Bacteremia

By Paul M. Maggio, MD, MBA, Carla Carvalho, MD, MPH

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Bacteremia, Sepsis, and Septic Shock

Introduction to Bacteremia, Sepsis, and Septic Shock

Bacteremia

Sepsis, Severe Sepsis, and Septic Shock

Bacteremia is the presence of bacteria in the bloodstream (see also Occult
Bacteremia).

Bacteremia may result from ordinary activities (such as vigorous toothbrushing),

dental or medical procedures, or from infections (such as pneumonia or a urinary
tract infection).

Having an artificial joint or heart valve or having heart valve abnormalities

increases the risk that bacteremia will persist or cause problems.

Bacteremia usually causes no symptoms, but sometimes bacteria accumulate in

certain tissues or organs and cause serious infections.

People at high risk of complications from bacteremia are given antibiotics before
certain dental and medical procedures.

Usually, bacteremia, particularly if it occurs during ordinary activities, does not cause
infections because bacteria typically are present only in small numbers and are rapidly
removed from the bloodstream by the immune system. However, if bacteria are present
long enough and in large enough numbers, particularly in people who have a weakened
immune system, bacteremia can lead to other infections and sometimes trigger a serious
bodywide response called sepsis.
Bacteria that are not removed by the immune system may accumulate in various places
throughout the body, causing infections there, as in the following:

Tissues that cover the brain ( meningitis)

The sac around the heart ( pericarditis)

The cells lining the heart valves and the heart ( endocarditis)

Bones ( osteomyelitis)

Joints ( infectious arthritis)

In bacteremia, bacteria tend to lodge and collect on certain body structures, such as
abnormal heart valves. Bacteria are particularly likely to collect on any artificial material
present in the body, such as intravenous catheters and artificial (prosthetic) joints and
heart valves. These collections (colonies) of bacteria may remain attached to the sites
and continuously or periodically release bacteria into the bloodstream.

Causes of Bacteremia
Bacteremia may occur during

Certain ordinary activities

Dental or medical procedures

Certain bacterial infections

Injection of recreational drugs

Ordinary activities sometimes cause bacteremia in healthy people. For example, vigorous
toothbrushing can cause bacteremia because bacteria living on the gums around the teeth are forced
into the bloodstream. Bacteria may also enter the bloodstream from the intestine during digestion.
Bacteremia that occurs during ordinary activities rarely leads to infections.
Dental or medical procedures can lead to bacteremia. During dental procedures (as during
tooth cleaning by a dental hygienist), bacteria living on the gums may become dislodged and enter
the bloodstream. Bacteremia may also occur when catheters are inserted into the bladder or tubes
are inserted into the digestive tract or urinary tract. Bacteria may be present in the area where the
catheter or tube has been inserted (such as the bladder or intestine). So even though sterile
techniques are used, these procedures may move bacteria into the bloodstream. Surgical treatment
of infected wounds, abscesses (collections of pus), and pressure sores can dislodge bacteria from the
infected site, causing bacteremia.
In some bacterial infections , such as pneumonia and skin abscesses, bacteria may periodically
enter the bloodstream, causing bacteremia. Many common childhood bacterial infections cause
bacteremia.
Injecting recreational drugs can cause bacteremia because the needles used are usually
contaminated with bacteria, and people often do not properly clean their skin.

Symptoms of Bacteremia
Usually, bacteremia that results from ordinary events, such as dental procedures, is temporary and
causes no symptoms. Bacteremia that results from other conditions may cause fever. If people with

bacteremia have fever, a rapid heart rate, shaking chills, low blood pressure, gastrointestinal
symptoms (such as abdominal pain, nausea, vomiting, and diarrhea), rapid breathing, and/or
become confused, they probably have sepsis, severe sepsis, or septic shock.

Diagnosis of Bacteremia

Culture of a blood sample

If bacteremia, sepsis, severe sepsis, or septic shock is suspected, doctors usually take a sample of
blood so they can try to grow (culture) the bacteria in the laboratory and identify it. If needed,
doctors may try to culture bacteria from other samples (such as urine or sputum).

Prevention of Bacteremia
People who are at high risk of complications due to bacteremia (such as those who have an artificial
heart valve or joint or certain heart valve abnormalities) are often given antibiotics before procedures
that can cause bacteremia:

Dental procedures

Surgical treatment of infected wounds

Insertion of bladder catheters

Antibiotics help prevent bacteremia and thus infections and sepsis from developing.

Treatment of Bacteremia

Antibiotics

If an infection or sepsis develops, it is treated with antibiotics.

Doctors remove sources of bacteria (such as catheters).

http://www.merckmanuals.com/home/infections/bacteremia,-sepsis,-and-septicshock/bacteremia

Bacteremia
Definition
Bacteremia is an invasion of the bloodstream by bacteria.

Description
Bacteremia occurs when bacteria enter the bloodstream. This may occur through a wound or infection, or
through asurgical procedure or injection. Bacteremia may cause no symptoms and resolve without treatm
ent, or it may producefever and other symptoms of infection. In some cases, bacteremia leads to septic s
hock, a potentially life-threateningcondition.

Causes and symptoms

Causes
Several types of bacteria live on the surface of the skin or colonize the moist linings of the urinary tract, lo
wer digestivetract, and other internal surfaces. These bacteria are normally harmless as long as they are
kept in check by the body'snatural barriers and the immune system. People in good health with strong im
mune systems rarely develop bacteremia.However, when bacteria are introduced directly into the circulat
ory system, especially in a person who is ill or undergoingaggressive medical treatment, the immune syst
em may not be able to cope with the invasion, and symptoms ofbacteremia may develop. For this reason,
bacteremia is most common in people who are already affected by or beingtreated for some other medica
l problem. In addition, medical treatment may bring a person in contact with new types ofbacteria that are
more invasive than those already residing in that person's body, further increasing the likelihood ofbacteri
al infection.
Conditions which increase the chances of developing bacteremia include:

immune suppression, either due to HIV infection or drug therapy

antibiotic therapy which changes the balance of bacterial types in the body

prolonged or severe illness

alcoholism or other drug abuse

malnutrition

diseases or drug therapy that cause ulcers in the intestines, e.g. chemotherapy for cancer

Common immediate causes of bacteremia include:

drainage of an abscess, including an abscessed tooth

urinary tract infection, especially in the presence of a bladder catheter

decubitus ulcers (pressure sores)

intravenous procedures using unsterilized needles, including IV drug use

prolonged IV needle placement

use of ostomy tubes, including gastrostomy (surgically making a new opening into the stomach)
, jejunostomy(surgically making an opening from the abdominal wall into the jejunum), and colostomy
(surgically creating anarticifical opening into the colon).

The bacteria most likely to cause bacteremia include members of the Staphylococcus, Streptococcus, Ps
eudomonas,Haemophilus, and Esherichia coli (E. coli) genera.

Symptoms
Symptoms of bacteremia may include:

fever over 101 F (38.3 C)

chills

malaise

abdominal pain

nausea

vomiting

diarrhea

anxiety

shortness of breath

confusion

Not all of these symptoms are usually present. In the elderly, confusion may be the only prominent sympt
om.Bacteremia may lead to septic
shock, whose symptoms include decreased consciousness, rapid heart and breathingrates and multiple
organ failures.

Diagnosis
Bacteremia is diagnosed by culturing the blood for bacteria. Samples may need to be tested several time
s over severalhours. Blood analysis may also reveal an elevated number of white blood cells. Blood press
ure is monitored closely; adecline in blood pressure may indicate the onset of septic shock.

Treatment
Bacteremia may cause no symptoms, but may be discovered through a blood test for another condition. I
n this situation,it may not need to be treated, except in patients especially at risk for infection, such as tho
se with heart valve defects orwhose immune systems are suppressed.

Prognosis
Prompt antibiotic therapy usually succeeds in clearing bacteria from the bloodstream. Recurrence may in
dicate anundiscovered site of infection. Untreated bacteria in the blood may spread, causing infection of t
he heart (endocarditisor pericarditis) or infection of the covering of the central nervous system (meningi
tis).

Prevention
Bacteremia can be prevented by preventing the infections which often precede it. Good personal hygiene,
especiallyduring viral illness, may reduce the risk of developing bacterial infection. Treating bacterial infec
tions quickly andthoroughly can minimize the risk of spreading infection. During medical procedures, the b
urden falls on medicalprofessionals to minimize the number and duration of invasive procedures, to reduc
e patients' exposure to sources ofbacteria when being treated, and to use scrupulous technique.

Key terms
Colostomy Surgical creation of an artificial anus on the abdominal wall by cutting into the colon and br
inging it up tothe surface.
Gastrostomy Surgical creation of an artificial opening into the stomach through the abdominal wall to
allow tubefeeding.
Jejunostomy Surgical creation of an opening to the middle portion of the small intestine (jejunum), thr
ough theabdominal wall.
Septic shock A life-threatening drop in blood pressure caused by bacterial infection.

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