The optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs. Methods
Full Answer
What causes bacteremia and how is it treated?
Many different bacteria can cause bacteremia. It can often occur due to another existing infection, a surgery, or by using a device like a breathing tube. Timely treatment of bloodstream infections with antibiotics is necessary to prevent complications. If you believe you have a bloodstream infection, be sure to get prompt medical attention.
What happens when bacteremia results in bloodstream infection?
When bacteremia results in a bloodstream infection, you’ll likely experience symptoms like: Bacteremia can be diagnosed using a blood culture. To do this, a sample of blood will be taken from a vein in your arm. It will then be sent to a lab to be tested for the presence of bacteria.
Does bacteremia meet medical necessity for an inpatient stay?
Consider also explaining that as a principal diagnosis, the condition of “bacteremia” will not likely meet medical necessity for an inpatient stay. Sepsis would. Here’s an example of what a query might look like, bearing in mind that the specifics of the encounter as documented in the medical record would need to be included.
What is the pathophysiology of bacteremia?
Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental, gastrointestinal, genitourinary, wound-care, or other procedures.
What are two potential consequences of bacteremia?
Bacteremia may cause metastatic infections, including endocarditis, especially in patients with valvular heart abnormalities. Transient bacteremia is often asymptomatic but may cause fever. Development of other symptoms usually suggests more serious infection, such as sepsis or septic shock.
What happens when you have bacteremia?
Symptoms of Bacteremia 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 or septic shock.
What are complications of bacteremia?
Most episodes of occult bacteremia spontaneously resolve, and serious sequelae are increasingly uncommon. However, serious bacterial infections occur, including pneumonia, septic arthritis, osteomyelitis, cellulitis, meningitis, and sepsis; death may result.
What is the treatment for bacteremia?
The treatment for a bloodstream infection requires prompt use of antibiotics. This can help to prevent complications like sepsis from occurring. You'll be hospitalized during treatment. When bacteria are confirmed in your blood, you'll likely be started on broad-spectrum antibiotics, typically via IV.
Why would septicemia be considered a more serious condition than bacteremia?
Septicemia is also known as blood poisoning....Differences Between Bacteremia and Septicemia.S.N.BacteremiaSepticemia1.Bacteremia is the simple presence of bacteria in the blood.Septicemia is the presence and multiplication of bacteria in the blood.2.Bacteremia is not as dangerous as Septicemia.Septicemia is a potentially life-threatening infection.7 more rows•Oct 26, 2018
What causes bacteremia infection?
Bacteremia is an infection, caused by bacteria, that enters the bloodstream. It may also be referred to as septicemia, sepsis, septic shock, blood poisoning, or bacteria in the blood.
Does bacteremia cause sepsis?
Most often, only a small number of bacteria are present, and they are removed by the body on its own. In such cases, most people have no symptoms. However, occasionally, bacteremia leads to infections, sepsis, or both. Sepsis: Bacteremia or another infection triggers a serious bodywide response (sepsis.
What is difference between sepsis and bacteremia?
Bacteremia is the presence of bacteria in the blood, hence a microbiological finding. Sepsis is a clinical diagnosis needing further specification regarding focus of infection and etiologic pathogen, whereupon clinicians, epidemiologists and microbiologists apply different definitions and terminology.
Does bacteremia always cause sepsis?
Although sepsis is associated with bacterial infection, bacteremia is not a necessary ingredient in the activation of the inflammatory response that results in sepsis. In fact, septic shock is associated with culture-positive bacteremia in only 30-50% of cases.
Do you need IV antibiotics for bacteremia?
There are no data to support oral antibiotics in the treatment of P aeruginosa bacteremia, and the use of IV therapy should be used for the entire duration of treatment.
What happens when infection gets in your bloodstream?
Septicemia is an infection that occurs when bacteria enter the bloodstream and spread. It can lead to sepsis, the body's reaction to the infection, which can cause organ damage and even death. Septicemia is more common in people who are hospitalized or have other medical conditions.
What is the classical presentation in a bacteremic patient?
The classical presentation in a bacteremic patient is the presence of a fever. Chills and/or rigors do not need to present; however, the presence of such signs should clue the provider that a febrile patient is now bacteremic. The development of septicemia leading to sepsis and septic shock will commonly cause hypotension, altered mental status, and decreased urine output due to hypovolemia from leaking capillaries. As the infection disseminates, other organs can become affected, causing acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI).
What labs are needed for septicemia?
Identifying or presuming the source of infection will dictate the diagnostic measures taken. There should be a low threshold for ordering labs and imaging since time is of the essence in preventing septicemia. Initial labs in all presumed bacteremic patients should include a lactate level and blood cultures; ideally, two sets assessing for aerobic and anaerobic organisms from each arm. In the hospital setting, most patients, at a minimum, will require a chest x-ray and urinalysis with culture. A surgical patient may require CT imaging of the location of their surgery to assess for abscess or collection formation, as well as wound cultures for surgical site infections. Likewise, an intubated or patient presenting with pulmonary disease will require sputum cultures. Patients with indwelling venous catheters, hemodialysis catheters, or ports should have their lines removed and tips cultured. [9][10]
Is bacteremia a disease?
Bacteremia, in the strictest sense, refers to viable bacteria in the blood. Asymptomatic bacteremia can occur in normal daily activities such as conducting oral hygiene and after minor medical procedures. In a healthy person, these clinically benign infections are transient and cause no further sequelae. However, when immune response mechanisms fail or become overwhelmed, bacteremia becomes a bloodstream infection that can evolve into many clinical spectrums and is differentiated as septicemia. Untreated and clinically significant bacteremia progresses to systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). [1][2][3]
Is bacteremia a septic infection?
Bacteremia, in the strictest sense, refers to viable bacteria in the blood. Asymptomatic bacteremia can occur in normal daily activities such as conducting oral hygiene and after minor medical procedures. In a healthy person, these clinically benign infections are transient and cause no further sequelae. However, when immune response mechanisms fail or become overwhelmed, bacteremia becomes a bloodstream infection that can evolve into many clinical spectrums and is differentiated as septicemia. This activity describes the causes and presentation of bacteremia and highlights the role of the interprofessional team in its management.
Where does Gram-negative bacteremia originate?
Gram-negative bacteremia secondary to infection usually originates in the genitourinary or gastrointestinal tract or in the skin of patients with decubitus ulcers.
What is the term for the presence of bacteria in the bloodstream?
Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental, gastrointestinal, genitourinary, wound-care, or other procedures.
Can transient bacteremia cause fever?
Transient bacteremia is often asymptomatic but may cause fever. Development of other symptoms usually suggests more serious infection, such as sepsis or septic shock. (See Neonatal Sepsis; see Occult Bacteremia and Fever Without Apparent Source in Infants and Young Children .)
When to give empiric antibiotics?
In patients with suspected bacteremia, empiric antibiotics are given after appropriate cultures are obtained. Early treatment of bacteremia with an appropriate antimicrobial regimen appears to improve survival.
Is bacteremia gram positive or negative?
If an infection in the abdomen causes bacteremia, the organism is most likely a gram-negative bacillus. If an infection above the diaphragm causes bacteremia, the organism is most likely a gram-positive bacillus.
Can bacteremia cause metastatic abscesses?
Transient or sustained bacteremia can cause metastatic infection of the meninges or serous cavities, such as the pericardium or larger joints. Metastatic abscesses may occur almost anywhere. Multiple abscess formation is especially common with staphylococcal bacteremia.
What is the term for bacteria in the blood?
Bacteremia is bacteria in the blood. Bacteremia happens when germs from infections in your body travel to your blood. It can also be caused by a catheter or drain that is inserted into the body and left in place. Examples of catheters and drains include a port-a-cath, PICC line, dialysis catheter, abdominal drain, or a urinary catheter.
How to care for a catheter?
Care for catheters and drains as directed. Wash your hands before and after you touch your catheter or drain. Follow directions for dressing changes and bathing. Watch for signs and symptoms of infection such as pus, fever, swelling, pain, or drainage. Report symptoms immediately to your healthcare provider.
Do you need to return for blood tests for antibiotics?
You may need to return for more blood tests. This will show if the antibiotics are working. Write down your questions so you remember to ask them during your visits.
What is the best treatment for occult bacteremia in infants?
The empiric treatment of infants and children aged 3-36 months at risk for occult bacteremia usually involves ceftriaxone. This third-generation cephalosporin has broad-spectrum gram-positive and gram-negative coverage, is active against all likely community-acquired pathogens in this age group, and is resistant to beta-lactamases produced by some pathogenic organisms. [ 12, 16] Ceftriaxone has the longest half-life of the third-generation cephalosporins, and high serum concentrations can be sustained for 24 hours with a single dose. Most body tissues and fluids are penetrated, including the CSF. [ 12]
What antibiotics are used for bacteremia in infants?
Empiric antibiotics used in practice vary in this age group. Some practitioners use ampicillin and gentamicin, some use ampicillin and cefotaxime, and others use ceftriaxone. [ 10, 14, 22] The risk for infection with Listeria is significantly decreased in children older than 4-6 weeks; whether coverage for Listeria is required in infants aged 1-3 months at risk for occult bacteremia is controversial. All these possible antibiotic regimens have excellent coverage against the other childbirth-acquired or community-acquired bacterial pathogens in this age group.
What antibiotics are used in empiric coverage?
Early studies of empiric coverage with oral antibiotics examined various agents, including amoxicillin and penicillin. Because of concern for infection with Hib positive for beta-lactamase, later studies focused on amoxicillin and clavulanic acid.
Is penicillin resistant to bacterial infection?
To understand the role of penicillin-resistant pneumococcus in serious bacterial infection and occult bacteremia, realize that all pneumococci are not equal, antibiotic resistance patterns are not static, and resistance does not necessarily equal virulence. Penicillin resistance varies from mildly resistant (minimal inhibitory concentration [MIC] < 0.1), to intermediately resistant (MIC 0.1-1), to highly resistant (MIC >1). The prevalence of penicillin resistance is increasing over time, and no change in mortality seems to be associated with invasive pneumococcal disease due to the increase in antibiotic-resistant pneumococcus. [ 29, 77, 81]
Is penicillin resistant to S pneumoniae?
Antibiotic resistance, most importantly in S pneumoniae infection, also affects the choice of empiric treatment for occult bacteremia. Studies in Sweden, Greece, Israel, Portugal, Russia, and Nebraska have shown that 40-50% of cases of S pneumoniae in children attending daycare centers are resistant to penicillin. [ 80] Unlike the beta-lactamase of staphylococcal penicillin resistance, streptococcal resistance is mediated by altered penicillin-binding protein affinity for the drug. This resistance can be overcome by sufficiently high doses of antibiotic. Tissue concentrations sufficient to treat penicillin-resistant infections, other than meningitis, are achieved with oral therapy. [ 77]
Can you take antibiotics for salmonella?
However, some form of antibiotic treatment, oral or intravenous, is recommended for all children with Salmonella bacteremia and for young infants and immunocompromised children with Salmonella gastroenteritis. [ 79]
Is parenteral antibiotics effective?
Parenteral antibiotics were generally found to be significantly more effective than oral treatment or no treatment in reducing the sequelae of occult bacteremia, most importantly meningitis. [ 10, 37] Table 12.
