 451–66. PMID 15767623.  Review in: ACP J Club. 2005 Nov-Dec;143(3):77

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