Bacteremia

Updated: April 12, 2024

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Background

In this medical condition the bacteria are present in the bloodstream. This infection generally seen in various body parts like urinary tract and skin. 

Bacteremia is classified as transient and persistent category. 

Transient bacteremia is common. It seen during dental procedures and is usually asymptomatic and self-limited. But persistent bacteremia occurs when bacteria present in the bloodstream for a longer time. 

Epidemiology

The incidence is noted higher in elderly patients and in hospitalized patients for e.g., intensive care units. 

In developed countries gram-positive bacteria are common causes of bacteremia. Gram-negative bacteria are more common in developing countries.  

 

Anatomy

Pathophysiology

Bacteremia can be caused by various factors. It includes infections in different regions of the body and invasive medical procedures. 

Once bacteria enter the bloodstream. They can interact with immune cells which triggers an inflammatory reaction. This leads to the release of cytokines can cause fever and chills. 

This disorder need to be treated otherwise it may cause the sepsis. It is a potentially fatal illness. 

 

Etiology

A gram-positive bacterium is a common cause of bacteremia. It is observed in hospitalized patients and those with weakened immune systems. 

This disorder is responsible to cause pneumonia, meningitis, and UTI. 

Genetics

Prognostic Factors

Old age people have higher chances to die from bacteremia. In case of underlying medical disorders the patients are at a higher risk of complications. 

The severity of sickness while examination can have an impact on the prognosis of patients. 

 

Clinical History

It depends on the patient’s age. In neonates and young infants, it presents with nonspecific symptoms such as fever and poor feeding.  

Physical Examination

Fever 

Tachycardia 

Joint pain  

Respiratory distress 

Hypotension  

Skin rash 

Abdominal pain 

Age group

Associated comorbidity

  • Underlying comorbidities or activities can also influence the clinical presentation of bacteremia. For example, patients with diabetes or other immunocompromising conditions may present with more severe symptoms and a higher risk of complications. Patients who have undergone recent invasive procedures or have indwelling catheters may be at higher risk of developing bacteremia, and their presence may reflect the underlying cause of the bacteremia.

Associated activity

Acuity of presentation

Acute onset of symptoms observes a more severe and rapidly progressing infection. In slower onset of symptoms may show a chronic or subacute infection. 

Differential Diagnoses

Bacterial infections  

Parasitic infections 

Fungal infections  

Viral infections 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The diagnosis of bacterium illness depends on blood cultures. The empirical broad-spectrum antibiotics are used as first-line therapy.  

In definitive therapy phase it minimizes the use of broad-spectrum antibiotics and reduce the risk of antibiotic resistance.  

Antibiotic resistance and associated consequences can be reduced by using shorter doses of antibiotics when affordable.  

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-treating-bacteremia

Source control helps prevent ongoing introduction of bacteria into the bloodstream.  

Non-pharmacological supportive measures, such as fluid resuscitation and maintenance are important for stabilizing patients with bacteremia.  

To maintain optimal nutrition for patients it supports the immune system and overall recovery.  

Fever is a common symptom of bacteremia. For that the cooling blankets and tepid sponge baths are used to manage fever and improve patient comfort.  

Role of broad-spectrum antibiotics in the treatment of bacteremia

Cephalosporins belongs to the class of antibiotics which are used in the treatment of bacteremia. It will block the production of bacterial cell walls.  

use-of-intervention-with-a-procedure-in-treating-bacteremia

Blood cultures are a critical diagnostic procedure in the evaluation of bacteremia. In some cases, endoscopy may be used to identify and treat infections in the gastrointestinal or respiratory tracts. 

In cases of soft tissue infections, surgical debridement may be performed to remove infected tissue and promote healing.  

use-of-phases-in-managing-bacteremia

In the initial phase the physician should obtain blood cultures before starting antibiotics to identify the causative organism. Evaluate the patient’s clinical status, signs, and symptoms of infection. Then adjust therapy based on culture results and susceptibility testing.  

Identify and address the source of infection for e.g., abscess, infected catheter, dental infection. Schedule follow-up appointments to monitor for relapse or recurrence. 

Medication

 

cefotaxime

1 g IM or IV given every 12hrs for mild conditions
1-2 g IM or IV every 8hrs moderate to severe infections
2 g IV every 6-8hrs high dosing for infections
2 g IV every 4hrs for life-threatening infections
12 g is the maximum dose required per day



minocycline

initial dose:

200

mg

Intravenous (IV)

followed by 100 mg IV for every 12hrs maximum dose: 400 mg IV per day



ceftriaxone

1-2 g IV or IM was given once a day or in equally divided doses 2x a day
maximum duration of therapy is 4-14 days
prolonged treatment recommends for complicated infections
At least treatment given ten days for diseases due to streptococcus pyogenes



daptomycin 


indicated for Staphylococcus aureus bacteremia:

6

mg/kg

Lyophilized powder for reconstitution, i

Intravenous (IV)

every 24 hours

2 - 6

weeks



quinupristin/dalfopristin 

Off-label:

7.5

mg/kg

Intravenous (IV)

3 times a day



ceftizoxime 

It is an antibacterial used to fight bacteria in our body that causes infections
The usual dose for the treatment of bacteremia is 1 to 4 g via Intravenous or Intramuscular administration twice or thrice a day for up to 14 days. The duration of the treatment depends on the severity and the nature of the infections
If the infection is severe, the dose can be increased up to 12 g per day



Dose Adjustments

Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min

piperacillin 

A dose of 3-4 g IV given every 4-6hrs is recommended
The maximum dose per day recommended is 24g



 

cefotetan

Age:> 1year
20-40 mg per kg IV or IM given every 12hrs
Surgical Prophylaxis:
Age:> 1year
40 mg per kg IV once 30-60 minutes before surgery
but in some cases, if ruptured viscus was seen, gentamicin 2 mg per kg may be added



daptomycin 


Indicated for Staphylococcus aureus bacteremia:


<1 year: Safety and efficacy not established
≥ 1 year:
1-6 years: 12mg/kg intravenous every 24 hours infusion over 60mins
7-11 years: 9mg/kg intravenous every 24 hours infusion over 30mins
12-17 years:7mg/kg intravenous every 24 hours infusion over 30mins



piperacillin 

For children 12years and above a dose of 200-300mg/kg/day given IV in divided doses for every 4-6hrs is recommended

The total dose per day given is 18g



 

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Bacteremia

Updated : April 12, 2024

Mail Whatsapp PDF Image



In this medical condition the bacteria are present in the bloodstream. This infection generally seen in various body parts like urinary tract and skin. 

Bacteremia is classified as transient and persistent category. 

Transient bacteremia is common. It seen during dental procedures and is usually asymptomatic and self-limited. But persistent bacteremia occurs when bacteria present in the bloodstream for a longer time. 

The incidence is noted higher in elderly patients and in hospitalized patients for e.g., intensive care units. 

In developed countries gram-positive bacteria are common causes of bacteremia. Gram-negative bacteria are more common in developing countries.  

 

Bacteremia can be caused by various factors. It includes infections in different regions of the body and invasive medical procedures. 

Once bacteria enter the bloodstream. They can interact with immune cells which triggers an inflammatory reaction. This leads to the release of cytokines can cause fever and chills. 

This disorder need to be treated otherwise it may cause the sepsis. It is a potentially fatal illness. 

 

A gram-positive bacterium is a common cause of bacteremia. It is observed in hospitalized patients and those with weakened immune systems. 

This disorder is responsible to cause pneumonia, meningitis, and UTI. 

Old age people have higher chances to die from bacteremia. In case of underlying medical disorders the patients are at a higher risk of complications. 

The severity of sickness while examination can have an impact on the prognosis of patients. 

 

It depends on the patient’s age. In neonates and young infants, it presents with nonspecific symptoms such as fever and poor feeding.  

Fever 

Tachycardia 

Joint pain  

Respiratory distress 

Hypotension  

Skin rash 

Abdominal pain 

  • Underlying comorbidities or activities can also influence the clinical presentation of bacteremia. For example, patients with diabetes or other immunocompromising conditions may present with more severe symptoms and a higher risk of complications. Patients who have undergone recent invasive procedures or have indwelling catheters may be at higher risk of developing bacteremia, and their presence may reflect the underlying cause of the bacteremia.

Acute onset of symptoms observes a more severe and rapidly progressing infection. In slower onset of symptoms may show a chronic or subacute infection. 

Bacterial infections  

Parasitic infections 

Fungal infections  

Viral infections 

The diagnosis of bacterium illness depends on blood cultures. The empirical broad-spectrum antibiotics are used as first-line therapy.  

In definitive therapy phase it minimizes the use of broad-spectrum antibiotics and reduce the risk of antibiotic resistance.  

Antibiotic resistance and associated consequences can be reduced by using shorter doses of antibiotics when affordable.  

Pediatrics, General

Source control helps prevent ongoing introduction of bacteria into the bloodstream.  

Non-pharmacological supportive measures, such as fluid resuscitation and maintenance are important for stabilizing patients with bacteremia.  

To maintain optimal nutrition for patients it supports the immune system and overall recovery.  

Fever is a common symptom of bacteremia. For that the cooling blankets and tepid sponge baths are used to manage fever and improve patient comfort.  

Pediatrics, General

Cephalosporins belongs to the class of antibiotics which are used in the treatment of bacteremia. It will block the production of bacterial cell walls.  

Pediatrics, General

Blood cultures are a critical diagnostic procedure in the evaluation of bacteremia. In some cases, endoscopy may be used to identify and treat infections in the gastrointestinal or respiratory tracts. 

In cases of soft tissue infections, surgical debridement may be performed to remove infected tissue and promote healing.  

Pediatrics, General

In the initial phase the physician should obtain blood cultures before starting antibiotics to identify the causative organism. Evaluate the patient’s clinical status, signs, and symptoms of infection. Then adjust therapy based on culture results and susceptibility testing.  

Identify and address the source of infection for e.g., abscess, infected catheter, dental infection. Schedule follow-up appointments to monitor for relapse or recurrence. 

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