Bacteremia

Bacteremia occurs when bacteria enter the bloodstream. This may occur througha wound or infection, or through a surgical procedure or injection. Bacteremia may cause no symptoms and resolve without treatment, or it may produce fever and other symptoms of infection. In some cases, bacteremia leads to septicshock, a potentially life-threatening condition.

Several types of bacteria live on the surface of the skin or colonize the moist linings of the urinary tract, lower digestive tract, and other internal surfaces. These bacteria are normally harmless as long as they are kept in check by the body's natural barriers and the immune system. People in good healthwith strong immune systems rarely develop bacteremia. However, when bacteriaare introduced directly into the circulatory system, especially in a personwho is ill or undergoing aggressive medical treatment, the immune system maynot be able to cope with the invasion, and symptoms of bacteremia may develop. For this reason, bacteremia is most common in people who are already affected by or being treated for some other medical problem. In addition, medical treatment may bring a person in contact with new types of bacteria that are more invasive than those already residing in that person's body, further increasing the likelihood of bacterial 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 theintestines, e.g. chemotherapy for cancer.

    Common immediate causes of bacteremia include:
  • Drainage of an abscess,including an abscessed tooth
  • Urinary tract infection, especially inthe 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 an articifical opening into the colon).

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

    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 maybe the only prominent symptom. Bacteremia may lead to septic shock, whose symptoms include decreased consciousness, rapid heart and breathing rates and multiple organ failures.

Bacteremia is diagnosed by culturing the blood for bacteria. Samples may needto be tested several times over several hours. Blood analysis may also reveal an elevated number of white blood cells. Blood pressure is monitored closely; a decline in blood pressure may indicate the onset of septic shock.

Antibiotics are the mainstay of treatment, and are often begun before positive identification of the bacteria is made. Close observation is required to guard against septic shock. Since bacteremia is usually associated with an existing infection elsewhere in the body, finding and treating this infection isan important part of treatment.

Bacteremia may cause no symptoms, but may be discovered through a blood testfor another condition. In this situation, it may not need to be treated, except in patients especially at risk for infection, such as those with heart valve defects or whose immune systems are suppressed.

Prompt antibiotic therapy usually succeeds in clearing bacteria from the bloodstream. Recurrence may indicate an undiscovered site of infection. Untreatedbacteria in the blood may spread, causing infection of the heart (endocarditis or pericarditis) or infection of the covering of the central nervous system (meningitis).

Bacteremia can be prevented by preventing the infections which often precedeit. Good personal hygiene, especially during viral illness, may reduce the risk of developing bacterial infection. Treating bacterial infections quickly and thoroughly can minimize the risk of spreading infection. During medical procedures, the burden falls on medical professionals to minimize the number and duration of invasive procedures, to reduce patients' exposure to sources ofbacteria when being treated, and to use scrupulous technique.

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