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Bacteremia (Also Bacteraemia or Bacteræmia) is the Presence of Bacteria

Bacteremia (Also Bacteraemia or Bacteræmia) is the Presence of Bacteria

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09/22/2011

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Bacteremia
(also
Bacteraemia
or 
Bacteræmia
) is the presence of bacteriain theblood.The blood is normally asterileenvironment, so the detection of bacteria in the blood (most commonly withblood cultures) is always abnormal.Bacteria can enter the bloodstream as a severe complication of infections(likepneumoniaor meningitis
 
), during surgery (especially wheninvolvingmucous membranessuch as thegastrointestinal tract
 
), or due tocathetersand other foreign bodiesentering thearteriesor veins (includingintravenousdrug abuse
 
).Bacteremia can have several consequences. Theimmune responseto the bacteria can causesepsis(blood poisoning) andseptic shock,which has a relatively highmortality rate.Bacteria can also use the blood to spread to other parts of the body (which is calledhematogenousspread), causing infections away from the original site of infection. Examples includeendocarditisor osteomyelitis. Treatment is withantibiotics
 
,and prevention withantibiotic prophylaxiscan be given in situations where problems are to be expected.
Definition
Bacteremia is the presence of viable bacteria in the blood stream. Bacteremia is different fromsepsis(so-called blood poisoning or toxemia),which is a condition where bacteremia is associated with aninflammatoryresponse from the body (causingsystemic inflammatory response syndrome
 
,characterised byrapid breathing
 
,fever,etc.). For example, adental procedure(or even brushing your teeth
 
)introduces a detectable amount of bacteria into the bloodstream, but these are unable to replicate in the blood of most people. Some patients with prosthetic heart valveshowever needantibioticprophylaxis for dental surgery because bacteremia might lead toendocarditis(infectionof the interior lining of theheart
 
). Salmonella - which is assumed to only cause gastroenteritis in much of the middle-class or developed world - cancause a specific and virulent form of bacteremia in the developing world, especially in Africa. This form of bacteremia is particularly deadly toinfants and people whose immune systems have been damaged by HIV, according to studies done by the Universities of Malawi and Liverpool atthe Wellcome Trust Clinical Research Programme in Blantyre. Researchers announced in March 2008 in the Journal of Clinical Investigation thata study of 352 Malawian children had revealed antibodies against salmonella when the bacteria leaves the safety of the cells and moves into the bloodstream, and these antibodies may form the basis of an eventual vaccine.Septicemiais an ill-defined non-scientific term introducing more confusion between sepsis and bacteremia: it suggests there is something in the bloodstream causing sepsis.
Causes
In the hospital, indwellingcathetersare a frequent cause of bacteremia and subsequentnosocomialinfections, because they provide a means by which bacteria normally found on the skin can enter the bloodstream. Other causes of bacteremia include dental procedures (occasionallyincluding simple tooth brushing),herpes(includingherpetic whitlow),urinary tract infections, intravenous drug use, andcolorectal cancer.  Bacteremia may also be seen inoropharyngeal,gastrointestinalor genitourinarysurgeryor exploration.
Consequences
Bacteremia, as noted above, frequently elicits a vigorous immune system response. The constellation of findings related to this response (such asfever,chills, or hypotension
 
) is referred to assepsis. In the setting of more severe disturbances of temperature, respiration, heart rate or white  blood cellcount, the response is characterized asseptic shock 
 
,and may result in
.Bacteremia is the principal means by which localinfectionsare spread to distant organs (referred to as
hematogenous spread 
). Bacteremia istypically transient rather than continuous, due to a vigorousimmune systemresponse when bacteria are detected in the blood. Hematogenousdissemination of bacteria is part of the pathophysiology of meningitisandendocarditis
 
,and of Pott's diseaseand many other forms of  osteomyelitis.
Diagnosis
Bacteremia is most commonly diagnosed byblood culture
 
,in which a sample of blood is allowed toincubatewith amediumthat promotes  bacterial growth. Since blood is normally sterile, this process does not normally lead to the isolation of bacteria. If, however, bacteria are presentin the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected. Any bacteria that incidentally findtheir way to the culture medium will also multiply. For this reason, blood cultures must be drawn with great attention to sterile process.Occasionally, blood cultures will reveal the presence of bacteria that represent contamination from theskinthrough which the culture wasobtained. Blood cultures must be repeated at intervals to determine if persistent — rather than transient — bacteremia is present.Bacteremia is the presence of bacteria in the bloodstream (see also Bacterial Infections: Bacteremia (Occult)
 
).
Bacteremia may result from ordinary activities (such as toothbrushing), dental or medical procedures, or from infections (such as pneumonia or a urinary tract infection).
Having an artificial joint or heart valve, or heart valve abnormalities increases the risk that bacteremia will persist or cause problems.
Bacteremia usually causes no symptoms, but sometimes bacteria accumulate in certain tissue 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 insmall numbers and are rapidly removed from the bloodstream by the immune system. However, if bacteria are present long enough and in largeenough numbers, particularly in people who have a weakened immune system, bacteremia can lead to other infections and sometimes trigger aserious 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 thefollowing:
Tissues that cover the brain (meningitis)
The sac around the heart (pericarditis)
The cells lining the heart valves and the heart (endocarditis)

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