SYSEMIC INFECTIONS 06/22/2020

1) Bacteremia:

Definition / is the presence of bacteria in the blood.

- Detection of any bacteria in the blood (blood cultures) is always abnormal.

- Bacteria can enter the bloodstream as a severe complication of
1- infections (like pneumonia or meningitis),
2- during surgery (especially when involving mucous membranes such as the
gastrointestinal tract),
3- or due to catheters and other foreign bodies entering the arteries or veins (including
during intravenous drug abuse)
- Transient bacteremia can result after dental procedures or brushing of teeth
Causative organism
- Most common organism involves in bacteremia is Staphylococcus aureus
- but for each case of bacteremia there is characteristic route of entry into the
bloodstream and characteristic organism for example
• Group A streptococcus (GAS) typically causes bacteremia from skin and soft tissue
infections.
• Group B streptococcus is an important cause of bacteremia in neonates,
• Viridans streptococci are normal bacterial flora of the mouth. Viridans strep can
cause temporary bacteremia following dental procedures or in patients receiving
chemotherapy.
• streptococcus bovis is a common cause of bacteremia in patients with colon cancer.
Complication
- Bacteria can also spread via the blood to other parts of the body (which is called
hematogenous spread), causing infections away from the original site of infection, such
as endocarditis or osteomyelitis.

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Treatment /
- Bacteremia is typically transient and is quickly removed from the blood by the immune
system
- Bacteremia is dangerous if the patient is at risk or has a prosthesis(for example
artificial heart valves)
Prevention / with antibiotic prophylaxis can be given in high risk situations

Bacteremia risk factors

There are several risk factors that increase the likelihood of developing bacteremia from any
type of bacteria. These include:
- HIV infection
- Diabetes Mellitus
- Chronic hemodialysis
- Solid organ transplant
- Stem cell transplant

2) Sepsis
- The immune response to the bacteria can cause sepsis , which has a high mortality rate
- This response includes the following symptoms : fever, chills, and hypotension,
increased heart rate, increased breathing rate, and confusion
- people with a weakened immune system may have no symptoms of a specific
infection, and the body temperature may be low or normal instead of having a fever
- Severe sepsis causing poor organ function or blood flow producing organ dysfunction
syndrome (MODS), which are potentially fatal.
- poor blood flow means low blood pressure, high blood lactate, or low urine output
- Septic shock is poor blood flow due to sepsis that does not improve after fluid
replacement

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Systemic inflammatory response syndrome (SIRS)

SIRS is the presence of two or more of the following ( abnormal vital signs)
1- abnormal body temperature----- Hyperthermia (> 38°C) or hypothermia (< 36°C)
2- abnormal heart rate ------ tachycardia (> 90/ min, no β-blockers)
3- abnormal respiratory rate, or blood gas, -------- tachypnea (> 20/ min, PCO2<
32mmHg)
4- abnormal white blood cell count--------------> 12 × 109 or < 4 × 109

Steps of sepsis
1- Sepsis
 is SIRS with a documented infection
2- Severe sepsis
 is defined as sepsis with sepsis-induced
organ dysfunction or tissue hypoperfusion
(manifesting as hypotension, elevated
lactate, or decreased urine output).
 Severe sepsis is an infectious disease state
associated with multiple organ dysfunction
syndrome (MODS)
3- Septic shock
 is severe sepsis plus persistently low blood
pressure, despite the administration of
intravenous fluids

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3) SEPTICEMIA
Definition
- is a potentially life-threatening infection in which large amounts of bacteria are present in
the blood, It is commonly referred to as blood poisoning.

S.N. Bacteremia Septicemia

Bacteremia is the simple presence of
1. bacteria in the blood.
Bacteremia is not as dangerous as
2. Septicemia.
Less amount of bacteria are present in
3. blood.
This may occur through a wound or
4. infection, or through a surgical procedure body, including infections in the lungs,
or injection.
5. Toxins are not produced.
Bacteremia usually causes no symptoms or
6. it may produce mild fever.
7. It can resolve without treatment.
Rapidly removed from the bloodstream by Antibiotics will be used to treat the bacterial
8. the immune system.
Caused by Staphylococcus, Streptococcus,
Pseudomonas, Haemophilus, E. coli, dental
procedures, herpes (including herpetic
9. whitlow), urinary tract infections,
peritonitis, Clostridium difficile colitis,
intravenous drug use, and colorectal
cancer.
Septicemia is the presence and multiplication
of bacteria in the blood.
Septicemia is a potentially life-threatening
infection.
Large amounts of bacteria are present in the
blood.
It can arise from infections throughout the
abdomen, and urinary tract.
Toxins may be produced by bacteria.
It shows symptoms like chills, fever,
prostration, very fast respiration and/or heart
rate.
Untreated septicemia can quickly progress to
sepsis.
infection that is causing septicemia.
Staphylococci, are thought to cause more
than 50% of cases of sepsis. Other
commonly implicated bacteria include
Streptococcus pyogenes, Escherichia coli,
Pseudomonas aeruginosa, Klebsiella species
and even Candida spp.