SHM's Clinical Quick Talks-Bacteremia

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Bacteremia refers to the presence of viable bacteria in the blood that are capable of infection and reproduction. It is diagnosed through positive blood cultures. Bacteria can enter the bloodstream through primary or secondary processes. Primary bacteremia occurs when there is an injury to a barrier allowing bacteria to enter the bloodstream without an initial infectious source, such as indwelling catheters or intravascular devices. Secondary bacteremia occurs when an infection in the body damages a barrier allowing the bacteria to spread and propagate the infection, such as pneumonia or urinary tract infections. <br /><br />Bacteremia is clinically significant when there is evidence of a systemic inflammatory response to the bacteria, although inflammatory signs are non-specific. Gram positive bacteremia is most commonly caused by S. aureus and can lead to complications such as endocarditis and osteomyelitis. Gram negative bacteremia is caused by multiple organisms, with the most common being E. coli, Klebsiella, Enterobacter, and Pseudomonas. It has a higher mortality rate due to the risk of acute onset septic shock.<br /><br />Clinical evidence of bacterial infection is present and two blood cultures identify the same bacterial species. Various methods can be used to identify the bacteria, including gene sequencing and MALDI-TOF mass spectrometry. Treatment involves adequate source control, which may include removing indwelling catheters or prosthetics, and appropriate antibiotic selection. Antibiotics should be initiated empirically before the diagnosis is confirmed, and the duration of treatment depends on the patient's condition and the presence of indwelling devices.<br /><br />Some clinical pearls include administering empiric antibiotics within 1 hour of recognizing bacteremia, consulting infectious disease specialists for staphylococcus bacteremia, and not necessarily needing repeat blood cultures to follow treatment for bacteremia with gram negative rods. Overall, early diagnosis and appropriate treatment are crucial in managing bacteremia and improving patient outcomes.

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Connor Mott, Kathryn Haroldson

Keywords

Bacteremia

Blood cultures

Primary bacteremia

Secondary bacteremia

Gram positive bacteremia

S. aureus

Endocarditis

Osteomyelitis

Gram negative bacteremia

Septic shock